Clip Application Versus Harmonic Scalpel in Sealing and Division of the Appendicular Stump during Laparoscopic Appendectomy in Children

Abstract Background: Sutureless (clipless) appendectomy using en-doscopic devices like the harmonic scalpel has emerged as a promising alternative for appendicular base closure in adults. However, there is a lack of sufficient studies in the pediatric population. Aim of Study: This study aimed to assess the efficacy and complications of using the ultrasonic-activated device (har-monic) scalpel compared to titanium clip application for seal-ing and division of the appendicular stump during laparoscopic appendectomy in pediatric patients. Patients and Methods: A prospective comparative study was conducted at Ain Shams University Hospitals and Mattaria teaching hospital on 40 pediatric patients diagnosed with acute appendicitis. The patients were randomly divided into two groups: Group 1 (n=20) underwent laparoscopic appendectomy with titanium clip application, and Group 2 (n=20) underwent laparoscopic appendectomy with harmonic scalpel usage. Results: The demographic characteristics, clinical symp-toms, pediatric appendicitis risk scores, and laboratory data showed no statistically significant differences between the two groups. However, the duration of surgery was significantly shorter in Group 2 (harmonic scalpel) than in Group 1 (titanium clip application). Postoperative pain scores were significantly lower in Group 2, and time to start oral fluids showed no signif-icant difference between the groups. The occurrence of com-plications did not significantly differ between the two groups. Conclusion: Both harmonic scalpel and clip application are effective methods for securing the appendicular stump during laparoscopic appendectomy in pediatric patients. Har-monic scalpel usage is advantageous due to its ease of use and time-saving benefits during surgery. However, the higher finan-cial cost of the harmonic device remains a limitation. Laparo-scopic appendectomy, overall, offers several advantages over open appendectomy in terms of reduced wound infection inci-dence, shorter hospital stay, less need for post-operative anal-gesia, and faster patient recovery. Further extensive studies are recommended to evaluate the cost-benefit of harmonic scalpel application on the appendicular stump in pediatric patients.