Comparison between Endoloop ligature and Hem-o-lok clip (Polymer ligation) for appendiceal stump closure during laparoscopic appendicectomy

Objective: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. Many studies show that the use of costly high tech instruments such as Endo-loops, Endo-GIA for transaction and closure of the appendiceal stump lowers the risk of infection. The Aim of this study was to evaluate the use of clips for closure of appendix stump as a safe and cost-effective method. Study Design: Descriptive Study. Period: Oct 2009 to Jun 2010. Setting: Shalamar Hospital, Lahore. Materials and Methods: Over a period of 9 months 36 patients were selected to have laparoscopic appendicectomy. All patients had stump closure by clips as used for cystic duct and cystic artery in laparoscopic cholecystectomy. No patient had Endo-loop or Endo-GIA for closure of stump. All patients had follow-up at one week and six weeks after discharge from hospital. Results: There was no clinical evidence of surgical site infection or leak from appendicular stump by this method. There was no discomfort in handling this instrument both for surgeon and scrub nurse. The price of the clips used was 4.30 Euros as compared to 112.00 and 232.77 Euros for the Endo-loops and Endo-GIA respectively. Conclusions: This study shows that clips can be used for stump closure without any additional risk to patient. It is also cost- effective. So appendiceal stump closure using clips is very convenient, an easy, safe, and cost-effective procedure.

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Appendiceal stump closure in children using polymeric clips is a reliable alternative to endoloops

Minerva Surgery ◽

10.23736/s0026-4733.20.08313-3 ◽

2020 ◽

Vol 75 (4) ◽

Author(s):

Raphael N. Vuille-Dit-Bille ◽

Ralph F. Staerkle ◽

Sarkis C. Derderian ◽

Lindel C. Dewberry ◽

Stefan Breitenstein ◽

...

Keyword(s):

Stump Closure ◽

Appendiceal Stump ◽

Appendiceal Stump Closure

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Technical modifications of appendiceal transection during laparoscopic appendectomy

10.33699/pis.2020.99.12.534-538 ◽

2020 ◽

Vol 99 (12) ◽

Keyword(s):

Postoperative Complications ◽

Laparoscopic Appendectomy ◽

Postoperative Morbidity ◽

Operative Time ◽

Length Of Hospital Stay ◽

Surgical Site Infections ◽

Stump Closure ◽

Technical Modifications ◽

Appendiceal Stump ◽

Appendiceal Stump Closure

Introduction: Appendiceal transection is the most critical part of laparoscopic appendectomy (LAPPE). The aim of our study was to evaluate postoperative and economic outcomes of laparoscopic appendectomy with different technical modifications of transection of the appendix. Methods: This was a prospective, randomized, unicenter clinical study comparing different techniques of appendiceal transection in patients with acute appendicitis during the study period (18 months). The patients were randomized to one of three arms – endoloop, hem-o-lok clips and the stapler. Results: In total, 120 patients were enrolled in the study. The shortest operative time was noted in the hem-o-lok arm (37.3 minutes); mean length of hospital stay (3.7 days) was comparable in all study arms. Postoperative morbidity was 6.6%; all recorded complications were SSIs (Surgical Site Infections). The number of postoperative complications was comparable in all study arms. Mean direct costs of laparoscopic appendectomy were lowest in the hem-o-lok arm. According to our findings, LAPPE is not a profit making surgery irrespective of the type of appendiceal transection (mean profit in the study patients was CZK -4019). Conclusion: The rate of postoperative complications was similar for all the technical modifications of appendiceal stump closure. As indicated by the study outcomes, hem-o-lok clips have the potential of becoming the method of choice in securing the appendix base during LAPPE.

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Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses

Langenbeck s Archives of Surgery ◽

10.1007/s00423-016-1459-3 ◽

2016 ◽

Vol 401 (5) ◽

pp. 661-666 ◽

Cited By ~ 7

Author(s):

Christopher Soll ◽

Paloma Wyss ◽

Hans Gelpke ◽

Dimitri Aristotle Raptis ◽

Stefan Breitenstein

Keyword(s):

Abdominal Abscesses ◽

Stump Closure ◽

Appendiceal Stump ◽

Appendiceal Stump Closure

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Cost Effectiveness of Different Methods of Appendiceal Stump Closure during Laparoscopic Appendectomy

The American Surgeon ◽

10.1177/000313481808400847 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1329-1332 ◽

Cited By ~ 4

Author(s):

Samuel Kim ◽

Leonard Weireter

Keyword(s):

Laparoscopic Appendectomy ◽

Care Center ◽

Tertiary Care ◽

Complication Rates ◽

Price Difference ◽

Procedure Time ◽

Stump Closure ◽

Appendiceal Stump ◽

Appendiceal Stump Closure ◽

Room Time

There is no standard method for closure of an appendiceal stump during laparoscopic appendectomy. This study compares stump closure using a stapler with closure using an Endoloop ligature. The charts of all patients who underwent laparoscopic appendectomy at a single tertiary care center over a two-year period were reviewed for demographics, comobidities, operative details and costs, and outcomes. There were 325 patients who underwent a laparoscopic appendectomy. The majority, 250 (77%), underwent stump closure with a stapler. They were equivalent in demographics and postoperative complication rates. Cases using an Endoloop were slightly faster in terms of procedure time and room time, and less expensive in terms of operative supply cost. The price difference is not explained by time saved in the operating room and more likely by the equipment price.

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