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Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy
Mohammed H Al-Temimi1, Mendy A Berglin2, Edwin G Kim1
1Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA, USA; Department of General Surgery, Kaiser Permanente (Fontana) Medical Center, Fontana, CA, USA.
Background:
Our study evaluates the safety and cost of using the Hem-O-Lok (HOL) clip in laparoscopic appendectomy (LA).
Method:
We prospectively compared 30-day postoperative outcomes and cost between HOL clip and endoscopic stapler (ES) in LA at a single institution.
Results:
HOL clip was used in 45 out of 92 LA. Perforated appendicitis (29.8% vs. 11.1%, P = 0.027) and postoperative complications were more common in the ES group (19.2% vs. 2.2%, p = 0.009). In multivariate analysis, HOL clip was associated with lower complications rate (OR = 0.05, 95% CI 0.003-0.744; p = 0.030). In propensity score matched cohort, complications were not different (p > 0.05). In patients with non-perforated appendicitis, HOL use increased operative time by 10 min on average (p = 0.004). Minimum ES cost per single appendectomy was $273.13, while HOL clip cost was $32.14.
Conclusion:
The use of HOL clip in LA is safe and it reduced the costs of the procedure in comparison to the use of ES.
