The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy

Abstract

PurposeThe purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip.MethodsFrom May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed.ResultsA total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group.ConclusionThe use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.

Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

“…In 1999, the hem-o-lok system was introduced to the market of endoscopic surgery with the intention of occlusion of vessels. More recently, hem-o-lok clips have been used as an alternative for securing the base of the appendix during a laparoscopic appendectomy procedure [7,8,15,31]. Since studies on endoloops demonstrate a relatively high rate of intra-abdominal abscesses (up to 5 %) [6], comparative trials using hem-o-lok clips are missing.…”

“…Plastic clips, the hem-o-lok ligation system, have become more and more popular for the laparoscopic closure of the appendiceal stump [7][8][9][10][11][12][13][14][15]. Originally, these polymer clips were developed for the endoscopic ligation of vessels.…”

Methods for closure of appendix stump during laparoscopic appendectomy procedure

“…The downside of clip use is its not being safe in case of intense inflammation where the diameter of appendix base is wide. Although it is reported that clips may be used up to a 16 mm diameter, the reliability is decreased in cases where the appendix base diameter is over 1 cm (6,20,21).…”

The Safety And Efficacy Of Different Methods Used For The Closure Of The Appendiceal Stump (CAS) İn Laparoscopic Appendectomy

“…[7,18,22,24] There are no Hem-olok clip failures in the literature, when the Federal Drug Administration's (FDA) databases are searched. [25] Also the recent studies cunducted that compared; the metal clips, hem-o-lok clips and endoloop ligatures demonstrated similar surgically related complication rates suggesting all of them as safe, feasible and cost-effective techniques for the CAS. [26,27] Inflamed appendix may be thick in size and the cecum may be fragile at the stump thus diameters above 10 mm may not be apropriate to use a metal or polymer clips for CAS.…”