Ligation versus Clipping of the Appendicular Stump in Laparoscopic Appendectomy

Abstract Background: Appendectomy is the most common surgical procedure performed in general surgery. For almost a century, open appendectomy, first described by Charles McBurney in 1889, has remained the gold standard treatment for acute appendicitis. The introduction of laparoscopic surgery has dramatically changed the field of surgery and laparoscopic surgery has been widely used as a minimally invasive surgery. Aim of Study: Comparative evaluation of intra-corporeal ligation versus titanium clip application as methods of securing the appendicular stump. As regard safety, simplicity, compe-tence, surgical technique, operative time, hospital stay and post-operative morbidity. Patients and Methods: This study was conducted to evaluate the results of the Intracorporeal ligation versus Titanium clips application in securing the appendicular stump in regarding operative time, operative findings, post-operative complications, hospital stay and return of the patients to their normal daily activities. Results: The overall post-operative complications were different in the 2 group. The incidence of wound infection was less in clips group (0% versus 10%). The mean hospital stay was shorter in clips group patients than ligation group patients (13.45 versus 18.95 hours). The mean time to return to normal activities was shorter in titanium clips patients (5.45 days versus 6.30 days). The use of laparoscope in suspected appendicitis is better than the open method especially in equivocal cases to reach an exact diagnosis. We must not hesitate to convert laparoscopic appendectomy to open appen-dectomy for the sake and safety of the patient. Conclusion: Both methods of intracorporeal ligation and clip application are cost effective in securing the appendicular stump. Titanium clip application is more easy to the surgeon, more time saving during the operation and less post-operative stay in the hospital. The only limitation of the clip application is the wider diameter of the base of the appendix beyond the large titanium clip in these cases intra-corporeal ligation is a safe and cheap alternative.