A Study of Single Hem-O-Lok Clip v/s Roeder’s Knot in Laparoscopic Appendiceal Stump Closure: A One Year Randomized Controlled Trial Study in KLE’S Dr. Prabhakar Kore Charitable Hospital, Belgavi

Abstract

Background and Objectives: Appendicitis is one of the most common abdominal condition emergencies in the world. Standard method of care is laparoscopic appendectomy (LA).In LA most important step is to secure base of the appendix. Now most commonly followed method is by using Roeder’s knot, which is usually of silk material. With advancement in surgical approach and technology, there are various other methods to secure appendicular stump. In this study we are comparing standard Roeder’s knot with Hem-o-lok polymeric clip. Through this study we would like to compare operative time, surgeons feasibility, pneumoperitoneum pressure gradient and post operative complications Materials and Methods: Patients diagnosed with Appendicitis (Acute, chronic or recurrent),who are willing to undergo LA were randomised in to two groups of 30 each. First group was named as Test Group and second with Control Group. Test group had patients in whom Hem-o-lok clips were used and in Control group standard Roeders knot was used. Study was done in Dept of Gen. Surgery in Dr.Prabhakar Kore Charitable Hospital, Belagavi. Study period was between Jan 2017 to Dec 2017. Results: In the present study 63.33% of the patients in Control group were males compared to 56.66% in Test group. The mean age in control group was 28.6 years and in Test group it was 29.76 (p=0.7360). Other variables including clinical presentation, medical history, anthropometry, vitals, clinical signs, diagnosis, haemoglobin and urine analysis were comparable. The time between insertion of clip applicator and retrieval of appendix in patients in Test group was between 239 to 598 seconds while in patients in Control group time between insertion of knot pusher and retrieval of appendix was between 480 to 740 seconds (p<0.0001). Surgeons feasibility in Test group was more feasible in 93.33% and 13.33 % in Control group (p<0.0001). The pneumoperitoneum pressure after insertion of clip applicator in Test group was between 12 to 14 mm of hg with mean value of 13.43 mm of hg and pressure after insertion of knot pusher and retrieval of appendix in Control group was between 7 to 11 of hg(p<0.0001). Post operative complications in both Test and Control group were on POD 1, however on POD3 in Test group 3 patients had fever and in Control group 4 patients had fever. Conclusion: Hem-o-lok clips to secure appendicular stump in LA is fast, feasible and safe as compared to standard Roeder’s knot.