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The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

A key step during laparoscopic appendicectomy is securing the appendiceal stump. This has traditionally been achieved using vicryl endoloops, but increasing evidence suggests that the use of polymeric clips (Hem-o-lok) may be a safe and viable method. Current evidence for its clinical use in laparoscopic appendicectomy is unknown. We performed a systematic review of the literature examining the clinical outcomes of laparoscopic appendicectomy using polymeric clips compared to other methods of stump closure.

Methods

A systematic literature review based on PRISMA guidelines was performed using MEDLINE, PubMed, EMBASE and Cochrane library databases between 2000 and 2017. All studies analysing appendiceal stump closure during laparoscopic appendicectomy using polymeric clips compared to other methods of stump closure were included. The methodological quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews. The review was registered with the PROSPERO register of systematic reviews.

Results

Ten studies were included, involving 702 patients, 7 of which were prospective studies and 1 a randomised control trial. Polymeric clips were found to be the cheapest method (€20.47 average per patient) and also had the lowest rate of complications (2.7%) compared to other commonly used closure methods. Meanwhile, operative time and duration of in-patient stay were similar between groups.

Conclusions

Current evidence suggests that polymeric clips are an effective and cost-efficient method for stump closure in laparoscopic appendicectomy for acute appendicitis. Further high-quality evidence is required before polymeric clips can be recommended as the gold standard for appendiceal stump closure.

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Authors and Affiliations

  1. Monklands Hospital, Airdrie, ML6 0JS, UK

    Stephen Robert Knight

  2. Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK

    Abdulla Ibrahim, Nav Makaram, Pradeep Patil & Michael Samuel James Wilson

Authors
  1. Stephen Robert Knight
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  2. Abdulla Ibrahim
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  3. Nav Makaram
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  4. Pradeep Patil
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Correspondence to Michael Samuel James Wilson.

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Conflict of interest

Stephen Robert Knight declares that he has no conflict of interest. Abdulla Ibrahim declares that he has no conflict of interest. Navnit Makaram declares that he has no conflict of interest. Pradeep Patil declares that he has no conflict of interest. Michael Samuel James Wilson declares that he has no conflict of interest.

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Knight, S.R., Ibrahim, A., Makaram, N. et al. The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review. Eur J Trauma Emerg Surg 45, 665–670 (2019). https://doi.org/10.1007/s00068-019-01105-5

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  • DOI: https://doi.org/10.1007/s00068-019-01105-5

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