{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:33:42Z","timestamp":1786707222798,"version":"build-2736575974"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Laparoscopic appendectomy (LA) is the standard of care for acute appendicitis, but the optimal method for appendiceal stump closure remains debated. Endoscopic staplers (ESs) are widely used but expensive, whereas polymeric clips (PCs) offer a cheaper alternative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted a single-centre, open-label, exploratory randomised controlled trial (September 2021\u2013August 2023) comparing PC (Group A,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 30) versus ES (Group B,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 30) for stump closure during LA. Primary outcomes included safety and cost-effectiveness; secondary outcomes included ease and time of application, operative time, hospital stay and complications. Learning curve analysis was performed for a trained surgical resident.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Sixty patients (mean age: 30.7 \u00b1 11.6 years) were randomised. Demographics and appendicitis severity were comparable between groups. No stump dehiscence occurred in either group. Operative time was similar (55.1 \u00b1 12.8 vs. 54.5 \u00b1 15.4 min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.86), although application time was longer with PC (80.1 \u00b1 10.0 vs. 68.3 \u00b1 10.9 s,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). Post-operative complication rates were comparable. Total cost was significantly lower with PC (\u20b979,815 \u00b1 4,072) versus ES (\u20b91,19,732 \u00b1 16,061;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). Learning curve analysis showed residents required ~20 cases to achieve operative efficiency.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>PCs are a safe, technically simple and cost-effective alternative to staplers for appendiceal stump closure in LA, with comparable outcomes and a short learning curve. Larger multicentre RCTs are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_410_25","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:00:08Z","timestamp":1786705208000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Polymeric clip versus endoscopic stapler for securing the base of the appendix during laparoscopic appendectomy: An exploratory randomised controlled trial"],"prefix":"10.4103","author":[{"given":"Ratnakar","family":"Namdeo","sequence":"first","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manjunath Maruti","family":"Pol","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manav","family":"Manohar","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venu Madhav","family":"Jarapala","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghav","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"R1-20260814","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s13304-016-0413-9","article-title":"Laparoscopic appendectomy: Hem-o-lok versus Endoloop in stump 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