Polymer Clips Versus Endoloops for Closure of the Appendiceal Stump During Emergency Laparoscopic Appendicectomy
Polymer Clips Versus Endoloops for Closure of the Appendiceal Stump During Emergency Laparoscopic Appendicectomy
The investigators propose a study to compare two methods of closing the stump of the appendix
 during an emergency excision of the appendix using a keyhole approach. One similarly designed
 study has been undertaken in another institution but there were not enough patients recruited
 to the study to allow meaningful conclusions to be drawn.

 Any patient over the age of 16 years whom the investigators suspect to have acute
 appendicitis will be considered for recruitment to the study. During their exploratory
 keyhole surgery, if the surgical team feels that excision of the appendix is indicated then
 the patient will be randomly allocated to either polymer clips or endoloops to the part of
 the procedure where the stump (base) of the appendix is closed.

 The main aim is to determine if polymer clips shorten the duration of the operation. The
 investigators will also determine if there is a difference between the rates of
 complications, the time spent in hospital and the number of times the participants had to be
 readmitted to hospital within 30 days.
The investigators propose to perform a randomised control trial within NHS Tayside comparing
 two forms of appendiceal stump closure in emergency laparoscopic appendicectomy. A previous
 RCT examining this topic could have been better designed, with a small trial population and
 the absence of a power calculation.

 All patients over 16 years old undergoing diagnostic laparoscopy for acute appendicitis will
 be eligible for recruitment to the trial and be consented prior to theatre.
 Intra-operatively, when the decision to perform an appendicectomy is taken, participants will
 be randomised to either the application of polymer (Locaclip) clips or endoloops to the
 appendiceal stump for closure during laparoscopic appendicectomy. The primary outcome will be
 operative time, while secondary outcomes include post-operative complications length of
 hospital stay and re-admission rate within 30 days. Participants will require no formal
 follow-up, either in the out-patient clinic or telephone consultations.

 Statistical analysis will predominantly use Fisher's exact test to determine any
 statistically significant differences between each intervention arm, whilst group homogeneity
 will be analysed for other important patient parameters.

 The investigators hypothesise that the operative time will be less in the polymer group
 compared to the endoloop group, while no significant difference will be seen in
 post-operative complications or other secondary outcomes between the two cohorts. The results
 of this RCT will add to the evidence-base for the use of polymer clips in appendiceal stump
 closure and potentially support its use for routine clinical practice. It is anticipated that
 it will take one year to recruit participants for the study and a further 30 days to complete
 follow up for the last participant recruited.
Inclusion Criteria:

 -  Patients with clinical suspicion of acute appendicitis who are to do undergo
 diagnostic laparoscopy +/- appendicectomy

 -  Over the age of 16 years

 -  Able to give informed consent for inclusion in the study

 Exclusion Criteria:

 -  Intraoperative decision to convert to open appendicectomy

 -  Primary open appendicectomy

 -  Under 16 years old

 -  Unable to give informed consent for participation in the study