Safety and Efficacy of Polymeric Clips for Appendiceal Stump Closure

Abstract

Background and Objectives:Laparoscopic appendectomy remains one of the most common emergency general surgical procedures in the United States. In an era of increasing focus on costs in medical care, we sought to evaluate the use of polymeric clips to secure the appendiceal base during laparoscopic appendectomy.Methods:We performed a prospective cohort study of patients undergoing laparoscopic appendectomy from April 2013 through September 2014 at a single academic teaching institution. Polymeric clips were used to secure the appendiceal stump. Tissue dissection techniques and control of the mesoappendix were the operating surgeon's choice. Clinical outcomes are reported.Results:A total of 25 patients (56% women; mean age, 41 y; body mass index of 29 kg/m2) were enrolled in our study and underwent laparoscopic appendectomy with polymeric clips. One patient was unable to have polymeric clips placed due to inflammation of the appendiceal base. There were no major perioperative complications. One patient developed a suture abscess in the umbilical incision, and another had prolonged ileus with computed tomography demonstrating persistent pelvic fluid that did not require intervention. Median length of stay was 1 d and mean length of follow-up was 81 d. The use of polymeric clips contributed ∼ $32 to the overall operative cost.Conclusions:Polymeric clips are a safe alternative for securing the appendiceal base in laparoscopic appendectomy. They offer significant cost savings without any evidence of increased complications.

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

“…pendicitis that gangrene doesn't involve it's base or cecum, that confirm other similar studies that use of polymeric clips for stump closure has been safe and time saving (4,14,18,22,23). There is no difference in polymeric clips safety and complications in comparison with other techniques such as endo stapler, endo loop or suture knot (4,7,10,14,18,22).…”

“…Laparoscopic appendectomy (LA) was done by Semm in 1983 for the first time and nowadays, it is the choice and maybe the gold standard procedure in the presence of an experienced surgeon (2-6) LA especially is preferred in female, obese and old patients (2)(3)(4)(5)(6)(7).…”

“…The ideal method must be safe, economic, accessible, easily operated and often is selected based on the surgeon's experience and appendiceal stump situation during laparoscopy, such as its diameter and degree of its base inflammation (4,18,(20)(21)(22).…”

“…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).…”

“…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).…”