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

Lars Ivo Partecke1, Wolfram Kessler, Wolfram von Bernstorff

  • 1Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital, Ernst-Moritz-Arndt-University, Greifswald, Germany. partecke@uni-greifswald.de

Langenbeck'S Archives of Surgery
|June 26, 2010
PubMed
Summary

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A single non-absorbable polymeric clip offers a safe and cost-effective method for closing the appendicular stump during laparoscopic appendectomy. This method is comparable to staplers in terms of morbidity and hospitalization time.

Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Cost-Effectiveness Analysis

Background:

  • Appendiceal stump closure is a critical step in appendectomy.
  • Traditional methods involve staplers, which can be costly.
  • Evaluating alternative, cost-effective methods is essential.

Purpose of the Study:

  • To compare the feasibility, morbidity, and cost-effectiveness of using a single non-absorbable polymeric clip versus a stapler for appendiceal stump closure.
  • To assess the safety and ease of use of the polymeric clip in laparoscopic appendectomy.

Main Methods:

  • Prospective, non-randomized trial involving 82 patients.
  • Appendiceal stump closure performed using either staplers (56 patients) or a single Hem-o-lok MLX polymeric clip (26 patients).

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  • Data collected included surgical time, costs, hospitalization, complications, and inflammatory markers (WBC, CRP).

    • Main Results:

    • No significant differences in age, sex, WBC, CRP, or hospitalization time between groups.
    • Surgical time was initially longer with the clip due to the learning curve.
    • Morbidity was comparable and acceptable in both groups; clip costs were significantly lower than staplers (€19.94 vs. €356.43).

    Conclusions:

    • The single non-absorbable polymeric clip is a safe, easy-to-use, and highly cost-effective alternative for appendiceal stump closure.
    • It is suitable for surgical trainees and recommended as a standard procedure in laparoscopic appendectomy.
    • This method presents a significant cost saving compared to stapler use.