Comparison Of Endo Clips Versus Suture In Laparoscopic Appendiceal Stump Closure

Abstract

AIMS & OBJECTIVES: To compare efficacy and safety of metallic endoclips with Roeder’s knot for appendiceal stump closure in patients undergoing laparoscopic appendicectomy. • METHODS: Prospective, comparative study. 90 cases were studied; in each group 45 cases were allocated. After coming to a diagnosis of appendicitis patients were taken up for laparoscopic appendicectomy. Three ports created, one 10mm over umbilicus and two 5mm over both iliac fossae. In 45 patients conventional Roeder’s knot was applied at appendiceal stump site and rest 45 titanium (LT 400) clips were applied, three, two at stump at one over specimen end. RESULTS: In study group (EC) 57.8% belonged to age group less than 20yrs and 40% in control (S) group. In EC group mean age was 21.56+/-12.48 years while in S group it was 24.04+/-11.580yrs. Males were 57.8 % in EC group where as 55.6% in S group. In EC group 53.3 % presented with complaints since 1-3months while in S group 82.2% within one-month onset. All patients in EC had Right iliac fossa tenderness while in S group 24.4% had guarding with right iliac fossa. In EC group 80% had diagnosis of chronic appendicitis while 75.6% had acute appendicitis in S group. In EC group 26.67% had appendix diameter of 6-7 mm on USG finding while 66.67% in S group had more than 10mm diameter. There was significant difference in time of surgery, with mean duration of 57.20+/-1.254 min in EC group while 66.89+/-1.729 min in S group. There were no significant differences in intraoperative complications, postoperative complications like surgical site complications, pain scale, length of stay, follow up period in both groups. Although clips were costlier than sutures. CONCLUSION: To conclude it can be said that titanium clips are safe to use requiring lesser time of surgery and ideal for beginners.