Original Article

J Minim Invasive Surg 2013; 16(1): 6-10

Published online March 15, 2013

https://doi.org/10.7602/jmis.2013.16.1.6

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

Study on the Feasibility and the Safety of Hem-o-lok Clipping for Complicated Acute Appendicitis during Laparoscopic Appendectomy

Ki Hyun Kim, M.D., Si Hak Lee, M.D., Kwang Ho Yang, M.D., Sun Hwi Hwang, M.D.

Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis.
Methods: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness.
Results: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group.
Conclusion: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.

Keywords Laparoscopic appendectomy, Hem-o-lok clip, ENDOLOOP

  1. Simpson J, Samaraweera AP, Sara RK, Lobo DN. Acute appendicitis--a benign disease? Ann R Coll Surg Engl 2008;90:313-316.
    Pubmed KoreaMed CrossRef
  2. Faiz O, Clark J, Brown T, et al. Traditional and laparoscopic appendectomy in adults: outcom es in English NHS hospitals between 1996 and 2006. Ann Surg 2008;248:800-806.
    Pubmed CrossRef
  3. Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S. Randomized clinical trial of laparoscopic versus open appendectomy. Br J Surg 2001;88:200-205.
    Pubmed CrossRef
  4. Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R. Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surg Endosc 2001;15:660-662.
    Pubmed CrossRef
  5. Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF. Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 2005;19:923-926.
    Pubmed CrossRef
  6. Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D. Analysis of s tapling versus endoloops in appendiceal stump closure. Br J Surg 2006;93:1390-1393.
    Pubmed CrossRef
  7. Raptopoulos V, Katsou G, Rosen MP, Siewert B, Goldberg SN, Kruskal JB. Acute appendicitis: effect of increased use of CT on selecting patients ear lier. Radiology 2003;226:521526.
    Pubmed CrossRef
  8. Partecke LI, von Bernstorff W, Karrasch A, et al. Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbecks Arch Surg 2009;23:28512854.
  9. Losanoff JE, Kjossev KT. A new technique for retrograde appendectomy. Eur J Surg 1999;165:268-269.
    Pubmed CrossRef
  10. Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C. Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases. Surg Endosc 1996;10:895-899.
    Pubmed CrossRef
  11. Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc 2007;21:1764-1767.
    Pubmed CrossRef
  12. Kuehnel F, Marusch F, Koch A, Gastinger I. Retained loose linear cutter staples after lapa roscopic appendectomy as the cause of mechanical small bowel obstruction. Int J Colorectal Dis 2007;22:717-718.
    Pubmed CrossRef
  13. Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendic itis. Int J Surg 2009;7:250-252.
    Pubmed CrossRef
  14. Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 2006;243:17-27.
    Pubmed KoreaMed CrossRef
  15. Cristalli BG, Izard V, Jacob D, Levardon M. Laparoscopic appendectomy using a clip applier. Surg Endosc 1991;5:176178.
    CrossRef
  16. Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 2007;11:59-62.
    Pubmed KoreaMed
  17. Paik PS, Towson JA, Anthone GJ, Ortega AE, Simons AJ, Beart RW Jr. Intra-abdominal abscesses following laparoscopic and open appendectomies. J G astrointest Surg 1997;1:188192.
    CrossRef
  18. Slim K, Pezet D, Chipponi J. Laparoscopic or open appendectomy? Critical review of random ized, controlled trials. Dis Colon Rectum 1998;41:398-403.
    Pubmed CrossRef
  19. Delibegovic S, Matovic E. Hem-o-lok plastic clips in securin g of the base of the appendix during laparoscopic appendectomy. Surg Endosc 2009;23:2851-2854.
    Pubmed CrossRef
  20. Cueto J, D'Allemagne B, Vazquez-Frias JA, et al. Morbidity of laparoscopic surgery for comp licated appendicitis: an international study. Surg Endosc 2006;20:717-720.
    Pubmed CrossRef
  21. Binnebosel M, Otto J, Stumpf M, et al. Acute appendicitis. Modern diagnostics--surgical ult rasound. Chirurg 2009;80:579587.

