Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy

Abstract

Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. Results A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postoperative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

“…Other studies have highlighted the cost-effectiveness of EL [ 34 , 36 ]. In the included studies cost reporting was inconsistent, with some studies quoting cost per loop [ 21 , 23 , 24 ], rather than total operative cost. Some studies failed to report cost [ 17 , 18 ].…”

“…Eleven studies assessed the effectiveness of endoloops in securing the appendiceal stump, totaling 4894 patients ( Table 1 ) [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. The majority of studies collected data prospectively, with five retrospective in nature [ 17 , [22] , [23] , [24] , [25] ]. The overall mean patient age was 30 years.…”

“…Thirteen studies assessed closure of the appendiceal stump using endoclips, totaling 1091 patients ( Table 1 ) [ [20] , [21] , [22] , [23] , [24] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Of these, three were randomized controlled trials, four were prospective observational studies, and six were retrospective studies.…”

“…Hanssen et al [ 26 ] estimated cost per operation at €192.82, however this cost was substantially reduced in other studies [ 20 , 21 , 30 ]. Lucchi et al [ 23 ], Wilson et al [ 24 ] and Al-Temini et al [ 32 ] all estimated costs per pack. The average cost per clip across studies was €29.73 and €33.40 per pack.…”

Hand-made Extracorporeal Knotting versus Hem-o-Lok Clip for Stump Closure in Laparoscopic Appendectomy

“…21 Wilson et al found hemo-lok clips to be safe as endoloop with the advantages of low cost and less operation time. 22 However, there are cheaper endoloops that costs between $15-32 and equal to hem-o-lok clip cost. 6 Mayir et al described hand-made loop for stump closure which is an effective, safe and cheap (only $1) method.…”