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Kumar A, Mustafa MS, Shafique MA, Haseeb A, Rangwala HS, Kumar H, Rangwala BS, Raja A, Raja S, Ali SMS. Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis. Surgery 2024:S0039-6060(24)00493-8. [PMID: 39181723 DOI: 10.1016/j.surg.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Appendicitis is a common surgical emergency with diverse clinical presentations, making its diagnosis challenging. Laparoscopic appendectomy has become the standard treatment, with various methods for appendiceal stump closure, including polymeric clips and endoloops. This study aims to compare the efficacy and safety of polymeric clips compared with endoloops in laparoscopic appendectomy. METHODS A systematic review and meta-analysis were conducted followingPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Scopus, and Embase were searched for studies up to March 25, 2024. RESULTS In total, 13 studies, including 6 randomized controlled trials, were analyzed. Polymeric clipping demonstrated significantly shorter surgical time compared with the endoloop (standardized mean difference 0.37, 95% confidence interval 0.22-0.53, P < .00001), with no difference in hospital stay or overall complications. However, the endoloop was associated with a greater incidence of intra-abdominal abscess (risk ratio 3.53, 95% confidence interval 1.56-8.00, P = .003). Other outcomes, including time from instrument application to appendiceal cutting, ileus, and surgical-site infection, showed no significant differences between the 2 techniques. CONCLUSION Polymeric clipping appears to be superior to endoloop in terms of shorter surgical time and lower risk of intra-abdominal abscess formation in laparoscopic appendectomy for uncomplicated appendicitis. However, both techniques have similar outcomes regarding hospital stay and overall complications. Further research addressing study limitations and exploring patient-centered outcomes is warranted to guide clinical practice.
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Affiliation(s)
- Aashish Kumar
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | | | | | - Abdul Haseeb
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Haimath Kumar
- Department of Surgery, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Adarsh Raja
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Sandesh Raja
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
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2
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Aday U, Çetin E, Kafadar MT, Oğuz A, Bahadır MV, Ülger BV, Gedik E, Girgin S, Yılmaz M. Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial. Langenbecks Arch Surg 2024; 409:89. [PMID: 38457041 PMCID: PMC10924000 DOI: 10.1007/s00423-024-03281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. METHODS This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. RESULTS One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1-10) in the single hem-o-lok group and 1 day (range 1-12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. CONCLUSIONS The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 ( http://www. CLINICALTRIALS gov ).
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Affiliation(s)
- Ulaş Aday
- Department of Gastroenterologycal Surgery, Dicle University School of Medicine, 21280, Sur/Diyarbakır, Turkey.
| | - Erman Çetin
- Department of General Surgery, Batman Regional Hospital, Batman, Turkey
| | - Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Ercan Gedik
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Yılmaz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Poon SHT, Law SY, Lai ATY. Clips closure versus endoloop ligation in laparoscopic appendectomy: a systematic review and meta-analysis of comparative studies. Ann Med Surg (Lond) 2023; 85:5011-5021. [PMID: 37811063 PMCID: PMC10553101 DOI: 10.1097/ms9.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Appendiceal stump closure (ASC) is a key step in performing laparoscopic appendicectomy. Currently, there is no gold standard method to achieve this goal. The ideal method should be safe, easily available, and have a short learning curve. Out of all those appendiceal stump closure methods, the use of hem-o-Lok demonstrates its feasibility in replacing the traditionally used endoloop. In this systematic review and meta-analysis, the authors aim to review the currently available evidence addressing the topic of interest. Method The PubMed and Embase databases were searched with the paired search terms appendicitis, clip, and endoloop by two authors separately. The quality of the randomized controlled trials was assessed with the Cochrane risk of bias tool, and the quality of the observational studies was assessed with the Newcastle-Ottawa scale. Meta-analysis was conducted with Cochrane Review Manager version 5.4. Result Eighteen studies were included for quantitative analysis. The appendiceal stump closure time was shortened by 2 min 7 s using a hem-o-lok with 95% CI 1 min 48 s-2 min 26 s, p less than 0.00001. The pooled results of 6 randomized controlled trials demonstrated a statistically significant reduction in operative time of 5.15 min from adopting the hem-o-lok approach (p=0.001, 95% CI -2.05 to -8.24 min). Both endoloop and hem-o-lok demonstrated a comparable postoperative hospital stay and infective complication profile. Conclusion The application of Hem-o-Lok demonstrates a comparable to endoloop ligation in terms of operative time and a potential benefit on the complication. When considering financial and technical aspects, it serves as an alternative to endoloop.
