Summary of findings 3. Clips versus ligature for appendix stump closure during laparoscopic appendectomy.
| Clips vs ligatures for appendix stump closure during laparoscopic appendectomy | |||||
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Patient or population: patients undergoing appendix stump closure during laparoscopic appendectomy Settings: hospital Intervention: clips Comparison: ligature | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with ligature | Risk with clips | ||||
| Total complications | 17 per 1000 | 18 per 1000 (3 to 105) | OR 2.03 (0.71 to 5.84) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Intraoperative complications | 21 per 1000 | 22 per 1000 (4 to 124) | OR 1.74 (0.33 to 9.04) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Postoperative complications | 17 per 1000 | 18 per 1000 (3 to 105) | OR 1.88 (0.63 to 5.64) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Postoperative superficial infections | 14 per 1000 | 15 per 1000 (2 to 86) | OR 1.25 (0.32 to 4.90) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Postoperative ileus | 10 per 1000 | 11 per 1000 (2 to 65) | OR 0.92 (0.15 to 5.64) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Postoperative deep infections | 3 per 1000 | 4 per 1000 (1 to 23) | OR 1.75 (0.28 to 10.93) |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c |
| Operative time (minutes) | Mean operative time was 40.0 minutes. |
Mean operative time in the intervention group was 8.14 minutes shorter (11.73 minutes shorter to 4.55 minutes shorter). |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | |
| Hospital stay (days) | Mean hospital stay was 1.5 days. |
Mean hospital stay in the intervention group was 0.03 days shorter (0.16 days shorter to 0.11 days longer). |
553 (6 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial. | |||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
aDowngraded one level for inconsistency (substantial heterogeneity).
bDowngraded one level for high risk of bias.
cDowngraded one level for imprecision (all included studies had few participants and events and thus wide confidence intervals, limiting the precision of estimates).