***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this prospect i ve r and omized trial was to evaluate the clinical outcomes of hem-o-lok ligation system in laparoscopic appendix stump closure by comparing the endoloop ligature . A total of 53 patients were evaluated in this study ( n=26 and 27 for hem-o-lok  and endoloop groups , respectively ) .  The mean operation time were shorter in hem-o-lok group than endoloop group ( 64.7±19.2 vs. 75.4±23 , respectively ) ; however , the difference was not significant . Other surgical findings were similar . There was no statistically significant difference in overall nonsurgically or surgically related complications . The mean postoperative hospitalization time was also similar in both groups . Although it is not possible to make general conclusions on basis of such a limited study , in our opinion , closure of the appendix stump with polymeric nonabsorbable clips in laparoscopic appendectomy may be a cheaper and simpler alternative to other widely used methods A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle . The aim of this study was to investigate the effect of LigaSure in  laparoscopic appendectomy . Between August 2007 and June 2008 , a total of 32 patients were included in the study . Patients were r and omized into 2 groups . The first group 's dissection of the mesoappendix was performed with LigaSure ( 5 to 10 mm ) , whereas the second group 's with endodissector and endoclip . The surgical time , postoperative complications , additional analgesics use and hospital stay were compared . There were no significant differences in complication rates , use of analgesics and hospital stay between the groups . The operation time ( 49.06±14.73 min vs. 59.69±12.54 min , P=0.036 ) was significantly lower in the LigaSure group . This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely . However , more experiences are needed to attain reliable scientific results A r and omized control trial was performed to evaluate the effectiveness and safety of absorbable polymeric clips for appendicular stump closure in laparoscopic appendectomy ( LA ) . Patients were r and omly enrolled into an experimental group ( ligation of the appendicular base with Lapro-Clips , L-C group ) or control group ( ligation of the appendicular base with Hem-o-lok Clips , H-C group ) . We identified 1,100 patients who underwent LA between April 1 , 2012 and February 3 , 2015 . Overall , 99 patients ( 9.0 % , 99/1,100 ) developed a complication following LA ( 47 [ 8.5 % ] in the L-C group and 52 [ 9.5 % ] in the H-C group ( P = 0.598 ) . No statistically significant differences were observed in intra-abdominal abscesses , stump leakage , superficial wound infections , post-operative abdominal pain , overall adverse events , or the duration of the operations and hospital stays between the groups ( all p > 0.05 ) . Adverse risk factors associated with the use of absorbable clips in LA included body mass index ≥ 27.5 kg/m2 , diabetes , American Society of Anesthesiologists degree ≥ III , gangrenous appendicitis , severe inflammation of the appendix base , appendix perforation , and the absence of peritoneal drainage . The results indicate that the Lapro-Clip is a safe and effective device for closing the appendicular stump in LA in select patients with appendicitis Background The aim of this study was to evaluate the feasibility , morbidity , and cost-effectiveness of the closure of the  appendicular stump with a single non-absorbable polymeric clip compared with the closure of the appendicular stump with a stapler . Methods From January 2009 to December 2009 , 82 patients , 31 males and 51 females ( mean age of 35.4 years ; range of 17 to 79 years ) , were included in this prospect i ve , non-r and omized trial . In 56 patients , the appendicular stump was closed by staplers , and in 26 patients , a single Hem-o-lok MLX polymeric clip was applied . The data collected included age , sex , time of surgery , costs , time of hospitalization , day-time of surgery , complications , and preoperative white blood count ( WBC ) and c-reactive protein ( CRP ) . Results There were no differences between the two groups regarding age , sex , WBC , CRP , and time of hospitalization . Time of surgery was longer in the clip group due to the introductory phase . Morbidity did not differ significantly and was highly acceptable in both groups . The costs of one set of Hem-o-lock clips were negligible compared to staplers ( 19.94 € versus 356.43 € ) . Conclusions The use of a single non-absorbable polymeric clip is easy to use even for surgical trainees ; it is safe and cost-effective . We suggest the use of a single clip for the closure of the appendicular stump as the st and ard procedure in laparoscopic appendectomy whenever possible We compared 140 appendectomies in a prospect i ve study with regard to length of operation , stay in hospital and intra- and postoperative complications . We operated by four methods and made up four groups , 35 patients in each : ( 1 ) application of RODER-loop and manual stump-sinking ; ( 2 ) application of RODER-loop without manual stump-sinking ; ( 3 ) application of Endo-GIA ; ( 4 ) conventional appendectomy according to McBurney  .  Intraoperative complications occurred mainly in laparoscopic appendectomy , while disturbances of wound-healing were observed mainly in conventional appendectomy . The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group ( RODER-loop without stump-sinking ) , while using the Endo-GIA involved only a little risk . In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended ; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results Background : Laparoscopic appendectomy is a well-described surgical technique . However , concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip , an endoloop , or other techniques . In this study , the effect of stump closure on duration of surgery and complications by endoclips was compared with endoloop in patients under laparoscopic appendectomy . The study was carried out as a prospect i ve r and omized clinical trial between 2013 and 2015 in Shariati Hospital of Tehran . Material s and Methods : Seventy-six