Efficacy of Single Hem-O-Lok Clip Versus Roeder’s Knot in Securing the Appendiceal Stump: A Prospective Comparative Study

Background: Laparoscopic appendectomy is considered as the surgical treatment of choice for acute appendicitis and securing the closure of the appendiceal stump is essential to avoid postoperative complications like stump leak and intra-abdominal infection. There are a number of ways this is done, such as Hem-o-lock clips and Roeder knot, both having their advantages. Comparative information regarding their efficacy, safety and cost-effectiveness in a typical surgical setting is lacking, however, especially in resource challenged areas. The objective is to assess the effectiveness, safety and operative outcomes of single Hem-o-lok clip closure versus Roeder's knot for appendiceal stump closure in LA. Material and Methods: Prospective comparative study was done in the department of General surgery of a tertiary care center for a period of 12 months. The total number of patients who were diagnosed as uncomplicated acute appendicitis and undergoing laparoscopic appendectomy were 60. According to this, patients received two random assignments: 30 patients each in group A (Hem-o-lok clip) and group B (Roeder's knot). All surgeries were performed as a standard three-port laparoscopic appendectomy. Operative time, ease of application, intraoperative and postoperative complications, wound infection, intra-abdominal abscess, stump leak, duration of hospital stay and cost were evaluated. The statistical analysis was done by applying appropriate tests, p value < 0.05 significant. Results: The operative time of the Hem-o-lok group was significantly shorter than that of the Roeder's knot group (42.3 ± 6.5 min vs 50.7 ± 7.2 min, respectively, p < 0.01). The ease of application was favored with the Hem-o-lok clips, especially when the bases of the appendix were edematous or inflamed. There were few intra-operative complications and no significant differences among the groups. Hem-o-lok showed no stump leak and no postoperative complications and Roeder's knot showed 3 (10.0%) with no statistically significant difference between the groups (p > 0.05). The mean hospital stay was similar in both groups (2.4 ± 0.8 vs. 2.6 ± 0.9 days). But the Roeder's knot technique proved to be more economical than Hem-o-lok clips. Conclusion: Appendiceal stump closure after a laparoscopy is safe and can be done with either Hem-o-lok clip or Roeder's knot. Hem-o-lok clips have the merits of less operating time and technique; Roeder's knot is more economical. Technique may vary according to surgeon preference, surgery type, and availability of resources.

Keywords: Appendix stump closure, Hem-o-lok clip, Laparoscopic appendectomy, Roeder's knot, Surgical outcomes.