A Comparison of Hem-o-lok® and ENDOLOOP for Ligation of Appendicular Stump in Improving Outcomes of Laparoscopic Appendicectomy

BACKGROUND

Acute appendicitis is a common condition that presents as an emergency, requiring definitive surgery. The ligation of appendicular stump is one of the important steps in the laparoscopic appendicectomy. Various techniques have been used and researched for the closure of stump of appendix but the method with superior results has not been demonstrated till now. This study aims to compare the advantages and outcomes of using ENDOLOOP and Hem-o-lok, a non-absorbable polymer for ligating the appendicular stump.

METHODS

This was a longitudinal follow up study of 60 consecutive patients who were planned for elective laparoscopic appendicectomy, at a tertiary care institution between April 2018 and September 2019. Patients above the age of 17 years were selected for undergoing elective laparoscopic appendicectomy and grouped into two groups, group 1 - ligation of appendicular stump by Hem-o-lok and group 2 - ligation with ENDOLOOP by sequential allocation method.

RESULTS

Sixty patients who were selected for elective laparoscopic appendicectomy were included in the study. Thirty patients underwent ligation with Hem-o-lok clips; thirty patients underwent ligation with ENDOLOOP. The average duration of surgery for the Hem-o-lok was 41.33 minutes and for ENDOLOOP was 49.83 minutes (p value = 0.006). The average cost of ligation of appendicular stump using Hem-o-lok was Rs. 320. The average cost in ligation of appendicular stump using ENDOLOOP was Rs. 650 (p < 0.001). The average size of the appendix ligated using the Hem-o-lok group was 9.03 mm and for ENDOLOOP 9.23 mm (p = 0.13). There were no intra operative or post-operative complications in any of the two groups.

CONCLUSIONS

The use of Hem-o-lok in the ligation of appendicular stump has proved to be good and a safe alternative to ENDOLOOP in laparoscopic appendicectomy. Hem-o-lok group showed reduced operating time with less expenditure when compared to the ENDOLOOP group.