Different techniques for closure of appendicular stump in laparoscopic appendectomy - are they safe and applicable?

Background Laparoscopic appendectomy (LA) is globally accepted as a less-invasive surgical approach for acute appendicitis. LA has many advantages over open appendectomy like less postoperative pain, earlier recovery, better cosmetic results, and shorter hospital stay. For appendicular stump closure, there are different techniques: endoligature [including preformed suture loops (endo-loops), extracorporeal sutures using knot pushers, and intracorporeal knot-ligature sutures], bipolar coagulation, endoscopic linear GIA staplers, metal clips, or hem-o-lock. Aim To compare among four methods for closure of the appendicular stump regarding their safety, applicability, competence, and complications. Patients and methods The study was conducted between December 2017 and March 2021 in Tanta University hospitals. The study included 260 patients with acute appendicitis who were randomly divided into four groups. In the first group, the base of the appendix was secured using intracorporeal knot, extracorporeal sutures using knot pushers in the second group, metallic clip in the third group, and Hem-o-lock clip in the fourth group. The primary outcome was assessment of safety and applicability of appendicular stump closure using four different techniques. Secondary outcomes were operative time, hospital stay time, and surgical outcome. Results A total of 260 patients (128 females and 132 males) were enrolled into the study. The mean age in group A was 27.30 ± 8.79 years, in group B was 28.94 ± 12.86 years, in group C was 25.96 ± 10.03 years, and in group D was 26.90 ± 6.07 years. A statistically significant difference was observed among the four groups regarding the time for stump closure (P