Polymer Clips Vs Endoloop for Appendicular Stump Ligation
Polymer Clips Vs Endoloop for Appendicular Stump Ligation
laparoscopic appendectomy is the gold standard procedure now a days for the treatment of
 appendicitis. Polymer clips are new modality used for the ligation of appendicular stump.
 this study aims to compare the polymer clips with endoloop for the ligation of appendicular
 stump.
Appendicitis is defined as an inflammation of the inner lining of the vermiform appendix that
 spreads to its other parts.[1] Features of acute appendicitis include right lower quadrant
 pain starting from epigastrium or umblical region which then shifts to right iliac fossa,
 associated with nausea, vomiting, anorexia or fever. On examination tenderness, rebound
 tenderness and guarding are usually present in right iliac fossa.

 Various laboratory investigations to diagnose appendicitis include complete blood count,
 ultrasound abdomen and CT scan abdomen. A large, single center study found that multi
 detector CT (MDCT) has a high rate of sensitivity and specificity (98.5% and 98%,
 respectively) for diagnosing acute appendicitis.[2] Appendicitis may occur for several
 reasons, such as an infection of the appendix, but the most important factor is the
 obstruction of the appendiceal lumen. Left untreated, appendicitis has the potential for
 severe complications, including perforation, peritonitis, sepsis, and may even cause death.

 Appendectomy is the most effective treatment of acute appendicitis and the most commonly
 performed operation of emergency surgery worldwide. Since the introduction of laparoscopy,
 the minimally invasive technique is being used to perform appendectomy. According to the 2010
 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline, the
 indications for laparoscopic appendectomy are identical to those for open appendectomy.[3]
 Laparoscopic appendectomy (LA) is a safe and easy operation offering well-known advantages of
 laparoscopy, such as faster postoperative recovery, good cosmetics, less wound complications
 and less postoperative pain although laparoscopic method is expensive as compared to open
 method.

 Various methods (endoloop, titanium clips, polymer clips and endo-staplers) are used to
 ligate the stump and mesentery of appendix during laparoscopic appendectomy.

 Endoloops are being used widely for the ligation of mesentery since long but it is expensive
 and requires more expertise and skill to use the endoloops and most of the times 2-3
 endoloops are used which increases the cost of operation. Now-a-days polymer clips are used
 for the ligation of stump and mesentery which are economical and require less expertise as
 compared to that required for the use of polymer clips. More over both of these methods does
 not have any side effects as investigated by various investigators in previous
 studies.[4][5][6] In a study done by Delibegović S. and Matović E.[4] who compared the
 polymer clips with the endoloop showed that mean operative time was 47.1 ± 6.7 min in the
 first group where the base was secured by endoloop ligatures, and was 38.7 ± 5.0 min in the
 group where the base was secured by hem-o-lok clips. The cost of the three hem-o-lok clips
 was 76.9 Euros, and that of the three endoloop ligatures was 88.5 Euros and according to them
 the simplicity of application, shorter time of operation, and lower cost of hem-o-lok clips
 are advantages of this way of securing of the base of the appendix in relation to the
 standard endoloop procedure. Various other studies have found similar results.[5],[6]
Inclusion Criteria:

 -  1. Patients of either gender with age ranging from 15 to 60 years. 2. Patients with
 MANTRELS score of 7 or above on admission.

 Exclusion Criteria:

 - 1. Patients having co-morbid factors such as diabetes, chronic liver disease and ischemic
 heart disease on previous / past medical history.

 2. Patients with history and clinical findings suggestive of appendicular mass. 3. Patients
 with known gastrointestinal malignancies. 4. Patients with history of any abdominal surgery