Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers

Abstract

Objective: Polymeric (Hem-o-lok) clips represent a novel technique with which to ligate the appendiceal stump following laparoscopic appendectomy. We compared the outcomes of using polymeric clips versus endostaplers for complicated and uncomplicated appendicitis. Methods: Six hundred seventy-three consecutive patients undergoing laparoscopic appendectomy with polymeric clips or endostaplers for acute appendicitis were assessed. The primary outcome was the incidence of intra-abdominal abscesses. Predictors of postoperative intraabdominal abscesses were calculated using univariate and multivariate analyses. Results: Polymeric clips were used in 65% of patients and endostaplers were used in 35%. Hemo-lok clips were not only applied in patients with uncomplicated appendicitis (83%), but also in those with complicated appendicitis (26%). The frequency of intra-abdominal abscesses using polymeric clips and endostaplers was similar in both patients with uncomplicated appendicitis (1% vs. 3%, respectively) and complicated appendicitis (2% vs. 6%, respectively). The univariate and multivariate analyses showed that the stump closure technique was not a risk factor for postoperative abscesses. Conclusions: Closure of the appendiceal stump using the nonabsorbable Hem-o-lok ligation system in patients with both uncomplicated and complicated appendicitis is a safe alternative to the application of endostaplers.

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

“…Still, the cutting injury may lead to a damaging inflammation caused by the rupture of the muscle fibres in the appendix wall; in severe cases, the mucosa can be injured, and the intestinal flora transferred to cause abdominal infection. Studies have shown that the incidence of abdominal infection after laparoscopic appendectomy with a cutting closure device is high; if the appendix stump is double ligated with a ligator device and the distance between the two ligature lines is more than 2 mm, the incidence of postoperative abdominal infection may be increased [ 30 ]. No difference was reported in the incidence of intra-abdominal infection after appendiceal stump ligation with a [ 31 ] ligator (that is, simple silk ligation of the appendiceal stump) compared with a Hem-o-lok clamp alone.…”

Statistics decrypted—a comprehensive review and smartphone-assisted five-step approach for good statistical practice

“…Qualitative variables can be categorized in either two (= binary, e.g., gender: male and female) or more categories (= nominal, where the variables nominate a condition, e.g., blood types). [8] Important to know: It is not allowed to calculate nominal variables; neither if numbers are assigned to nominal variables (e.g., male = 0, female = 1). Ordinal variables are a special subgroup of nominal variables where the groups can be arranged in a logic order.…”

“…In cases of small sample sizes (in a 2 × 2 table, if one of the fields expected value is < 5; in larger tables, if > 20% of the fields have an expected value < 5), a Fishers exact test should be used [8]. The Fishers exact test is less powerful, but it does not require a minimal number of entries for each field.…”

“…Mann Whitney U test is also called the Wilcoxon rank sum test [45] which is used for comparison of non-normally distributed data between two independent groups [8].…”

Evidence according to Cochrane Systematic Reviews on Alterable Risk Factors for Anastomotic Leakage in Colorectal Surgery

“…In 1991, Jacobs et al first described the feasibility of colectomy by video-assisted, endoscopic surgery, without laparotomy [70], which offered reduced postoperative morbidity, faster oral feeding, and shorter hospital stay [71]. Nowadays, laparoscopy is more prevalent and applied to both simple [72][73][74] and complex [75] surgical cases. Although technically more difficult, after a learning curve, laparoscopic resection has shown equivalent operative results to conventional open colectomy [76].…”