Table 1.
| Author, date of publication, journal and country | Study type and level of evidence | Patient group and study period | Exclusion Criteria | Post operative Follow up | Outcomes | Key results | Additional comments |
|---|---|---|---|---|---|---|---|
| Delibegovic' et al. [2], 2012, Journal of Laparoendoscopic & Advanced Surgical Techniques, Bosnia and Herzegovina | Randomized clinical trial (RCT), level II | The study included 90 patients who were randomised into 3 groups: a. Appendix base secured using endoloop
|
Not mentioned | Not mentioned | To compare safety, intraoperative timing and cost effectiveness | The use of one Hem-o-lok clip is as safe as an endoloop and/or stapler; however, the time of the laparoscopic procedure using the Hem-o-lok was shorter in comparison with the use of an endoloop, with the cost of the procedure being the lowest |
High level of evidence, reasonable sample size, single centre, no power calculation, no mention of the randomization technique, no blinding, follow up period was not mentioned, risk of bias |
| Hue et al. [3], 2013, Journal of the Korean Surgical Society, Korea | Randomized clinical trial (RCT), level II | The study included 105 patients who were classified into two groups: a. The endoloop group consisted of 66 patients
|
In some cases, Hem-o-lok clip was not used due to an enlarged appendix base and severe inflammation of the appendix base; in these patients, the endoloop was used | All patients were followed for a month postoperatively | to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and its limitations |
The use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter |
High level of evidence, reasonable sample size, single centre, no power calculation, no mention of the randomization technique, no blinding, risk of bias |
| Colak et al. [4], 2013, Surgical Laparoscopy Endoscopy & Percutaneous Techniques Journal, Turkey | Randomized clinical trial (RCT), level II | The study included 53 patients. a. 26 in hem-o-lok group
|
Exclusion criteria were (1) the patients under 16 years of age, (2) the patients with previous major abdominal operations, (3) the patients with pregnancy, (4) the patients who refused to consent for the study, and (5) the patients converted to open appendicectomy |
patients were invited to attend outpatient clinics at the first and fourth week postoperatively |
To evaluate the clinical outcomes of hem-o-lok ligation system in laparoscopic appendix stump closure by comparing it to the endoloop ligature |
The mean operation time were shorter in hem-o-lok group than endoloop group. However, the difference was not significant. Other surgical findings were similar |
High level of evidence, clearly mentioned the randomization procedure and the follow up time, small sample size, single centre, no blinding, risk of bias |
| Soll et al. [5], 2016, Journal of Langenbeck's Archives of Surgery, Switzerland | Retrospective observational study, Level III | The outcome of 813 consecutive patients, operated between 2009 and 2013 receiving laparoscopic appendectomy either with hem-o-look or endoloop for acute appendicitis, was analysed. Hem-o-lok clips were used in 54% (n = 435) and endoloop sutures were applied in 46% (n = 378) of the patients |
Hem-o-lok clips or endoloop ligatures were used in uncomplicated appendectomy without inflammation of the base of the appendix while endostaplers were applied in complicated cases |
30 Days | The aim of the study was to compare the hem-o-lok ligation system with endoloop suture to close the appendiceal stump with regard to postoperative intra-abdominal abscesses |
Closure of the appendiceal stump using the nonabsorbable hem-o-lok ligation system did result in a reduced rate of intra-abdominal surgical abscesses as compared to the application of endoloops |
Large sample size, multivariate analysis, single centre, risk of bias cannot be excluded |
| Sadat-Safavi et al. [6], 2016, Journal of Research in Medical Sciences, Iran | Randomized clinical trial (RCT), level II | The study included 76 patients who were randomly classified into two groups: a. 38 patients in Hem-o-lok appendiceal stump closure group
|
The exclusion criteria included the following: 1-Patients who were in pain more than 4 days 2-finding a mass in the right lower quadrant area in the examination 3-phlegmon in images or peritonitis symptoms 4- patients who underwent surgeries which turned into open laparoscopic due to adhesion 5-improper anatomic conditions were excluded from the study |
Not mentioned | To Compare the effect of stump closure by endoclips versus endoloop sutures on the patients who underwent lap. Appendicectomies | The effect of stump closure with endoloop versus endoclips is not different for complications, but the duration of surgery was shorter in endoclips method | High level of evidence, reasonable sample size, Single centre, no power calculation, no mention of the randomization technique, no blinding, follow up period was not mentioned, risk of bias |
| Lucchi et al. [7], 2016, Journal of Updates in Surgery, Italy | Retrospective observational study, Level III | The study included 259 patients for which: a. 121 patients in Group A where endloop suture used to close the appendiceal stump
|
When the base of appendix was perforated or too large due to the inflammation stapler was used to close the stump |
Not mentioned | The aim of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stump, comparing these data with those concerning the endo-loop |
Both the Endoloop and Hem-o-lok are safe for the closure of the appendicular stump. Hem-o-lok appears to be superior than Endoloop in terms of easiness of use and cheapness, maintaining the same safety. | Large sample size, single centre, follow up period was not mentioned, risk of bias cannot be excluded |