Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

Abstract

Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.

Hand Assisted versus Intracorporeal Ligation of Appendicular Base During Laparoscopic Appendicectomy

“…Technique for appendicular stump ligation is a controversial topic among surgeons. However, it can be performed safely with extracorporeal knot, intracorporeal clips and hand assisted technique (10) . The current work aimed to compare intracorporeal to extracorporeal hand assisted ligation of the appendicular stump regarding safety and effectiveness.…”

Endoscopic Submucosal Dissection of a Giant Rectal Adenoma Manifesting as McKittrick-Wheelock Syndrome

“…There are undoubtedly cases of locally advanced malignant tumors or mechanical complications, such as intussusception and massive rectal prolapse, where surgery is the only suitable treatment, and careful clinical examination and tumor staging are essential for the identification of such patients [45,46,47]. Very large tumors situated in the upper sigmoid colon might also be suitable for surgery since the position of the endoscope is unstable and the ESD procedure is highly demanding, while laparoscopic sigmoidectomy is associated with low morbidity and very rarely requires an ostomy [48,49]. But apart from those rare cases, we strongly believe that endoscopic resection and particularly ESD should be considered as the treatment of choice for large rectal lesions associated with MKWS.…”

Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review

“…The superiority of one technique over another has not yet been evaluated, and is an area of active research. Data comparing mechanical and ligation techniques showed no significant differences in intra- or postoperative complications between the two groups [ 71 ]. However, the costs of these techniques vary significantly.…”