Currently, LA has been successfully performed both in complicated and uncomlicated cases of appendicitis. Recently, it is shown that LA provides less morbidity and short recovery time with lower cost compared to open surgery even in complicated cases
8. In our center, we have performed routine laparoscopic exploration in patients with acute appendicitis for the last four years.
Closure of the stump is an important point in LA due to the potential risk of serious complications such as fistulas, peritonitis and sepsis9. Therefore, there have been many defined methods with some superiorities to the others. Operation time, hospital stay and postoperative complications are widely used parameters to compare the benefits of these methods9.
Operation time was significantly longer in intracorporeal knot tying group both in complicated and uncomplicated cases. It is not hard to understand that intracorporeal knot tying requires more time when compared to application of a clip. Similarly, Ates et al.2 reported a significantly longer operative time in cases of intracorporeal knot tying when compared with titanium clip application. In another study, Colak et al.4 reported short operative time with the use of hem-o-lok clip when compared the use of endoloop, but the difference was not statistically significant.
Hospital stay is directly associated with postoperative complications, therefore we detected similar results in these two parameters. Hospital stay and postoperative complication rates were better in hem-o-lok clip group, but it was not statistically significant. However, the p value was close to 0.05 (0.061 for hospital stay and 0.051 for postoperative complications). In two prospective studies that compared the hem-o-lok clip with endoloop, there were no difference between the groups in terms of hospital stay and postoperative complications4,5. Additionally, Partecke et al.10 reported that the use of a single hem-o-lok clip is easy to use, safe and cost-effective. They suggested the use of a single clip for the closure of the appendicular stump as the standard procedure in LA. All of the postoperative complications were seen in complicated cases. It can be considered that postoperative complications and hence longer hospital stay were associated with whether the appendicitis was complicated or not, rather than the method for stump closure.
In conclusion, in our opinion, closure of appendix stump with a hem-o-lok clip is a simple and a safe method in LA. Postoperative complications is generally related with presence of perforation, peritonitis or accompanying abscess formation rather than the use of hem-o-lok clip or knot tying.