Appendiceal stump closure with hem-o-lok clips in laparoscopic appendectomy

Abstract

Various appendiceal stump closure techniques are used in laparoscopic appendectomy (LA). The purpose of this study was to investigate the safety and usefulness of the Hemolok clip for the closure of appendicular stumps in LA. From January 2015 to October 2018, a total of 87 consecutive patients underwent LA by three surgeons with planned use of Hemolok clips. In 9 (10.3%) patients, hemolok clips could not be used for the closure of the stump. The remaining 78 patients were included for analysis. The demographics, operation time, hospitalization time and complications were recorded. Of these 78 patients, 39 (50%) were male and 39 (50%) were female. The mean age was 28.55 ± 10.61 (18- 73) years and median operation time was 51.3 (30-160) minutes. Twenty-two (28.2%) of the patients had complicated appendicitis (perforated, necrotic). The median time until oral diet allowance was 10.48 (4-36) hours after surgery and median hospitalization time was 22.92 (6-72) hours. Postoperative complications were seen in 4 (5.1%) patients; two had abdominal pain, one had abdominal distention and one had trocar site infection. None of the complications were associated with the use of hemolok clips. None of the patients required reoperation. The appendiceal diameter was found to be greater in patients without hemolok closure compared to patients with hemolok closure (p = 0.003). The closure of the appendix stump with hemolok in LA is an appropriate, safe, fast and cost-effective technique. It is important to note that the appendix stump should not be extremely edematous or necrotic in order to be able to apply hemolok clips. Ideally, the stump should have a diameter smaller than 1 cm.