Article

Original Article

J Minim Invasive Surg 2013; 16(1): 6-10

Published online March 15, 2013 https://doi.org/10.7602/jmis.2013.16.1.6

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

Study on the Feasibility and the Safety of Hem-o-lok Clipping for Complicated Acute Appendicitis during Laparoscopic Appendectomy

Ki Hyun Kim, M.D., Si Hak Lee, M.D., Kwang Ho Yang, M.D., Sun Hwi Hwang, M.D.

Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis.
Methods: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness.
Results: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group.
Conclusion: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.

Keywords: Laparoscopic appendectomy, Hem-o-lok clip, ENDOLOOP

References

  1. Simpson J, Samaraweera AP, Sara RK, Lobo DN. Acute appendicitis--a benign disease? Ann R Coll Surg Engl 2008;90:313-316.
    Pubmed KoreaMed CrossRef
  2. Faiz O, Clark J, Brown T, et al. Traditional and laparoscopic appendectomy in adults: outcom es in English NHS hospitals between 1996 and 2006. Ann Surg 2008;248:800-806.
    Pubmed CrossRef
  3. Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S. Randomized clinical trial of laparoscopic versus open appendectomy. Br J Surg 2001;88:200-205.
    Pubmed CrossRef
  4. Piskun G, Kozik D, Rajpal S, Shaftan G, Fogler R. Comparison of laparoscopic, open, and converted appendectomy for perforated appendicitis. Surg Endosc 2001;15:660-662.
    Pubmed CrossRef
  5. Kouwenhoven EA, Repelaer van Driel OJ, van Erp WF. Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic. Surg Endosc 2005;19:923-926.
    Pubmed CrossRef
  6. Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D. Analysis of s tapling versus endoloops in appendiceal stump closure. Br J Surg 2006;93:1390-1393.
    Pubmed CrossRef
  7. Raptopoulos V, Katsou G, Rosen MP, Siewert B, Goldberg SN, Kruskal JB. Acute appendicitis: effect of increased use of CT on selecting patients ear lier. Radiology 2003;226:521526.
    Pubmed CrossRef
  8. Partecke LI, von Bernstorff W, Karrasch A, et al. Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbecks Arch Surg 2009;23:28512854.
  9. Losanoff JE, Kjossev KT. A new technique for retrograde appendectomy. Eur J Surg 1999;165:268-269.
    Pubmed CrossRef
  10. Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C. Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases. Surg Endosc 1996;10:895-899.
    Pubmed CrossRef
  11. Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc 2007;21:1764-1767.
    Pubmed CrossRef
  12. Kuehnel F, Marusch F, Koch A, Gastinger I. Retained loose linear cutter staples after lapa roscopic appendectomy as the cause of mechanical small bowel obstruction. Int J Colorectal Dis 2007;22:717-718.
    Pubmed CrossRef
  13. Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendic itis. Int J Surg 2009;7:250-252.
    Pubmed CrossRef
  14. Aziz O, Athanasiou T, Tekkis PP, et al. Laparoscopic versus open appendectomy in children: a meta-analysis. Ann Surg 2006;243:17-27.
    Pubmed KoreaMed CrossRef
  15. Cristalli BG, Izard V, Jacob D, Levardon M. Laparoscopic appendectomy using a clip applier. Surg Endosc 1991;5:176178.
    CrossRef
  16. Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 2007;11:59-62.
    Pubmed KoreaMed
  17. Paik PS, Towson JA, Anthone GJ, Ortega AE, Simons AJ, Beart RW Jr. Intra-abdominal abscesses following laparoscopic and open appendectomies. J G astrointest Surg 1997;1:188192.
    CrossRef
  18. Slim K, Pezet D, Chipponi J. Laparoscopic or open appendectomy? Critical review of random ized, controlled trials. Dis Colon Rectum 1998;41:398-403.
    Pubmed CrossRef
  19. Delibegovic S, Matovic E. Hem-o-lok plastic clips in securin g of the base of the appendix during laparoscopic appendectomy. Surg Endosc 2009;23:2851-2854.
    Pubmed CrossRef
  20. Cueto J, D'Allemagne B, Vazquez-Frias JA, et al. Morbidity of laparoscopic surgery for comp licated appendicitis: an international study. Surg Endosc 2006;20:717-720.
    Pubmed CrossRef
  21. Binnebosel M, Otto J, Stumpf M, et al. Acute appendicitis. Modern diagnostics--surgical ult rasound. Chirurg 2009;80:579587.

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