A Prospective Study: Comparing Stump Closure by Hem-o-Lok Clips Versus Roeder’s Knot in Laparoscopic Appendectomy

Abstract

Background: Laparoscopic appendectomy has become the preferred surgical approach for acute appendicitis due to its advantages, such as reduced postoperative pain, shorter hospital stays, and faster recovery. However, the method of appendiceal stump closure remains a topic of debate, with techniques such as Hem-o-Lok clips and Roeder’s knot being widely used. The choice between these two techniques is crucial, as it impacts operative time, patient outcomes, complication rates, and overall cost-effectiveness. Despite existing research comparing the two methods, a consensus on the superior technique remains elusive. This study aims to compare the efficacy, safety, and cost-effectiveness of Hem-o-Lok clips and Roeder’s knot in appendiceal stump closure during laparoscopic appendectomy.

Objectives: This study evaluates and compares the operative time, postoperative pain levels, complication rates, and cost-effectiveness of Hem-o-Lok clips versus Roeder’s knot for stump closure in laparoscopic appendectomy.

Methods: This prospective observational study was conducted at Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital (VMKVMCH), Salem, from August 2022 to December 2023. A total of 60 patients diagnosed with uncomplicated acute appendicitis were included, with patients alternately assigned to two groups: Group H (Hem-o-Lok clips, n=30) and Group R (Roeder’s knot, n=30). Demographic variables, preoperative and intraoperative parameters, postoperative pain scores (measured using the Visual Analog Scale), incidence of surgical site infections (graded by the Southampton wound grading system), hospital stay duration, and cost of materials used were recorded. Statistical analysis was performed using Jamovi software, and results were analyzed with appropriate tests, considering p<0.05 as statistically significant.

Results: The two groups were comparable in terms of demographic characteristics and baseline health status. The operative time was significantly shorter in the Hem-o-Lok group (p<0.05), suggesting that clip application is more efficient than Roeder’s knot tying. Both techniques demonstrated similar outcomes in postoperative pain reduction, complication rates, and hospital stay duration, with no statistically significant difference observed. However, a notable difference was seen in cost-effectiveness, with Hem-o-Lok clips proving to be a more economical option compared to Roeder’s knot.

Conclusion: Both Hem-o-Lok clips and Roeder’s knot are effective and safe for appendiceal stump closure during laparoscopic appendectomy. However, Hem-o-Lok clips offer advantages in terms of reduced operative time and cost-effectiveness, making them a preferable choice for routine laparoscopic appendectomies. The selection of the technique may ultimately depend on surgeon expertise, institutional policies, and patient-specific factors. Further large-scale studies are warranted to validate these findings and establish standardized guidelines for appendiceal stump closure in laparoscopic appendectomy.