Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Soll, Christopher; Wyss, Paloma; Gelpke, Hans; Raptis, Dimitri Aristotle; Breitenstein, Stefan

doi:10.1007/s00423-016-1459-3

Cited by 25 publications

(23 citation statements)

References 38 publications

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“…Of those, 1082 records were excluded after screening for inappropriate article type; only randomized control trials and review articles were included, and those reporting key outcomes; 675 full text articles were then assessed for eligibility and 598 were excluded due to data being either inadequate for data interpretation, relating to interval appendectomy or duplication of studies. 77 were found to meet the inclusion criteria, and 45 of these were included for analysis after applying the MINORS score cut off . The modified PRISMA flowchart for identification and inclusion of relevant papers is included as Appendix S1.…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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Background Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta‐analysis of readmission post‐appendectomy has not been published. This meta‐analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. Methods An ethically approved PROSPERO‐registered (ID CRD42017069040) meta‐analysis following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non‐comparative studies, using Methodological Index for Non‐Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random‐effects, Mantel–Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. Results A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0–14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63–2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43–5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08–1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. Conclusion This meta‐analysis identified that readmission is not uncommon post‐appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high‐risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.

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Section: Resultsmentioning

confidence: 99%

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Bailey

Choynowski

Kabir

et al. 2019

ANZ Journal of Surgery

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show abstract

“…The etiology of this complication remains unclear. On the one hand, some authors speculate that the occurrence of postoperative IAA might be influenced by several factors, such as advanced appendicular disease, appendicular perforation, the type of technique used for the removal of the appendix and the lack of an adequate perioperative antibiotics' regimen [4]. On the other hand, there are suggestions that a large-volume intraoperative peritoneal lavage might increase the rate of postappendectomy IAA [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients

et al. 2020

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“…Many studies have been conducted in order to evaluate the efficiency of polymer clips in minimally invasive surgery. Some studies have shown that it is possible to apply a double HOL to secure the base of the appendix during a laparoscopic appendectomy (5)(6)(7)(8), and many others have compared its effectiveness with LL and/or a stapler device in adults (9,10).…”

Section: Discussionmentioning

confidence: 99%

Use of hem-o-lok clips for laparoscopic appendectomy in children: retrospective analysis and comparison to ligature loop and endoscopic surgical stapler

Fuentes¹,

Pérez²,

Díez³

et al. 2021

Transl Gastroenterol Hepatol

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Background: There are multiple techniques used for laparoscopic appendectomy (LA): ligature loop (LL), surgical stapler (SS) (Endopath Ets-Flex-Endoscopic Articulating Linear Cutter 33 mm Standard Ref Atb 35. Ethicon, Somerville, New Jersey, US), and hem-o-lok clips (HOL) (Weck Closure System. Triangle Park, NC, USA). The application of the LL usually demands dexterity and training, whilst using HOL may be more advantageous due to its simplicity in terms of application and its low cost in contrast with the SS.The objective of this study is to determine safety and efficacy of the different devices that can be used in the surgical procedure.Methods: From June 2016 to December 2019, 253 consecutive children aged to 1 to 18 years were retrospectively reviewed. They were divided into three groups depending on the device used to secure the appendix: (I) in the first group, the base of the appendix was secured by double LL, (II) in the second group the base of the appendix was secured with SS, and (III) in the third group the base of the appendix was secured with two non-absorbable HOL. The data collected includes age, gender, operative time, device used to ligate the base of the appendix, previous tests (blood analysis, imaging), antibiotic prophylaxis administered, length of hospital stay, intraoperative and postoperative complications, shoulder pain and histological study of the specimen.Results: There were 253 patients that underwent laparoscopic appendectomy during the study time, with a mean age of 10.3±4.1 in the LL group, 9.4±2.7 in the SS group and 10.4±3.3 in the HOL group, P=0.165. Distribution by gender was 77.8% for males in the LL group, 65.2% in the SS group and 61.3% in the HOL group, P=0.559. The mean surgical time with IQR in brackets was 60.0 (10.0) minutes (min), in the first group in which the base of the appendix was secured with LL, in the second group in which the base of the appendix was secured with SS 60.0 (15.0) min and finally in the third in which the base of the appendix was secured with HOL 40.0 (30.0) min, P<0.001. HOL clips have a significantly lower cost than their analogues. Specifically, 5 HOL clips have a cost of EUR 26.75, while three LL have a cost of EUR 53.70 and a single SS has a cost of EUR 276.58. Postoperative complications were found in 14.3% of the LL group, 9.8% in the SS group and 4.6% in the HOL group, P=0.137. Efficacy and safety in controlling the base of appendix were the same in all groups.Conclusions: The HOL are safe and reduce surgical costs during laparoscopic appendectomy in children.

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Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Abstract: Closure of the appendiceal stump using the non-absorbable hem-o-lok ligation system did result in a reduced rate of intra-abdominal surgical abscesses as compared to the application of endoloops.

Cited by 25 publications

References 38 publications

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Meta‐analysis of unplanned readmission to hospital post‐appendectomy: an opportunity for a new benchmark

Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients

Use of hem-o-lok clips for laparoscopic appendectomy in children: retrospective analysis and comparison to ligature loop and endoscopic surgical stapler

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