Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump

Abstract

Background: The aim of this study was to evaluate the feasibility, morbidity, and cost-effectiveness of the closure of the appendicular stump with a single non-absorbable polymeric clip compared with the closure of the appendicular stump with a stapler.

Methods: From January 2009 to December 2009, 82 patients, 31 males and 51 females (mean age of 35.4 years; range of 17 to 79 years), were included in this prospective, non-randomized trial. In 56 patients, the appendicular stump was closed by staplers, and in 26 patients, a single Hem-o-lok MLX polymeric clip was applied. The data collected included age, sex, time of surgery, costs, time of hospitalization, day-time of surgery, complications, and preoperative white blood count (WBC) and c-reactive protein (CRP).

Results: There were no differences between the two groups regarding age, sex, WBC, CRP, and time of hospitalization. Time of surgery was longer in the clip group due to the introductory phase. Morbidity did not differ significantly and was highly acceptable in both groups. The costs of one set of Hem-o-lock clips were negligible compared to staplers (19.94 euros versus 356.43 euros).

Conclusions: The use of a single non-absorbable polymeric clip is easy to use even for surgical trainees; it is safe and cost-effective. We suggest the use of a single clip for the closure of the appendicular stump as the standard procedure in laparoscopic appendectomy whenever possible.