# Endoloop Versus Metallic Clip for Stump Closure in Laparoscopic Appendectomy: A Systematic Review and Meta-Analysis

## TL;DR

This study compares two methods for closing the appendix during surgery and finds that using metal clips is faster without increasing complications.

## Contribution

A systematic review and meta-analysis comparing endoloop and metallic clip techniques for appendicular stump closure.

## Key findings

- Metal clips significantly reduced operation time compared to endoloop.
- Readmission, reoperation, and infection rates were similar between the two methods.

## Abstract

Appendectomy is the treatment of choice for most cases of acute appendicitis, and, considering that the availability of technical variables for closing the appendicular stump raises questions for surgeons, analyzing which closure method provides the best results is necessary. This study aims to compare the variables of operating time, readmission rate, reoperation, and surgical wound infection regarding the endoloop and metallic clip techniques for closing the appendicular stump in laparoscopic appendectomy. Only randomized clinical trials that compared metallic clip and endoloop appendicular stump closing in laparoscopic appendectomy were used. Of these, those that did not fit the PICOT (Patient, Intervention, Comparison, Outcome, and Time) question and inclusion criteria were excluded, with five articles being included for the analysis phase. Five randomized clinical trials were included in the statistical analysis, totaling a population of 344 patients, with 181 patients in the metal clip group. It was observed that the operation time was significantly shorter in the metal clip group (STD -0.81, 95% CI: -1.13, -0.49, p < 0.00001, I² = 50%). To the extent that the reoperation rate (RR 1.27, 95% CI: 0.20, 7.88, p = 0.80, I² = 0%), the readmission rate (RR 0.93, 95% CI: 0.29, 2.91, p = 0.89, I² = 0%), and the surgical wound infection rate (RR 0.87, 95% CI: 0.24, 3.13, p = 0.83, I² = 0%) were statistically similar between the two groups. The findings of this study demonstrate that the closure of the appendicular stump using metal clips in laparoscopic appendectomy is faster, with similar rates of readmission, reoperation, and surgical wound infection between the two groups.