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Affiliation(s)
- Samuel Ho Ting Poon
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
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Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy. Medicina (B Aires) 2023; 59:medicina59030533. [PMID: 36984534 PMCID: PMC10059700 DOI: 10.3390/medicina59030533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.
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Hsu KF, Feng TY, Wang SC, Liao GS, Chen TW, Chan DC. A comparison of absorbable polymetric clips and metallic clips in laparoscopic appendectomy. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/jmedsci.jmedsci_372_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Bekki T, Abe T, Namba Y, Okimoto S, Mukai S, Saito Y, Oishi K, Fujisaki S, Ohdan H, Fukuda T. Validation of appendiceal stump invagination in laparoscopic appendectomy. Asian J Endosc Surg 2022; 16:203-209. [PMID: 36300645 DOI: 10.1111/ases.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are various methods for appendiceal stump dissection, but the necessity for stump invagination remains unclear. This study aimed to assess the efficacy of appendiceal stump invagination in patients with acute appendicitis after laparoscopic appendectomy (LA). METHODS We enrolled 327 patients with acute appendicitis who underwent LA between 2012 and 2020. Perioperative variables and surgical outcomes were analyzed between the invagination of the appendiceal stump and noninvagination groups. Propensity score-matched analysis (PSM) was performed. RESULTS More patients experienced severe inflammation and severe intra-abdominal contamination in the noninvagination group than in the invagination group. Patients in the noninvagination group had an older age, higher body mass index, and poorer American Society of Anesthesiologists physical status than the invagination group. Severe inflammation in the noninvagination group was associated with longer hospital stays and poorer postoperative complications than in the invagination group. PSM analysis was performed to minimize bias in the two groups. After PSM analysis, there were no significant differences in surgical site infection, postoperative intra-abdominal abscess, Clavien-Dindo class ≥IIIa, or postoperative stay between the two groups. During the follow-up period, the postoperative adhesive ileus was not significantly different between the invagination and noninvagination groups. CONCLUSION Invagination of the appendiceal stump during LA is not necessary to prevent short- and long-term complications. Even in cases dissected using a laparoscopic endostapler, the appendiceal stump per se is not related to postoperative adhesive ileus.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Tomoyuki Abe
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Hiroshima, Japan
| | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Kim S, Jeon BH, Cho SS, Shin US, Moon SM. Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature. Ann Coloproctol 2022; 38:160-165. [PMID: 35038819 PMCID: PMC9021853 DOI: 10.3393/ac.2021.00598.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure. Methods Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups. Results LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012). Conclusion Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.
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Affiliation(s)
- Seokwon Kim
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Byong Ho Jeon
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sang Sik Cho
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Ui Sup Shin
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sun Mi Moon
- Department of Surgery, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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8
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Abounozha S, Saafan T, Obaid M, Ibrahim R. Comparison between Endoloop ligature and Hem-o-lok clip (Polymer ligation) for appendiceal stump closure during laparoscopic appendicectomy. Ann Med Surg (Lond) 2022; 73:103232. [PMID: 35079368 PMCID: PMC8767279 DOI: 10.1016/j.amsu.2021.103232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing laparoscopic appendicectomy is Hem-o-lok clip safer than Endoloop ligature for closure of appendiceal stump? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the safety and cost effectiveness of Hem-o-lok clip (Polymer ligation) versus Endoloop ligature for appendiceal stump closure during laparoscopic appendicectomy. We concluded that Hem-o-lok clip is a safe and feasible tool for appendiceal stump closure. It's also a cost-effective way and could be a cheaper option compared to other measures.
