A comparison of titanium clips v/s roeder’s knot tying suture in laparoscopic appendiceal stump closure: a one year randomized controlled trial study in kle’s dr. Prabhakar kore charitable hospital, belgaum

Abstract

Background and Objectives Appendiceal stump closure during laparoscopic appendectomy is an important step. The present study was an attempt to evaluate the ease of use and safety of titanium clips compared to Roeder’s knot in the appendiceal stump closure in patients undergoing laparoscopic appendectomy by comparing complications (intraoperative and post operative), hospital stay and follow up period. Methodology This one year randomized controlled trial was done in under the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum from January 2014 to December 2014. A total of 60 patients were divided into two groups of 30 each that is, Group R (Roeder’s Knot using Silk suture and Group T (Titanium clips). Results In the present study 53.33% of the patients in group R were females compared to 36.67% in group T (p=0.795). The mean age in group R was 29.77±11.24 years and in group T it was 29.53±8.96 (p=0.929). Other preoperative characteristics of the study population in group R and T were comparable (p>0.050). Significantly higher number of patients (60%) in group T required lower operative time (45 to 60 minutes) compared to group R. (83.33% patients required 61 to 75 minutes p<0.001). The pressure gradient was 1 in 23.33% of the patients in group R compared to 56.67% in group T (p<0.001). The mean operative time, pressure gradient (the difference between the initial pneumoperitoneum pressure and the pressure during clip / knot application) and hospital stay were significantly high in group R compared to group T (p<0.050). However, the intra-operative complications (p=0.177), post operative complications (p=0.303) and follow up period in both the groups was comparable (p>0.050). Conclusion and interpretation Appendiceal stump closure with titanium clips is advantageous in terms of operative time, pressure gradient and offers early resumption of daily activities.