Feasibility and Efficacy of Using Hem-o-lok Polymeric Clips in Appendicular Stump Closure in Laparoscopic Appendectomy

Abstract

Laparoscopic appendectomy is becoming the gold standard for the management of acute appendicitis. Appendicular stump closure is a critical step in this procedure, and several methods have been used to secure the appendicular stump during laparoscopic appendectomy. We highlight the feasibility and efficacy of ‘Hem-o-lok’ polymeric clips in securing the base of the appendix. We selected 20 consecutive patients who underwent laparoscopic appendectomy using a single or double ‘Hem-o-lok’ clip to secure the base of the appendix for acute appendicitis from October 2011 to August 2013. Thirteen study participants were men, and seven were women. There were no instances of clip slippage, obstruction due to adhesion to the clip or postoperative collections. Laparoscopic appendectomy using polymeric ‘Hem-o-lok’ clips to secure the base of the appendix is a feasible and efficacious option.

Comparison of three techniques for appendiceal stump closure during laparoscopy

“…Safe closure of the appendix stump is important to prevent potential postoperative complications (such as postoperative peritonitis, sepsis, and fistulas) and reoperation. Numerous studies have been carried out on techniques such as the endoloop, endostapler, metal clips, and Hem-o-lok clips, and intracorporeal knot for the closure of the appendix stump [3][4][5][6][7][8][9][10][11][12][13]. However, there is still no consensus on the ideal technique.…”

“…Recently, the use of simple non-absorbable clips, such as the Hem-o-lok clip, has become widespread for the closure of the appendix stump. The advantages of these clips are effortless application, low cost, and robust and safe stump closure [10][11][12][13][14][15]. In a clinical study, Delibegovic et al stated that the method is effective and safe for closure of the appendix stump.…”

“…The stump closure techniques affect the operation times. While devices such as the Hem-o-lok clip, metal clip, and endostapler can be applied easily [6][7][8][9][10][11][12][13]27], techniques such as the intracorporeal knot, endoloop, and LPS techniques require surgical skills and experience [3][4][5]. A Cochrane review published in 2017 compared the results of endostapler and ligation methods (endoloop and intracorporeal knot) and found that the endostapler technique significantly reduced the operation time [28].…”

“…It is also cheaper than an endostapler. Polymeric clips have found a wider range of application in daily practice [7,10,[12][13][14]. With the widespread use of titanium endoclips in surgery, endoscopic procedures have been made easier, and operation times have significantly shortened.…”

Risk-Benefit Comparison Between Endoloop and Endostapler Devices for the Closure of Appendiceal Stumps in Laparoscopic Appendectomy

“…Over time, various methods have been developed for the closure of the appendicular residual limb, and some factors that influence the selection of a closure method are the ease of application, the severity of the swelling of the residual limb, and the cost and availability of the method [5]. Some of the methods for closure of the appendicular residual limb are endostapler devices, endoloop, hem-o-locks, metal clips, bipolar coagulation, polymeric clips, and intracorporeal sutures [6][7].…”