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Affiliation(s)
- Sabry Abounozha
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | - Tamer Saafan
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
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9
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Muacevic A, Adler JR, Nanda NS, Ravindran GC. Comparison of Two Stump Closure Techniques in Laparoscopic Appendicectomy: A Single-Centre Prospective Cohort Study. Cureus 2022; 14:e21796. [PMID: 35251863 PMCID: PMC8891722 DOI: 10.7759/cureus.21796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Acute appendicitis is a frequent illness that manifests as an emergency and most of the cases necessitate surgical intervention. One of the most critical processes in a laparoscopic appendicectomy is the closure of the appendicular stump. For the closure of the stump of the appendix, several approaches have been employed and explored, but the one with the best outcomes has yet to be proved. The purpose of this study was to evaluate the medical results and cost analyses of laparoscopic appendicectomy with two of the commonly used stump closure techniques - ENDOLOOP® and Hem-o-lok®. Materials and methods A two-year prospective hospital-based cohort study was conducted from June 2019 to July 2021. All the patients in the study were randomly assigned to one of two experimental arms (ENDOLOOP® and Hem-o-lok®). The clinical and follow-up data of these patients were collected and tabulated into a data sheet and analyzed. Results In total, 180 individuals were included in the research (90 in each arm). No statistically significant difference was found in comparing the age, gender or diameter of the appendix among the two groups. The time taken for surgery showed significant differences among the two study groups. The time taken for the procedure in the Hem-o-lok® group was significantly lower than the ENDOLOOP® group (40.3 ± 12.3 minutes vs 50.83 ± 10.5 minutes, p < 0.001). No intraoperative or immediate postoperative complications were noted in either of the groups. The average duration of hospital stay was 2.7 ± 0.9 days in the Hem-o-lok® group, while it was 3.1 ± 0.8 days in the ENDOLOOP® group (p = 0.986). The material cost for the stump ligation with Hem-o-lok® was Rs. 310 ± Rs. 76 while that using ENDOLOOP® was Rs. 630 ± Rs. 118 (p < 0.001). In the Hem-o-lok® subset of patients, the mean direct expenses of laparoscopic appendicectomy were considerably lower. During the 12-week follow-up period, none of the patients had any post-operative complications. Conclusion According to the results of this study, both the technical variations of appendix stump closure are equal in terms of postoperative complications. When compared to the ENDOLOOP® group, the Hem-o-lok® group had a shorter duration of surgery and ended up spending less money. Hem-o-lok® clips have the potential to become the preferred way of anchoring the appendix base during laparoscopic appendicectomy.
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10
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Fuentes EJ, Pérez EA, Díez R, Aguado P, Moreno C, Souto H, Alonso JL. Use of hem-o-lok clips for laparoscopic appendectomy in children: retrospective analysis and comparison to ligature loop and endoscopic surgical stapler. Transl Gastroenterol Hepatol 2021; 6:44. [PMID: 34423165 DOI: 10.21037/tgh-20-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022] Open
Abstract
Background There are multiple techniques used for laparoscopic appendectomy (LA): ligature loop (LL), surgical stapler (SS) (Endopath Ets-Flex-Endoscopic Articulating Linear Cutter 33 mm Standard Ref Atb 35. Ethicon, Somerville, New Jersey, US), and hem-o-lok clips (HOL) (Weck Closure System. Triangle Park, NC, USA). The application of the LL usually demands dexterity and training, whilst using HOL may be more advantageous due to its simplicity in terms of application and its low cost in contrast with the SS. The objective of this study is to determine safety and efficacy of the different devices that can be used in the surgical procedure. Methods From June 2016 to December 2019, 253 consecutive children aged to 1 to 18 years were retrospectively reviewed. They were divided into three groups depending on the device used to secure the appendix: (I) in the first group, the base of the appendix was secured by double LL, (II) in the second group the base of the appendix was secured with SS, and (III) in the third group the base of the appendix was secured with two non-absorbable HOL. The data collected includes age, gender, operative time, device used to ligate the base of the appendix, previous tests (blood analysis, imaging), antibiotic prophylaxis administered, length of hospital stay, intraoperative and postoperative complications, shoulder pain and histological study of the specimen. Results There were 253 patients that underwent laparoscopic appendectomy during the study time, with a mean age of 10.3±4.1 in the LL group, 9.4±2.7 in the SS group and 10.4±3.3 in the HOL group, P=0.165. Distribution by gender was 77.8% for males in the LL group, 65.2% in the SS group and 61.3% in the HOL group, P=0.559. The mean surgical time with IQR in brackets was 60.0 (10.0) minutes (min), in the first group in which the base of the appendix was secured with LL, in the second group in which the base of the appendix was secured with SS 60.0 (15.0) min and finally in the third in which the base of the appendix was secured with HOL 40.0 (30.0) min, P<0.001. HOL clips have a significantly lower cost than their analogues. Specifically, 5 HOL clips have a cost of EUR 26.75, while three LL have a cost of EUR 53.70 and a single SS has a cost of EUR 276.58. Postoperative complications were found in 14.3% of the LL group, 9.8% in the SS group and 4.6% in the HOL group, P=0.137. Efficacy and safety in controlling the base of appendix were the same in all groups. Conclusions The HOL are safe and reduce surgical costs during laparoscopic appendectomy in children.
