Meta-analysis Of Safety And Practicability Of Appendix Base Treated With Hem-o-lok Clip And Endoloop Ligature In Laparoscopic Appendectomy

Objective:To evaluation the safety and practicability of appendix base treated with Hem-o-lok clips and Endoloop ligature in laparoscopic appendectomy(LA).Methods:Six databases(PubMed,Embase,the cochrane library,Ovid CNKI,SinoMed and WAN-FANG database)were comprehensively searched(publication dates ranging from library to march 2018)with controlled clinical trial(RCT)or controlled clinical trials(CCT)that Comparison of hem-o-lok clips and Endoloop ligature trea-tment of appendix base in laparoscopic appendectomy.strictly screening accordance to the standard,assessing the quality of these studies,data were extracted from these trials and analyzed by the Review Manager 5.3 software.Results:1.The baseline characteristics of the selected studies: Seven observational studies that include 5 English articles and 2 Chinese articles with a total of 535 patients(271 in LAH groups and 264 in LAE groups)were identified in our study.2.Comparison of operative time in two groups: Compared to LAE group,LAH group has shorter operation time(WMD=-5.15,95%CI:-7.42~-2.88 P < 0.00001).3.Comparison of the time of application in two groups: Compared to the LAE group,the time of the appendix base application was reduced during the LAH group(WMD=-130.89,95%CI:-146.48~-115.29 P < 0.00001).4.Comparison of the cost of dealing with appendix roots in two groups:Compared to the LAE group,LAH groups cost less to deal with appendix roots.(See figure for details).5.Comparison of hospital staying after operation in two groups :Compared with the LAE group,there was no significant difference in the number of hospital staying after operation in the LAH group(WMD=0.02,95%CI:-0.11~ 0.15;P = 0.75).6.Comparison of complication after operation in two groups : There was no significant difference in postoperative complications in the LAH group compared to the LAE group(OR=0.74,95%CI: 0.30~1.87;P = 0.53).Conclusions:1.The Hem-o-lok clip versus the Endo-Loop ligature treats appendix base in laparoscopic appendectomy to shorten the time of the appendix base application and overall operative time and reduce the cost of appendix base treatment.2.There was no statistically significant difference between the LAH group and the LAE group in terms of postoperative hospital stay and postoperative complica-tions.3.In summary,from the current study,the Hem-o-lok clip and Endoloop ligature device are safe and effective for appendix base closure in laparoscopic appendectomy,but in practicality Hem-o-lok clips have an advantage.In addition,for the more specific case of acute appendicitis(appendiceal root diameter is too large,perforation of the appendix,etc.),the closure of the appendix base in the operation still requires the surgeon to select the ligation program as appropriate.In addition,due to the limitations of this study,it is still necessary to wait for the multi-center participation of high-quality large sample randomized controlled clinical research data to provide a more reliable theoretical basis.