The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy

Abstract

Purpose: The 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.

Methods: From 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.

Results: A 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.

Conclusion: The 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.

Keywords: Appendicitis; Appendicular stump; Hem-o-lok clip; Laparoscopic appendectomy.

Fig. 1

(A) Position of surgeon and ports. (B) Appendix base of applied double Hem-o-lok clips was transected by harmonic scalpel without third Hem-o-lok clip. (C) Hem-o-lok clip could not be used due to enlarged appendix base. (D) Appendectomy specimen base of same patient was too large in diameter (greater than 10 mm) for safe use of Hem-o-lok clip.

Fig. 2

Histological characteristics of all appendectomy specimens.