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Affiliation(s)
- Ennio J Fuentes
- Department of Pediatric Surgery, University Hospital, Fundación Jiménez Díaz, Madrid, Spain
| | - Eduardo A Pérez
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Díez
- Department of Pediatric Surgery, University Hospital, Fundación Jiménez Díaz, Madrid, Spain
| | - Pablo Aguado
- Department of Pediatric Surgery, University Hospital, Fundación Jiménez Díaz, Madrid, Spain
| | - Cecilia Moreno
- Department of Pediatric Surgery, University Hospital, Fundación Jiménez Díaz, Madrid, Spain
| | - Henar Souto
- Department of Pediatric Surgery, University Children's Hospital of the Niño Jesús, Madrid, Spain
| | - Jose L Alonso
- Department of Pediatric Surgery, University Children's Hospital of the Niño Jesús, Madrid, Spain
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Vuille-Dit-Bille RN, Staerkle RF, Derderian SC, Dewberry LC, Breitenstein S, Soll C. Appendiceal stump closure in children using polymeric clips is a reliable alternative to endoloops. MINERVA CHIR 2020; 75:274-275. [PMID: 32456398 DOI: 10.23736/s0026-4733.20.08313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Raphael N Vuille-Dit-Bille
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland - .,Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA -
| | - Ralph F Staerkle
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland.,Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital, University Hospital Basel, Basel, Switzerland
| | - Sarkis C Derderian
- Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA
| | - Lindel C Dewberry
- Department of Pediatric Sugery, Children's Hospital Colorado, Aurora, CO, USA
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Christopher Soll
- Department of Visceral and Thoracic Surgery, Cantonal Hospital, Winterthur, Switzerland
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12
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Tartaglia D, Fatucchi LM, Mazzoni A, Miccoli M, Piccini L, Pucciarelli M, Di Saverio S, Coccolini F, Chiarugi M. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg 2020; 72:1175-1180. [PMID: 32338352 DOI: 10.1007/s13304-020-00749-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intra-abdominal abscesses (IAA) may develop after laparoscopic appendectomies (LA) for acute appendicitis. The identification of risk factors for postoperative IAA could lead to a decrease in the readmission rate and surgery redoes after LA for acute appendicitis. MATERIALS AND METHODS The present study retrospectively analyzed patients undergone LA for acute appendicitis during the period 2001-2017. Clinical, intraoperative, and postoperative outcomes were described. Comparison between groups was made via univariate and multivariate analyses. RESULTS The charts of 2076 patients undergone LA were reviewed. Thirty-seven patients (1.8%) developed a postoperative IAA. Male gender (p < 0.05), ASA score ≥ 2 (p < 0.05), a gangrenous or perforated appendicitis (p < 0.0001), abscess or pelvic peritonitis (p < 0.0001), clipping the mesoappendix (p < 0.0001), appendix division by mechanical stapler (p < 0.05), prolonged antibiotic therapy (p < 0.05), and piperacillin/tazocin regimen (p < 0.0001) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p = 0.010), perforated appendicitis (p = 0.0002), and clipping the mesoappendix (p = 0.0002) were independent predictive factors for postoperative IAA. CONCLUSION Patients with peritonitis or a perforated appendicitis, and those who had their mesoappendix clipped showed a higher likelihood of developing an IAA. At risk patients should be provided with careful follow-up for the early detection and management of this complication.
