title: Management of appendiceal stump in laparoscopic appendectomy--clips or ligature: a systematic review and meta-analysis.
abstract: BACKGROUND
  Appendicular stump closure is a crucial step during laparoscopic appendectomy. Recently, endoclips (ECs) have been described for ligation of the appendicular stump. The objective of this review was to compare outcomes with EC versus endoligature (EL) for appendiceal stump closure during laparoscopic appendectomy.
  
  
  METHODS
  A literature search of Medline, Embase, Cochrane Database, and Google Scholar was performed to identify studies comparing use of EL versus EC in laparoscopic appendectomy between January 1992 and September 2013. Reviews of each study were conducted, and data were extracted. The random-effects model was used to combine data, and between-study heterogeneity was assessed.
  
  
  RESULTS
  Seven of the 101 identified studies met the inclusion criteria: four randomized controlled trials and three case controlled series. For the primary outcome of perioperative and postoperative complications, there was no significant difference between the EC versus EL groups. No differences were noted in length of hospital stay. However, a significant reduction in operative time was observed with EC as opposed to EL (standardized mean difference=-0.90, 95% confidence interval=-1.26 to -0.54, P=.001). Moreover, EC procedures were less expensive than EL procedures.
  
  
  CONCLUSIONS
  EC application in the management of appendiceal stump during laparoscopic appendectomy appears to be simple, efficacious, safe, and a cost-effective alternative.
authors.affiliation: Department of Surgery, Royal College of Surgeons in Ireland , Dublin, Republic of Ireland .
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Shaikh
authors.forename: Raazi
authors.initials: R
authors.lastname: Bajwa
authors.forename: Ciaran O
authors.initials: CO
authors.lastname: McDonnell
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000295:instrumentation; D013536:Suture Techniques / Q000295:instrumentation*