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Hem-O-Lock Clip to Replace Stapler for Laparoscopic Appendectomy Provides Value-Based Care.

Angel Guan1,2, Aldin Malkoc1,2, Ashley Wang1,2

  • 1Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA, USA.

The American Surgeon
|April 15, 2026
PubMed
Summary

Hem-O-Lok clips (HOL) offer a cost-effective alternative to endoscopic staplers for laparoscopic appendectomy (LA). This study found no significant difference in patient outcomes or complications, supporting HOL clips for stump closure in LA.

Keywords:
Hem-O-lock clipacute appendicitis

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Area of Science:

  • Surgical Innovation
  • Cost-Effectiveness in Healthcare

Background:

  • Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis.
  • Stump closure methods, such as Hem-O-Lok clips (HOL) and endoscopic staplers (ES), vary in cost.
  • Evaluating cost-saving strategies without compromising patient outcomes is crucial in healthcare.

Purpose of the Study:

  • To compare the cost-effectiveness of Hem-O-Lok clips (HOL) versus endoscopic staplers (ES) for stump closure during laparoscopic appendectomy (LA).
  • To evaluate if HOL clips can provide cost savings without negatively impacting patient outcomes.

Main Methods:

  • Retrospective case-control study of 571 patients undergoing LA from 2016-2022.
  • Patients were divided into groups based on stump closure: HOL clips (n=341) or ES (n=230).
  • Propensity score matching (1:1) created 177 pairs, controlling for age, sex, BMI, and ASA classification.
  • Outcomes assessed included 30-day complications, length of stay, estimated blood loss (EBL), and readmission rates.

Main Results:

  • The HOL group had patients who were older, had more comorbidities, higher BMI, and higher ASA classifications.
  • Despite demographic and comorbidity differences, no increased post-operative complication rates were observed between HOL and ES groups.
  • Return to hospital rates were similar: 5.3% for HOL vs. 7.9% for ES.
  • Cost analysis revealed HOL clips ($32 for a six-pack) are significantly cheaper than ES ($273 per load).

Conclusions:

  • Hem-O-Lok clips are a safe and effective alternative for stump closure in laparoscopic appendectomy.
  • Utilizing HOL clips demonstrates no increase in patient morbidity compared to endoscopic staplers.
  • HOL clips represent a substantial cost-saving opportunity for healthcare systems performing LA.