To systematically evaluate the effects of direct clamping and suture embedding in laparoscopic appendectomy, and to provide evidence-based reference for clinical treatment.

Pubmed, Embase, Web of Science, Clinical Trail, Cochrane Library, CBM, WanFang, CNKI and VIP databases were searched, the retrieval period was from the establishment of the database to January 2020. Relevant randomized controlled trials (RCT) of laparoscopic appendectomy using stump clipping and suture embedding were collected, and Meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria.

A total of 1 739 patients in 14 RCTs were included. There was no significant difference in the recovery time of gastrointestinal function between the two methods (MD=-0.61, 95% CI: -1.93 to 0.70, P=0.36). However, compared with the suture embedding method, the direct clamping method had the advantages of shorter operation time (MD=-14.81, 95% CI:-17.20 to -12.43, P<0.001), less intraoperative bleeding (MD=-3.54, 95% CI: -4.79 to -2.29, P<0.001), shorter total hospital stay (MD=-0.38, 95% CI: -0.68 to -0.09, P=0.01) and postoperative hospital stay (MD=-0.20, 95% CI: -0.38 to -0.03, P=0.02), and less postoperative complications (RR=0.70, 95% CI: 0.50 to 0.98, P<0.05). Suture embedding method had the advantages of reducing hospital costs (MD=2.84, 95% CI: 1.56 to 4.12, P<0.001).

There are respective advantages in clipping the appendix stump and suturing the embedded stump during laparoscopic appendectomy. For patients with good condition of appendix stump, direct clipping can be the first choice. The choice of treatment plan and final decision should be based on the comprehensive consideration of the internal and external factors.