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Affiliation(s)
- Dario Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Maria Fatucchi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alessio Mazzoni
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Piccini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Marsia Pucciarelli
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Salomone Di Saverio
- Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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13
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A comparison of non-absorbable polymeric clips and staplers for laparoscopic appendiceal stump closure: analysis of 618 adult patients. Langenbecks Arch Surg 2019; 404:711-716. [PMID: 31446471 DOI: 10.1007/s00423-019-01814-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/15/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this long-term study was the comparison of appendiceal stump closure with polymeric clips or staplers with respect to perioperative costs and surgical outcome under routine conditions in a university centre. METHODS For this retrospective chart review, a total of 618 patients undergoing laparoscopic appendectomy for suspected acute appendicitis between 2010 and 2017 were reviewed: 410 patients in the stapler group and 208 patients in the clip group. The database contained demographic data, operation time, inflammation parameters, closure method of the stump, surgeon status, length of hospital stay, and complications as well as histology reports. The costs were also compared. RESULTS Clip application was more likely among younger patients (mean age 33.6 years vs. 41.7 years). Histopathological evidence for appendiceal pathology was found in 96.6% of patients in the clip group and 99.5% of patients in the stapler group. Laparoscopic appendectomy in the clip group was more frequently performed by resident physicians (69.2%) than in the stapler group (57.8%). The mean postoperative stay was 2.9 days in the clip group and 3.7 days in the stapler group. The use of the polymeric clip resulted in considerable cost savings (19.94€ vs. 348.70€). CONCLUSIONS The use of polymeric clips for appendiceal stump closure during appendectomy is safe and effective. The base of the appendix is amenable to clipping in 32% of appendectomies in adult patients. This study supports the use of polymeric clips over staplers to decrease cost and environmental impact.
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14
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Bailey K, Choynowski M, Kabir SMU, Lawler J, Badrin A, Sugrue M. Meta-analysis of unplanned readmission to hospital post-appendectomy: an opportunity for a new benchmark. ANZ J Surg 2019; 89:1386-1391. [PMID: 31364257 DOI: 10.1111/ans.15362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/03/2019] [Accepted: 06/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta-analysis of readmission post-appendectomy has not been published. This meta-analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark. METHODS An ethically approved PROSPERO-registered (ID CRD42017069040) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non-comparative studies, using Methodological Index for Non-Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random-effects, Mantel-Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5. RESULTS A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0-14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63-2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43-5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08-1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres. CONCLUSION This meta-analysis identified that readmission is not uncommon post-appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high-risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.
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Affiliation(s)
- Kate Bailey
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Michelle Choynowski
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Syed Mohammad Umar Kabir
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.,Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland
| | - Jack Lawler
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Adibah Badrin
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland
| | - Michael Sugrue
- Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.,Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland.,EU INTERREG Centre for Personalised Medicine Project, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Londonderry, Northern Ireland
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15
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Vuille-Dit-Bille R, Soll C, Mazel P, Staerkle RF, Breitenstein S. Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers. J Int Med Res 2019; 48:300060519856154. [PMID: 31234666 PMCID: PMC7140204 DOI: 10.1177/0300060519856154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Polymeric (Hem-o-lok) clips represent a novel technique with which to ligate
the appendiceal stump following laparoscopic appendectomy. We compared the
outcomes of using polymeric clips versus endostaplers for complicated and
uncomplicated appendicitis. Methods Six hundred seventy-three consecutive patients undergoing laparoscopic
appendectomy with polymeric clips or endostaplers for acute appendicitis
were assessed. The primary outcome was the incidence of intra-abdominal
abscesses. Predictors of postoperative intra-abdominal abscesses were
calculated using univariate and multivariate analyses. Results Polymeric clips were used in 65% of patients and endostaplers were used in
35%. Hem-o-lok clips were not only applied in patients with uncomplicated
appendicitis (83%), but also in those with complicated appendicitis (26%).
