PurposeThe purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip.MethodsFrom May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed.ResultsA total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group.ConclusionThe use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.

BackgroundTotally implantable access ports (TIAPs) are widely used in pediatric hematology–oncology patients. We investigated the incidence of complications, causes of TIAP removal, and risk factors for infection.ProcedureWe retrospectively analyzed the clinical, demographic, and surgical characteristics in 225 pediatric hematology–oncology patients implanted with 238 TIAPs between January 2004 and December 2005.ResultsExcept for 20 patients lost to follow‐up, the mean maintenance period was 724.8 ± 500.6 days (range: 17–2,124). Mechanical complications occurred in seven patients (2.9%). The causes of TIAP removal were termination of use in 130 patients (59.6%), death from primary disease with TIAP in situ in 35 (14.7%), infection in 35 (14.7%), and obstruction in 4 (1.8%). Early infections occurred in nine patients at mean 37.77 ± 16.44 days (range: 17–56). Late infections occurred in 26 patients at mean 334.5 ± 257.82 days (range: 68–997). Univariate analysis showed that the risk factors of early infection were re‐implantation (P = 0.022) and long operation time (P = 0.045). The risk factors of late infection were ANC <500/mm3 (P = 0.011) and platelet count <50,000/mm3 (P < 0.001). In multivariate analysis, re‐implantation was a significant risk factor of early infection (P = 0.033, OR 4.528) and low platelet count (<50,000/mm3) was the independent risk factor for late infection (P = 0.005, OR 4.24).ConclusionsCorrect procedure and careful use decreases the incidence of early infection and leads to the prevention of re‐implantation. Initial thrombocytopenia was attributable to bone marrow suppression caused by hematologic malignancies or severe infection. Thus, this condition is of value in predicting late infection. Pediatr Blood Cancer 2010;54:546–551. © 2009 Wiley‐Liss, Inc.

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