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

Abstract

Abstract 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.