Comparative Effectiveness and Safety of Hem-o-Lok® Clips Versus Endoloops for Appendiceal Stump Closure in Laparoscopic Appendectomy: A Randomized Controlled Trial in a Tertiary Care Center in Eastern Uttar Pradesh, India

Secure closure of the appendiceal stump is a key determinant of safe laparoscopic appendectomy. Endoloop (Ethicon, Johnson & Johnson, Cincinnati, OH) ligatures and Hem-o-Lok® (Teleflex Medical, Wayne, PA) clips are both used for this purpose, but current guidelines do not favor one over the other technique.

To compare Hem-o-Lok® clips and endoloops for appendiceal stump closure with respect to operative time, intraoperative complications, postoperative complications, and hospital stay.

This prospective randomized controlled trial was conducted at AIIMS, Gorakhpur, India. Sixty-eight patients undergoing laparoscopic appendectomy for uncomplicated appendicitis were randomly allocated into either the Hem-o-Lok® clip group (n = 34, 50%) or the endoloop group (n = 34, 50%). All patients diagnosed with appendicitis who fulfilled the study's inclusion criteria were sent back to the registration counter, where the counter-in-charge assigned them to the study groups using sealed, concealed envelopes. Sample size was calculated with G*Power (d = 0.7, α = 0.05, power = 0.80, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). Groups were compared using the independent-samples t-test/Mann-Whitney U test (continuous variables) and the chi-square test (categorical variables); P < 0.05 was considered significant.

Groups were well matched for age, sex, body mass index (BMI), comorbidity, prior abdominal surgery, and appendix diameter (all P > 0.05). Mean operative time was shorter with Hem-o-Lok® clips (45.94 ± 9.87 vs. 59.24 ± 11.66 minutes; t = -5.08, P < 0.001), an advantage seen in both emergency (t = -3.28, P = 0.005) and elective cases (t = -4.04, P < 0.001). Hospital stay was modestly shorter with clips (4.85 ± 0.89 vs. 5.44 ± 1.11 days; t = -2.42, P = 0.019). Minimal intraoperative bleeding, drain placement, or conversion occurred in either group, and no complications occurred in either arm over 40 days of follow-up.

Hem-o-Lok® clips reduce operative time and modest hospital stay compared with endoloops in uncomplicated laparoscopic appendectomy. No increase in observed early complications was identified, although the study was not powered to assess uncommon safety outcomes, and they are a comparatively safe, efficient alternative.