SP3.1.12 A Comparison of Polymeric Clips vs Endoloops to Secure Appendicular Stump in Adult Emergency Laparoscopic Appendicectomy

Aims To assess the use of polymeric clips (PC) as an alternative to Endoloops (EL) to secure appendicular stump in adult emergency laparoscopic appendicectomy. Method A retrospective analysis of all patients who underwent emergency laparoscopic appendicectomy from 1/11/19 to 31/10/20, following introduction of polymeric clips in our institute as a safe alternative to endoloops to secure appendicular stump in October 2019. Patient demographics, operative duration, intraoperative findings, methods to control the appendicular mesentery and stump, post-operative length of stay, complications and grade of operating surgeon were compared in both groups (PCvsEL) and data analysed using SPSS. Results A total of 333 patients were included, who underwent laparoscopic appendicectomy and satisfied the inclusion criteria. PC were used in 160 (48%) patients and EL in 173 (52%). Patient demographics, surgeon grade and intra-operative severity of disease were statistically similar between both groups. Mean operative time was 10 minutes shorter in PC group (71 vs 81minutes, p = 0.001). Mesoappendix was ligated by applying laparoscopic titanium clips in EL group 25%, vs 6% PC group (p < 0.001), while 42% of the PC group, used PC on mesoappendix, which was without any additional cost. Post-operative complication rates were similar in both groups, apart from post-operative ileus, which was more in EL group (p = 0.003). Conclusion The use of PC in emergency laparoscopic appendicectomy is a safe and effective way to secure the appendicular stump, which results in, not only reduced operating time, but also a significant cost saving (£49/3x Endoloops vs £21/pack of 6x Polymeric clips) to NHS.

Hem-o-lok clips are safe and efficacious for laparoscopic cholecystectomy: Preliminary results of a single center experience

Introduction: The aim of this retrospective study was to compare the outcomes after laparoscopic cholecystectomy using titanium clips or Hem-o-lok polymeric clips to close cystic artery and cystic duct. Methods: A total of 154 patients who underwent laparoscopic cholecystectomy for gallbladder disease from January 2019 to December 2019 at the Department of Surgery of the San Giovanni Addolorata Hospital in Rome (Italy) were studied retrospectively. In 100 patients, titanium clips were used, while Hem-o-lok clips were used in 54 patients. In the two groups, patients' demographic characteristics, laboratory tests and postoperative complications were analyzed. Results: The mean length of hospital stay was shorter in the Hem-o-lok group compared to the titanium clips group (2.0 SD0.7 vs. 3.6 SD5.5, p < 0.05). The overall complication rates for the titanium clips and the Hem-o-lock clips groups were 9% and 0% 7 days after surgery (p < 0.05), 10% and 9.3% 30 days after surgery, 13% and 16.7% 180 days after surgery. There were no statistically significant differences between the two groups in the typology of complications. Conclusion: Based on our results, Hem-o-lock have better postoperative outcomes after laparoscopic cholecystectomy for gallbladder disease in terms of complication rate 7 days after surgery and in terms of mean length of hospital stay. Keywords: laparoscopic cholecystectomy; Hem-O-Lok polymeric clips; titanium clips; biliary leakage; retrospective study.

Usefulness of Vascular Clips in Surgery for Gynecologic Cancer

In gynecological surgery for cervical cancer and endometrial cancer with lymphadenectomy, many lymph vessels are ligated to prevent postoperative lymph leakage and lymphocele, and many blood vessels leading to the pelvic floor are ligated. Therefore, the labors required for ligation are very large. However, no studies have examined ligation methods in gynecologic cancer surgery. Therefore, we retrospectively examined gynecologic cancer patients who had been treated at our hospital by dividing them into a group using absorbent threads and a group using titanium clips. In addition, the surgical procedure was classified into three groups: a group with only pelvic lymphadenectomy, a group with pelvic and para-aortic lymphadenectomy, and a group with radical hysterectomy with pelvic lymphadenectomy. As a result, analysis of all cases clearly showed less complications and less time for surgery in the clip group. Furthermore, the analysis of RH + PLN group showed that surgery time was clearly shorter and less complications tended to occur in the clip group. In conclusion, by using this easily usable device, surgery for gynecologic malignancies will be more comfortable and safer.

Flexible Endoscopic Treatment of Esophageal Diverticulum: A Case Report

BackgroundIn the past, surgical resection was the only treatment available for esophageal diverticulum. Minimally invasive endoscopic treatment of esophageal diverticulum has become more and more popular in recent years. We reported a case of transoral endoscopic resection of esophageal diverticulum and crestectomy, which had a similar effect to surgery and retained the physiological function of the esophagus. It has the advantages of short procedure time, short hospital stay, and good long-term prognosis.Case presentationA 67-year-old gentleman presented with persistent dysphagia and repeated nausea and vomiting for 2 years. Combined with chest CT, barium esophagography and esophagogastroduodenoscopy, the diagnosis was a mid-esophageal diverticulum. After discussion and communication, the patient underwent oral endoscopic esophageal diverticulectomy. During the operation, the weak area of the bottom muscle layer of the diverticulum was completely removed, and the crest of the diverticulum was cut off, and the kiss suture was performed with titanium clips to reduce tension. After the operation, the right pleural effusion occurred and the lung infection was aggravated, and the right pleural drainage tube was placed to relieve the symptoms. An 18*100mm fully covered metal stent was placed under a gastroscope. Place the duodenal nutrition tube and the gastric tube drainage tube for vacuum suction. After a long period of fasting, enteral nutrition support, adequate postoperative drainage treatment and antibiotic treatment eventually l resulted in full recovery without recurrence.ConclusionThe selection of treatment for esophageal diverticulum needs to refer to many factors. For the middle esophageal diverticulum, especially those with large diverticulum sac and small mouth, and those who have indications for surgery, in addition to selective surgery and conventional endoscopic surgery, you can also try endoscopic diverticulectomy and crestectomy.

