Laparoscopic appendectomy using a clip applier

Abstract

The diagnostic worth and therapeutic value of laparoscopic surgery are known for ovarian cysts and ectopic pregnancies. Diagnosis of appendicitis is difficult, and laparoscopy is useful in these cases. The present study was done to assess the feasibility, efficacy, and advantages of a new laparoscopic appendectomy technique. Between August 1, 1989, and July 31, 1990, patients exhibiting right pelvic pain associated with fever were divided into three groups according to the pre-operative diagnosis: appendicitis, pelvic inflammatory disease (PID), and diagnostic doubt between appendicitis and PID. An intra-peritoneal appendectomy was performed if the diagnosis was not PID. Via three suprasymphyseal trocars, the appendix was exposed and the mesoappendix was coagulated. The appendix stump was closed using a clip applier (Ethnor T1300). In all, 20 patients underwent laparoscopic appendectomies. The mean duration of the procedure was 36.5 min; in no case was laparotomy necessary. There were no post-operative complications, and digestive transit returned on the 2nd day post-surgery. Both patients and nurses appreciated the technique. The subjects experienced comfortable post-operative periods and gained aesthetic advantages. The operative procedure could be completed on each attempt. We conclude that this technique is sure, quick, and easily reproducible in young patients presenting with right pelvic pain associated with fever.

Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump

“…Furthermore, lost stapler clips have been shown to cause peritoneal adhesions and may be the cause of small-bowel obstruction, and hence, an ileus [13]. The use of clips to close the appendicular stump was first described by Cristalli et al 1991 who used metal clips [9]. However, this technique has not gained general acceptance.…”

“…In our opinion, this procedure is easier, faster than, and at least as safe as the loop. Furthermore, in contrast to previous studies [7][8][9], we have used only one clip for the closure of the appendicular stump. This has led to the presented prospective trial here, simplifying the closure of the appendicular stump by a single clip.…”

Laparoscopic Appendectomy Using Endoloops: A Prospective, Randomized Clinical Trial

“…After mobilisation of the appendix, the division of the base can be done using a stapler, simple coagulation, or endoloops [1,6]. The use of a stapler is safe and quick, but the costs are much higher than the use of a endoloop.…”

Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?

“…In the early days of LA, the stump was closed with preknotted loops (Roeder loops or endoloops) [1,8,26]. After the introduction of laparoscopic linear staplers, it became ''en vogue'' to apply these in LA, particularly for difficult cases such as perforation at the appendiceal base [4,5,11]. Currently, some authors advise the routine use of linear staplers during LA to avoid leakage from the appendiceal stump [24].…”