Comparison between Laparoscopic Suturing and Metallic Endoclips in the Closure of Appendiceal Stumps during the Laparoscopic Management of Complicated Appendicitis

Background: Closure of the appendiceal stump is a crucial step during laparoscopic appendectomy. Multiple techniques have been described to close the appendiceal stump, with no clear consensus on which one offers the best results. In addition, most comparative results included patients with uncomplicated appendicitis. In this study, the intracorporeal sutures and metallic endoclips were compared in appendiceal stump closure in cases with complicated appendicitis. Methodology: One hundred patients were enrolled in this prospective randomized trial and divided into two groups: The endoclip group (n = 50) and the Suture group (n = 50). Postoperative outcomes were compared between the two groups. Results: Both preoperative and intraoperative findings were statistically comparable between the two approaches. Nonetheless, the application of metallic clips was associated with a significant shortening in the operative time (75 vs. 95 minutes with sutures). All patients were discharged within 24 hours after the operation. Only one patient (2%) required readmission in the suturing group. That patient presented with ileus, and radiological assessment revealed the presence of a postoperative intraabdominal abscess that needed reoperation via laparoscopy (for evacuation and drainage) that was the only patient who required readmission and reoperation in the current study. No patients developed fecal fistula, whereas port site infection occurred in 8% of cases in each group. Conclusion: Both metallic endoclips and intracorporeal sutures are available safe options for appendiceal stump closure during laparoscopic appendectomy for patients with complicated appendicitis. However, the former could provide a benefit over the latter, manifested in the decreased operative time.