Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis

Abstract

BackgroundClosure of appendicular stump has been performed in different ways; however, the use of the metal endoclip in complicated grades of acute appendicitis, has not been evaluated yet in a prospective way.ObjectiveTo establish the effectiveness of appendiceal stump closure by metal endoclip for complicated appendicitis.MethodFrom January 2009 to January 2011 were evaluated 131 consecutive patients who underwent a laparoscopic appendectomy for complicated acute appendicitis. From those, 118 underwent appendiceal stump closure by metal endoclip. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 52.7% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix, which may lead to abscess formation and degrees of peritonitis. The outcomes viability, operative time, infection complication, operative complications, and conversion rate were chosen to evaluate the procedure.ResultsThe appendiceal stump closure by metal endoclip was used in 90% of cases. The presence of appendix base necrosis was the most important factor involved in failure of the procedure. Laparoscopic knot (1.5%), laparoscopic endo-suture (3.8%) and video assisted laparotomy (4.7%) were the alternatives used in difficult cases. The mean operative time was (67.54 ± 28.13 minutes). The wound and intra-abdominal infection rates were 2.54% and 5.08%, respectively. There were no operative complications and the conversion rate was 0.85%.ConclusionThe appendiceal stump closure by metal endoclip, in complicated grades of acute appendicitis, is a safe and effective procedure. In patients with appendix base necrosis it should be avoided in favor of other alternatives.

Use of Polymeric Clip (Hem-O-Lock) for Appendiceal Stump Ligation as a Favorable Technique in Laparoscopic Appendectomy

“…In our study, our mean operation time was 59.6 ± 11.8 minutes that was near to other studies that used metallic clips, endostapler and endoloop (5,14).…”

“…In our academic hospital, most of appendectomies are performed by residents in open technique, and only few cases are operated by MIS fellows in laparoscopic technique. The stump closure may be most important and more difficult step in LA (14,16,17,27).…”

“…Polymeric clip is a safe, available, cost-effective and easy to apply instrument for ligation of appendiceal stump and can decrease the operating time, but it is not suitable for gangrenous or wide appendiceal stump > 10 mm, because the maximum of its XL size is 9.4 mm (4,10,14,22,27). There is no difference in safety, between one or two clips application for stump closure (10).…”

“…There are some methods for appendiceal stump closure, that all are safe, such as metallic clips (1,6,11,14,16,18,20,22), polymeric clips (Hem-o-lock) (4,8,10,14,18,22,23), endo loop (2,5,7,13,14,(16)(17)(18)(19)(21)(22)(23)(24)(25), endo stapler (5,8,11,13,(19)(20)(21)(22)24), intra corporeal knot (3,7,11,20,22) and bipolar and vessel sealing devices (15,22,26).…”

“…The most important stage of LA, maybe is stump closure, because, incomplete ligation may lead to serious complications such as intraabdominal infections, colonic fistula, postoperative peritonitis and even sepsis (13)(14)(15)(16)(17).…”