The frequency of intra-abdominal abscesses using polymeric clips and
endostaplers was similar in both patients with uncomplicated appendicitis
(1% vs. 3%, respectively) and complicated appendicitis (2% vs. 6%,
respectively). The univariate and multivariate analyses showed that the
stump closure technique was not a risk factor for postoperative
abscesses. Conclusions Closure of the appendiceal stump using the nonabsorbable Hem-o-lok ligation
system in patients with both uncomplicated and complicated appendicitis is a
safe alternative to the application of endostaplers.
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Affiliation(s)
- Raphael Vuille-Dit-Bille
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Christopher Soll
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Peter Mazel
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Ralph F Staerkle
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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16
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Obrist NM, Tschuor C, Breitenstein S, Vuille-Dit-Bille RN, Soll C. Appendectomy in Switzerland: how is it done? Updates Surg 2019; 71:375-380. [PMID: 30982171 DOI: 10.1007/s13304-019-00654-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
Abstract
More than 10,000 appendectomies are performed every year in Switzerland. The aim of this study was to investigate the treatment strategy for appendicitis among Swiss surgeons with particular interest in laparoscopic technique, method of appendiceal stump closure, and abdominal lavage. We performed an anonymous survey among 540 members of the Swiss Surgical Society. Technical details and differences between the surgical procedures in adults and children as well as in complicated and non-complicated appendicitis were investigated. The overall response rate was 45% (n = 243). 78% of the surgeons perform laparoscopic appendectomies in children and 95% in adult patients. Only 3% use a single incision site technique. Surgeons consider pus or stool in the abdomen (94%), an abscess (86%) or perforation of the appendix (82%), but not an inflamed appendiceal base (16%) as complicated appendicitis. 41% of surgeons use endoloops, 36% a stapling device, and 20% polymeric clips in non-complicated appendicitis for appendiceal stump closure. However, 82% of the surgeons use a stapler in complicated appendicitis. Most (76%) of surgeons do not plunge the appendiceal stump. 24% of surgeons lavage the abdomen with > 1 L of fluid independent of the intraabdominal finding. Most Swiss surgeons perform multiport laparoscopic appendectomies. Endoloops and staplers are mostly used for appendiceal stump closures in uncomplicated appendicitis, and staplers in complicated appendicitis. Only a minor part of surgeons plunge the appendiceal stump or perform routine abdominal lavage.
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Affiliation(s)
- Nicolas M Obrist
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christoph Tschuor
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Raphael N Vuille-Dit-Bille
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Christopher Soll
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
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17
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Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy. Am J Surg 2017; 214:1143-1148. [PMID: 28943064 DOI: 10.1016/j.amjsurg.2017.08.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/30/2017] [Accepted: 08/16/2017] [Indexed: 01/15/2023]
Abstract
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.
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18
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Pogorelić Z, Kostovski B, Jerončić A, Šušnjar T, Mrklić I, Jukić M, Jurić I. A Comparison of Endoloop Ligatures and Nonabsorbable Polymeric Clips for the Closure of the Appendicular Stump During Laparoscopic Appendectomy in Children. J Laparoendosc Adv Surg Tech A 2017; 27:645-650. [PMID: 27996377 DOI: 10.1089/lap.2016.0433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, Split University Hospital, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | | | - Ana Jerončić
- Department for Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Tomislav Šušnjar
- Department of Pediatric Surgery, Split University Hospital, Split, Croatia
| | - Ivana Mrklić
- University of Split School of Medicine, Split, Croatia
- Department of Pathology, Forensic Medicine and Cytology, Split University Hospital, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, Split University Hospital, Split, Croatia
| | - Ivo Jurić
- Department of Pediatric Surgery, Split University Hospital, Split, Croatia
- University of Split School of Medicine, Split, Croatia
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