Hem-o-lok clip versus endoloop for appendiceal stump closure in laparoscopic appendectomy: a systematic review and meta-analysis.

BACKGROUND

Hem-o-lok clips and endoloops are commonly used techniques for appendiceal stump closure during laparoscopic appendectomy. However, evidence regarding their relative safety and efficacy remains inconsistent. This meta-analysis compared clinical outcomes between the two techniques.

METHODS

PRISMA guidelines were followed. PubMed, Google Scholar, and other electronic databases were searched for comparative studies evaluating Hem-o-lok clips versus endoloops in laparoscopic appendectomy. Primary outcomes were intra-abdominal abscess and surgical site infection; secondary outcomes were operative time and hospital length of stay. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale. Pooled estimates were calculated using fixed- or random-effects models.

RESULTS

A total of 23 studies involving 4296 patients were included. No statistically significant differences were observed between the groups regarding surgical site infection (p = 0.112) or hospital length of stay (p = 0.355). Operative time was significantly shorter in the Hem-o-lok clip group (MD 5.41 min, 95% CI 3.40-7.42; p = 0.019). Intra-abdominal abscess formation was significantly less frequent in the Hem-o-lok group compared with the endoloop group (OR 1.87, 95% CI 1.05-3.32; p = 0.035). Heterogeneity was low for intra-abdominal abscess and SSI analyses, whereas substantial heterogeneity was observed for operative time and LOS outcomes.

CONCLUSIONS

Both Hem-o-lok clips and endoloops are safe and effective methods for appendiceal stump closure. Hem-o-lok clips were associated with shorter operative time, while postoperative outcomes were largely comparable between techniques. Further randomized studies are warranted.