Faster, safer and easier: A randomised study on the outcomes of polymeric clips for appendicular stump management

Secure closure of the appendiceal stump is critical in laparoscopic appendectomy to prevent post-operative complications. Traditional methods such as Endoloop ligatures are effective but technically demanding, while self-locking polymeric clips may offer a simpler alternative.

To compare intra-operative time, ease of application and safety between self-locking polymeric clips and Endoloop ligatures for appendiceal stump closure.

A prospective randomised controlled trial was conducted on 50 adult patients undergoing elective laparoscopic appendectomy. (CTRI-2023/12/060687; retrospectively registered) Patients were randomised into two groups: stump closure with Endoloop ligatures (n = 25) or self-locking clips (n = 25). Primary outcomes were intra-operative time and ease of application, measured using the Single Ease Question (SEQ) score. Secondary outcomes included post-operative complications and hospital stay.

The clip group demonstrated significantly shorter operative times (mean difference: -9.04 min; 95% confidence interval: -16.76 to -1.32; P = 0.023) and higher SEQ scores (6.1 ± 0.9 vs. 4.6 ± 0.9; P < 0.0001) compared to the Endoloop group. Post-operative complications and hospital stay showed no significant differences between groups. Correlation analysis revealed a moderate negative relationship between operative time and ease of surgery.

Self-locking polymeric clips provide a faster, easier and equally safe method for appendiceal stump closure compared to Endoloop ligatures. Their efficiency and simplicity make them particularly suitable for high-volume and resource-limited surgical settings.