Comparison of Extracorporeal Knot-tying Suture and Endoclips in Laparoscopic Appendiceal Stump Closure in Uncomplicated Acute Appendicitis

Muhammad Nadeem, MBBS, Sohaib Mohammad Khan, MBBS, Saeed Ali, MBBS, Muhammad Shafiq, MBBS, Muhammad Waqar Elahi, MBBS, Farooq Abdullah, MBBS, Irshad Shirazi, MBBS. Nishtar Hospital


An inadequate closure of the appendiceal stump can lead to intra-abdominal surgical site infections. There are various techniques for the closure of base of appendix while performing a laparoscopic appendectomy like endoloops, knotting, clips and staplers.


The goal of this study was to compare the complications and cost of extracorporeal knot-tying suture with metallic endoclips in appendiceal stump closure during laparoscopic appendicectomy.


This study was conducted as a single-blinded randomized controlled trial. The project included patients undergoing laparoscopic appendicectomies in three tertiary care hospitals of Peshawar i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex from 1st June 2013 to 1st June 2014. The patients were randomized into two groups – patients undergoing base closure with metallic endoclip and patients having base closed by extracorporeal knotting. The two techniques were compared in terms of operative time, hospital stay, complication rates and cost.


A total of 68 patients were enrolled in the study and randomized into two groups:

Metallic endoclip group n=32 (47.1%)

Extracorporeal knot group n=36 (52.9%)

No statistically significant differences were present between the two groups in terms of age (p>0.9). The mean operative time for the endoclip group was shorter (42.1min) as compared to the extracorporeal knot group (48.9min) with a p value of 0.002. The cost of endoclip group was higher (800) as compared to the extracorporeal knot group (220). There were no statistically significant differences in terms of hospital stay and complication rates (p>0.05).


The use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it’s a useful alternative to the extracorporeal knotting.

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