LAUSR

One of the crucial steps of laparoscopic appendicectomy is to secure the base of appendix. A variety of techniques for stump closure have been described as Endoloops(Vicryl or PDS), Hem-o-lok clips, intracorporeal suturing and endoscopic staplers. A detailed literature survey using Pubmed, MEDLINE and EMBASE databases was carried out to extract studies conducted between 1990 and 2020. A total of 14 studies- 3 randomized controlled trials & 11 comparative studies enrolling 2098 (1030 in HL & 1068 in EL group) patients were included in the final analysis comparing Hem-o-lok versus endoloops for closure of appendiceal base. Outcome measures were Operative time, Cost benefit, Post-operative complications, and length of hospital stay. The average time of operation was significantly shorter in the HL group (SMD -0.79; 95% CI -1.03 – 0.56; z = 6.61; p < 0.00001). HL was found to be more cost-effective. (SMD -5.00; 95% CI-7.00 – 3.00; z = 4.90; p < 0.00001). However, no statistical difference was found between both the groups when comparing mean postoperative length of hospital stay & post-operative. Based on the results of the above study, applying Hem-o-lok clips seems to be a safe, effacious and cost-effective way of securing the base of appendix.