patients under laparoscopic appendectomy  were enrolled and r and omly assigned to receive either endoclips or endoloop for stump closure . The results in terms of the operating time , length of hospital stay , and the complications were compared and analyzed between two groups . After collecting the essential data by using a checklist and examination of patients , the data were analyzed with SPSS . Results : The mean age was 23.13 ± 5.07 years and 44.7 % of the patients were male . Moreover , in this study , it was seen that the mean duration of surgery was 23.2 min versus 21.5 min in endoloop and endoclips groups , respectively ( P = 0.021 ) . There was no difference between hospital stay among two groups ( P > 0.05 ) . Furthermore , the complications were same in two groups ( P > 0.05 ) . Conclusion : The effect of stump closure with endoloop versus endoclips is not different for complications , but the duration of surgery was shorter in endoclips method . Both methods could be used based on the opinion of the surgeon without expecting a statistically significant difference in the results Purpose The purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip . Methods From May 2010 to August 2011 , 105 consecutive patients underwent laparoscopic appendectomies by three surgeons .  XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon . The remaining surgeons used double endoloop ligatures . Prospect ively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively review ed . Results A total of 105 laparoscopic appendectomies were performed . The  endoloop group consisted of 66 patients ( mean age , 34.6 years ; range , 16 to 82 years ) , while the  Hem-o-lok group consisted of 39 patients ( mean age , 43.5 years ; range , 11 to 88 years ) . In three cases , the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base . No specific intraoperative or postoperative complications were observed in either group . Conclusion 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 Background : The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler . Methods : This was a prospect i ve study in 2 stages . In phase 1 , 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups . In 14 patients , the appendicular base was occluded by using an endoscopic linear cutting stapler . In the remaining 14 , the appendicular base was ligated by using nonabsorbable polymeric clips ( Hem-o-lock ) . We compared the surgical time , hospital stay , hospital costs , and complications . In phase 2 , 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the appendicular mesentery . Ligation of the appendicular stump was performed with Hem-o-lock clips . Results : We found a significant difference in procedure costs , with the endoscopic staplers being more expensive . Conclusion : The use of polymeric clips is feasible , safe , and an economic alternative for ligation of the appendicular stump during laparoscopic appendectomies The applicability and safety of a new operative technique for laparoscopic appendectomy  using an automatic stapling device , the Multifire Endo-GIA 30 , was evaluated . This instrument , which can be passed through a 12-mm trocar sleeve , compresses the appendix as well as the resting stump , occluding its lumen with three lines of titanium staples and cutting between them . Data from 40 laparoscopic appendectomy patients collected between August 1991 and March 1992 were analyzed prospect ively . Using this stapler , the mean operation time was 58.33 min ( range , 35 - 95 min ) , with no complications or mortality . In 35 cases , an acute , and in one case , a chronic , appendicitis was histologically confirmed ; in four cases no inflammation was detected . Our preliminary results suggest that this new stapling device offers a simple and safe method for use in laparoscopic appendectomy Background During  laparoscopic appendectomy ( LA ) , the st and ard technique in securing of the base of the appendix is by endoloop ligatures . However , application of the endoloop dem and s dexterity and a short training , while hem-o-lok clips may be more advantageous to use due to their simplicity of application and low cost . The objective of this study was to evaluate the technical feasibility and eventual advantages of this way of securing of the base of the appendix . Patients and methods Prospect i ve study was conducted in the period from August 2006 to August 2008 . The patients were divided into two groups ; in the first group the base of the appendix was secured by double endoloop ligatures , while in the second group it was done by double nonabsorbable hem-o-lok clips . The data collected included age , gender , operative time , hospital stay , costs , and intra- and postoperative complications . Results There was no difference in hospital stay between the two groups of patients  ; mean operative time was 47.1 ± 6.7 min in the first group where the base was secured by endoloop ligatures , and was 38.7 ± 5.0 min in the group where the base was secured by hem-o-lok clips . The cost of the three hem-o-lok clips was € 76.9 , and that of the three endoloop ligatures was € 88.5 . In hem-o-lok group of patients , one intraoperative complication was observed , involving bleeding of mesoappendix . There were no postoperative complications in either group of patients . Conclusion The simplicity of application , shorter time of operation , and lower cost of hem-o-lok clips are advantages of this way of securing of the base of the appendix in relation to the st and ard endoloop procedure Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis . Clinical studies have shown this approach to be a reasonable alternative to open appendectomy . The objective of the current study was to assess the outcome 
    Output:
    
Given the limitations of all studies in terms of bias and the low quality of available evidence , a clear conclusion regarding superiority of any one particular type of mechanical device over another is not possible .
Evidence is insufficient at present to advocate omission of conventional ligature-based appendix stump closure in favour of any single type of mechanical device over another in uncomplicated appendicitis