The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review

Knight, S. R.; Ibrahim, Amel; Makaram, Navnit S; Patil, Pradeep; Wilson, Michael

doi:10.1007/s00068-019-01105-5

Cited by 17 publications

(24 citation statements)

References 21 publications

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“…In the recent meta-analysis by Knight et al including over 700 patients, polymeric clips were found to be the cheapest method (€20.47 average per patient) and had the lowest rate of complications (2.7%) compared to other commonly used closure methods. Meanwhile, operative time and duration of in-patient stay were similar between groups [172].…”

Section: Q47: Does Aspiration Alone Confer Clinical Advantages Overmentioning

confidence: 78%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q47: Does Aspiration Alone Confer Clinical Advantages Overmentioning

confidence: 78%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Our findings are supported by a recent systematic review investigating the use of polymeric clips in stump closure. Knight et al [ 41 ] noted that polymeric clips were the cheapest method (20.47 euros) of stump closure, and also had the lowest rate of complications (2.7%) when compared with other closure methods, with no adverse effect on operative time or duration of in-patient stay.…”

Section: Discussionmentioning

confidence: 99%

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

Makaram

Knight

Ibrahim

et al. 2020

Annals of Medicine and Surgery

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Background Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure. Methods A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies. Results From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure.

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“…10,15,23,24 The handling of polymeric clips is technically easy, resulting in a shallow learning curve and short operation time. 19,25 Unlike comparisons between polymeric clips and endoloops, studies assessing appendiceal stump closure with polymeric clips versus staplers are sparse in the literature. 14,26,27 Only one such randomized controlled trial has been published; this trial included 30 patients treated with polymeric clips and 30 patients treated with staplers.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers

et al. 2019

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Objective: Polymeric (Hem-o-lok) clips represent a novel technique with which to ligate the appendiceal stump following laparoscopic appendectomy. We compared the outcomes of using polymeric clips versus endostaplers for complicated and uncomplicated appendicitis. Methods: Six hundred seventy-three consecutive patients undergoing laparoscopic appendectomy with polymeric clips or endostaplers for acute appendicitis were assessed. The primary outcome was the incidence of intra-abdominal abscesses. Predictors of postoperative intraabdominal abscesses were calculated using univariate and multivariate analyses. Results: Polymeric clips were used in 65% of patients and endostaplers were used in 35%. Hemo-lok clips were not only applied in patients with uncomplicated appendicitis (83%), but also in those with complicated appendicitis (26%). The frequency of intra-abdominal abscesses using polymeric clips and endostaplers was similar in both patients with uncomplicated appendicitis (1% vs. 3%, respectively) and complicated appendicitis (2% vs. 6%, respectively). The univariate and multivariate analyses showed that the stump closure technique was not a risk factor for postoperative abscesses. Conclusions: Closure of the appendiceal stump using the nonabsorbable Hem-o-lok ligation system in patients with both uncomplicated and complicated appendicitis is a safe alternative to the application of endostaplers.

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The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review

Cited by 17 publications

References 21 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

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

Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers

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