الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute appendicitis is a highly frequent cause of abdominal surgical emergencies. The preferred treatment is still an open appendectomy or laparoscopic appendectomy. Because laparoscopic appendectomy offers vantages over open appendectomy as regard wound infection after surgery, analgesic needs, hospital stay length, duration passed till returning work, and general healing, it has replaced OA as a therapeutic option. The most important step in a LA is the CAS. Inappropriate closure may result in intra-abdominal infections at the region of surgery or life-threatening adverse effects including leak and development of sepsis. Many methods such as ligation using extracorporeal knots, intracorporeal knots, endostapling, endoloop or endoclips have been used for CAS in LA. This study aimed to compare 2 different methods of closure of appendix stump, the extracorporeal Roeder’s knot and the polymeric non-absorbable Hem-o-lok clip as regards feasibility, cost and complications.
The study was carried on forty patients presented to the emergency department of the Alexandria Main University Hospital with acute appendicitis. Patients were randomized by closed envelope technique into 2 groups: group I who used the Roeder’s knot in closure of appendix stump and group II who used Hem-o-lok clip in closure of appendix stump. Patients with appendicular abcess, appendicular mass and diffuse peritonitis were ruled out from the study.
A detailed history was taken from all cases, physical examinations and routine investigations. Abdominal ultrasonography was done to confirm the diagnosis and CT if the Ultrasound was inconclusive.
Both the Roeder’s knot and hem-o-lok clips are safe effective ways of CAS with no increase in incidence of following surgery complications such as leak, intra-abdominal collection or wound infection however, the usage of Hem-o-lok is limited to appendicular stump not more than 12mm in diameter.
The total cost of clips used in closure of appendix stump showed significant increase in the Hem-o-lok group with a median of 500LE than the Roeder’s knot group with a median of 45LE. Thus, the same results can be achieved using the relatively cheap Roeder’s knot rather than the Hem-o-lok clip. But we might prefer to use Hem-o-lok in cases of sever adhesion owing to its easy application and short time of application rather than Roeder’s knot.