Over-the-Scope Clip-Associated Endoscopic Muscular Dissection for Seven Cases of Small Gastric Submucosal Tumor: A Video-Based Case Series

Objectives. To evaluate the methodology, feasibility, safety, and efficacy of a novel method called over-the-scope clip- (OTSC-) associated endoscopic muscular dissection for small GSMT. Methods. A pilot study on small GSMT diameter ≤ 1 cm was performed. OTSC-associated endoscopic muscular dissection was based on the requirement of OTSC apparatus and ESD technique; after ligaturing the bottom of small GSMT by OTSC, ESD was performed to resect the tumors, and the wounds of ESD were closed by clips finally. All the patients were followed up for more than 3 months, and the complications during and after OTSC-associated endoscopic muscular dissection were recorded. Results. A total of 7 consecutive patients with small GSMT were included. All tumors were completely dissected without any perforation or infection during and after the procedure in all cases, while three patients had mild abdominal pain, and one experienced postoperative bleeding after the procedure which was treated by the endoscopy with titanium clips. All the patients were followed by endoscopy three months later, all the wounds healed well, and all the OTSCs were still in the gastric wall. Conclusions. OTSC-associated endoscopic muscular dissection as a novel endoscopic interventional therapy should be a convenient, safe, and effective therapy for small GSMT. The short-time outcome is excellent, whereas long-term effect is unclear, and the further follow-up is needed to schedule.

Repair of Incidental Durotomy Using Sutureless Nonpenetrating Clips via Biportal Endoscopic Surgery

Study Design: Technical report. Objectives: Dural tear is one of the most common complications of endoscopic spine surgery. Although endoscopic dural repair of the durotomy area may be difficult, we successfully repaired the dural tear area using nonpenetrating clips during biportal endoscopic surgery. We introduce the surgical technique of dural repair using nonpenetrating titanium clips in biportal endoscopic spine surgery and report its clinical outcome. Methods: We retrospectively reviewed and analyzed 5 patients who were treated via primary dural repair using nonpenetrating titanium clips during biportal endoscopic lumbar surgery. The 2 methods of dural clipping and repair include 2 or 3 portals. We analyzed radiological parameters such as cerebrospinal fluid collection as well as clinical parameters, including postoperative clinical outcomes. Results: Five patients underwent biportal endoscopic dural repair using nonpenetrating clips. Incidental durotomy was successfully repaired using nonpenetrating titanium clips in all 5 patients. No cerebrospinal fluid collection was detected in the postoperative magnetic resonance images. Clinically, preoperative symptoms improved significantly after surgery ( P < .05). Conclusions: We repaired the dural tear area completely using nonpenetrating titanium vascular anastomosis clips in biportal endoscopic lumbar surgery. Dural repair via clipping method may be an effective alternative for incidental durotomy.

Effects and Results of Omentopexy During Laparoscopic Sleeve Gastrectomy on Possible Post Operative Bleeding and/or Leakage

Background In laparoscopic sleeve gastrectomy, patients may experience some post-operative complications as hemorrhage or leakage.We aim by this study to evaluate the benefit of omental fixation with full thickness stitches in decreasing post-operative hemorrhage and leakage, and the mutual effect on the patient and the surgeon. Methods A retrospective analysis of collected data including 200 laparoscopic sleeve gastrectomy (LSG) from September 2016 to September 2018, procedures were divided into two groups, group A of 100 LSG procedures without omental fixation but clipping the whole suture line with titanium clips if any bleeding point present, and group B 100procedures with omental fixation with full thickness stitches till the level of incisura above, and below with titanium clips to control bleeders if present. Results Of group A there were 9 cases of leakage needed intragastric stent and feeding jejunostomy (0.9%), 26 cases of bleeding (2.6%) 15 cases of them needed relaparoscopy and ful lthickness stitches (1.5%) and 11 cases of them managed conservatively with blood transfusion (1.1%), and 3 cases of perigastric localized collection managed by pigtail and antibiotics (0.3%), average operative time was 55 minutes (between 35-75 minutes).Of group B there were 8bleeding cases of drain with less than 300 cc were managed conservatively (0.8%), and 1 case of perigastric localized collection managed conservatively without pigtail (0.1%), No leakage was identified nor hematoma, average operative time 85 minutes (between 50 to 120 minutes). Conclusion The step of omental fixation with full thickness stitches has shown to be effective in decreasing staple line bleeding and leakage although it minimally prolongs the operative time of LSG.