Polymer Clips vs Endoloop for Appendicular Stump Ligation during Laparoscopic Appendectomy: A Randomized Controlled Trial

Introduction: Laparoscopic Appendectomy is the most common surgical procedure worldwide and an important step is the ligation of stump of appendix. Conventional method to ligate the stump and mesentary is by using a loop of vicryl suture. We decided to investigate the use of polymer clips for stump and mesentery ligation in terms of operative cost, complications and time of surgery during laparoscopic appendectomy. Methods: 100 patients were recruited from emergency department and randomized to undergo loop closure and polymer clip closure for appendicular stump during laparoscopic appendectomy. Primary outcome measure was the cost of operation and time of surgical procedure while secondary outcome measure was operative complication of stump leakage,infection and bleeding. Results: Mean age of patients was 28 years. Out of hundred patients 54% (54) were females and 44% (44) were males. Mean time required for appendicular stump and mesentary ligation with vicryl loop was 15 minutes while mean time for polymer clips was 6.50 minutes (p< 0.001). Mean cost of operation was 15$ for polymer clips while for vicryl loop was 50$ (p <0.001). No difference was found in terms of complications in the two groups. (p= 0.598) Conclusion: Ligation of appendicular stump and mesentery with Polymer clips for laparoscopic appendectomy is cost effective, safe and feasible alternative to vicryl loops.