A Comparative Study of Harmonic Scalpel Versus Suture Ligation for Appendix Base Closure in Patients With Appendicitis Undergoing Laparoscopic Appendectomy: A Randomized Controlled Trial.

Background and objective Appendicitis is a common cause of acute abdominal pain and a frequent indication for emergency abdominal surgery. Laparoscopic appendectomy has become the preferred surgical treatment due to its many advantages over open appendectomy, including reduced morbidity, shorter hospital stay, and faster recovery. A critical step in laparoscopic appendectomy is the secure closure of the appendix stump to prevent postoperative complications. While laparoscopic appendectomy is widely practiced, there is no consensus on the optimal method for appendix stump closure. This prospective study aimed to compare the harmonic scalpel (HS) with suture ligation (SL) for appendix base closure in terms of operative time, surgical site infection (SSI), postoperative pain, postoperative ileus, and hospital stay. Methods This prospective randomized controlled trial was conducted at the Department of General Surgery, GSVM Medical College, Kanpur, involving 60 patients with appendicitis undergoing laparoscopic appendectomy. The data entry was performed using Microsoft Excel. The final statistical analysis was carried out using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY). Continuous variables were presented as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on data distribution. Categorical variables were expressed as frequencies and percentages. A p-value <0.05 was considered statistically significant. Results A total of 60 patients were randomized into two groups (30 each): HS and SL. The most affected age group was 18-42 years, with a male-to-female ratio of 1.2:1. The mean operative time was significantly shorter in the HS group (28.4 ± 6.2 minutes) compared to the SL group (43.3 ± 7.1 minutes, p<0.05). Postoperative pain scores were lower in the HS group at six, 24, and 48 hours (p<0.05). SSI (6.6% vs. 13.3%), postoperative ileus (6.6% vs. 13.3%), and readmission rates (3.3% vs. 10%) were all lower in the HS group. Hospital stay was also reduced (2.8 ± 1.2 vs. 3.5 ± 1.4 days, p<0.05), and patients returned to normal activities earlier. Conclusions This study demonstrates HS is a safe and effective alternative to suture ligation, offering improved surgical outcomes and faster recovery for appendiceal stump closure during laparoscopic appendectomy. HS significantly reduces operative time, postoperative pain, complication rates, hospital stay, and readmissions, while enhancing recovery and overall patient outcomes.