# Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial

## TL;DR

This study compares using one or two Hem-o-lok clips during laparoscopic appendectomy and finds that using a single clip is just as safe and effective as using two.

## Contribution

The study provides new clinical evidence on the effectiveness of single versus double Hem-o-lok clips for appendiceal stump closure.

## Key findings

- Single Hem-o-lok clips resulted in shorter operative times compared to double clips.
- Hospital stay was shorter in patients using single Hem-o-lok clips.
- Drain placement was identified as a predictive factor for longer hospital stays.

## Abstract

Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump.

This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes.

One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1–10) in the single hem-o-lok group and 1 day (range 1–12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay.

The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective.

Trial registration NCT04387370 (http://www.clinicaltrials.gov).