Feasibility and Efficacy of Using Hem-o-lok Polymeric Clips in Appendicular Stump Closure in Laparoscopic Appendectomy.

Gigi Varghese

doi:10.7759/cureus.2871

Abstract

Laparoscopic appendectomy is becoming the gold standard for the management of acute appendicitis. Appendicular stump closure is a critical step in this procedure, and several methods have been used to secure the appendicular stump during laparoscopic appendectomy. We highlight the feasibility and efficacy of ‘Hem-o-lok’ polymeric clips in securing the base of the appendix. We selected 20 consecutive patients who underwent laparoscopic appendectomy using a single or double ‘Hem-o-lok’ clip to secure the base of the appendix for acute appendicitis from October 2011 to August 2013. Thirteen study participants were men, and seven were women. There were no instances of clip slippage, obstruction due to adhesion to the clip or postoperative collections. Laparoscopic appendectomy using polymeric ‘Hem-o-lok’ clips to secure the base of the appendix is a feasible and efficacious option.

Highlights

Received 06/05/2018 Review began 06/11/2018 Review ended 06/20/2018 Published 06/23/2018Laparoscopic appendectomy is gradually evolving as the ‘gold standard’ in the treatment of acute appendicitis, especially in the obese, elderly, and in cases where the diagnosis is uncertain [1,2]
The technique for appendiceal stump closure is crucial in laparoscopic appendectomy [4,5,6]
Histopathological examination revealed a diagnosis of acute appendicitis in 16 patients, perforated appendicitis in two patients, necrotizing appendicitis in one patient, and acute appendicitis with lymphoid hyperplasia in one patient

Summary

Introduction

Received 06/05/2018 Review began 06/11/2018 Review ended 06/20/2018 Published 06/23/2018Laparoscopic appendectomy is gradually evolving as the ‘gold standard’ in the treatment of acute appendicitis, especially in the obese, elderly, and in cases where the diagnosis is uncertain [1,2]. Disadvantages like a higher incidence of intra-abdominal collection, longer operating time, and higher costs have been documented These may be dependent on the technique of appendicular stump closure. Numerous methods of stump closure have been used, like intracorporeal suturing of the stump [7], endoloop application, endostapler application [8], LigaSure [9], customized titanium clip application, and, more recently, using nonabsorbable plastic clips [7,10]. Many of these techniques are either time consuming or expensive, or not available universally

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