Polymer Clips Vs Endoloop for Appendicular Stump Ligation
Condition: Appendicitis; Polymer Clips; Surgitie
MeSH terms: Appendicitis
Study type: Interventional

Summary: 
      laparoscopic appendectomy is the gold standard procedure now a days for the treatment of
      appendicitis. Polymer clips are new modality used for the ligation of appendicular stump.
      this study aims to compare the polymer clips with endoloop for the ligation of appendicular
      stump.
    

Detailed description: 
      Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that
      spreads to its other parts.[1] Features of acute appendicitis include right lower quadrant
      pain starting from epigastrium or umblical region which then shifts to right iliac fossa,
      associated with nausea, vomiting, anorexia or fever. On examination tenderness, rebound
      tenderness and guarding are usually present in right iliac fossa.

      Various laboratory investigations to diagnose appendicitis include complete blood count,
      ultrasound abdomen and CT scan abdomen. A large, single center study found that multi
      detector CT (MDCT) has a high rate of sensitivity and specificity (98.5% and 98%,
      respectively) for diagnosing acute appendicitis.[2] Appendicitis may occur for several
      reasons, such as an infection of the appendix, but the most important factor is the
      obstruction of the appendiceal lumen. Left untreated, appendicitis has the potential for
      severe complications, including perforation, peritonitis, sepsis, and may even cause death.

      Appendectomy is the most effective treatment of acute appendicitis and the most commonly
      performed operation of emergency surgery worldwide. Since the introduction of laparoscopy,
      the minimally invasive technique is being used to perform appendectomy. According to the 2010
      Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline, the
      indications for laparoscopic appendectomy are identical to those for open appendectomy.[3]
      Laparoscopic appendectomy (LA) is a safe and easy operation offering well-known advantages of
      laparoscopy, such as faster postoperative recovery, good cosmetics, less wound complications
      and less postoperative pain although laparoscopic method is expensive as compared to open
      method.

      Various methods (endoloop, titanium clips, polymer clips and endo-staplers) are used to
      ligate the stump and mesentery of appendix during laparoscopic appendectomy.

      Endoloops are being used widely for the ligation of mesentery since long but it is expensive
      and requires more expertise and skill to use the endoloops and most of the times 2-3
      endoloops are used which increases the cost of operation. Now-a-days polymer clips are used
      for the ligation of stump and mesentery which are economical and require less expertise as
      compared to that required for the use of polymer clips. More over both of these methods does
      not have any side effects as investigated by various investigators in previous
      studies.[4][5][6] In a study done by Delibegović S. and Matović E.[4] who compared the
      polymer clips with the endoloop showed that mean operative time was 47.1 ± 6.7 min in the
      first group where the base was secured by endoloop ligatures, and was 38.7 ± 5.0 min in the
      group where the base was secured by hem-o-lok clips. The cost of the three hem-o-lok clips
      was 76.9 Euros, and that of the three endoloop ligatures was 88.5 Euros and according to them
      the simplicity of application, shorter time of operation, and lower cost of hem-o-lok clips
      are advantages of this way of securing of the base of the appendix in relation to the
      standard endoloop procedure. Various other studies have found similar results.[5],[6]
    

Intervention name(s): polymer clip; endoloop
Intervention type(s): Device; Device
Intervention description(s): polymer clips will be used to ligate the stump of appendix during appendectomy and time for application and cost of clips will be calculated; endoloop will be used to ligate the stump of appendix during appendectomy and time for application and cost of clips will be calculated
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment