Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the feasibility, morbidity, and cost-effectiveness of the closure of the appendicular stump with a single non-absorbable polymeric clip compared with the closure of the appendicular stump with a stapler.

Methods

From January 2009 to December 2009, 82 patients, 31 males and 51 females (mean age of 35.4 years; range of 17 to 79 years), were included in this prospective, non-randomized trial. In 56 patients, the appendicular stump was closed by staplers, and in 26 patients, a single Hem-o-lok MLX polymeric clip was applied. The data collected included age, sex, time of surgery, costs, time of hospitalization, day-time of surgery, complications, and preoperative white blood count (WBC) and c-reactive protein (CRP).

Results

There were no differences between the two groups regarding age, sex, WBC, CRP, and time of hospitalization. Time of surgery was longer in the clip group due to the introductory phase. Morbidity did not differ significantly and was highly acceptable in both groups. The costs of one set of Hem-o-lock clips were negligible compared to staplers (19.94 € versus 356.43 €).

Conclusions

The use of a single non-absorbable polymeric clip is easy to use even for surgical trainees; it is safe and cost-effective. We suggest the use of a single clip for the closure of the appendicular stump as the standard procedure in laparoscopic appendectomy whenever possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hardin DM Jr (1999) Acute appendicitis: review and update. Am Fam Physician 60:2027–2034

    PubMed  Google Scholar 

  2. Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64

    Article  CAS  PubMed  Google Scholar 

  3. Hansen JB, Smithers BM, Schache D, Wall DR, Miller BJ, Menzies BL (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20:17–20, discussion 21

    Article  CAS  PubMed  Google Scholar 

  4. Reiertsen O, Trondsen E, Bakka A, Andersen OK, Larsen S, Rosseland AR (1994) Prospective nonrandomized study of conventional versus laparoscopic appendectomy. World J Surg 18:411–415, discussion 415–416

    Article  CAS  PubMed  Google Scholar 

  5. Cothren CC, Moore EE, Johnson JL, Moore JB, Ciesla DJ, Burch JM (2005) Can we afford to do laparoscopic appendectomy in an academic hospital? Am J Surg 190:950–954

    PubMed  Google Scholar 

  6. Partecke LI, von Bernstorff W, Karrasch A, Cziupka K, Glitsch A, Stier A, Heidecke CD, Tepel J (2009) Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis. Langenbecks Arch Surg (Epub ahead of print)

  7. Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11:59–62

    PubMed  Google Scholar 

  8. Delibegovic S, Matovic E (2009) Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy. Surg Endosc 23:2851–2854

    Article  Google Scholar 

  9. Cristalli BG, Izard V, Jacob D, Levardon M (1991) Laparoscopic appendectomy using a clip applier. Surg Endosc 5:176–178

    Article  CAS  PubMed  Google Scholar 

  10. Reissfelder C, Mc Cafferty B, von Frankenberg M (2009) Open appendectomy. When do we still need it? Chirurg 80:602–607

    Article  CAS  PubMed  Google Scholar 

  11. Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C (1996) Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases. Surg Endosc 10:895–899

    Article  CAS  PubMed  Google Scholar 

  12. Arcovedo R, Barrera H, Reyes HS (2007) Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc 21:1764–1767

    Article  CAS  PubMed  Google Scholar 

  13. Kuehnel F, Marusch F, Koch A, Gastinger I (2007) Retained loose linear cutter staples after laparoscopic appendectomy as the cause of mechanical small bowel obstruction. Int J Colorectal Dis 22:717–718

    Article  CAS  PubMed  Google Scholar 

  14. Yano H, Okada K, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Monden T (2003) Efficacy of absorbable clips compared with metal clips for cystic duct ligation in laparoscopic cholecystectomy. Surg Today 33:18–23

    Article  PubMed  Google Scholar 

  15. Lindemann F, Geissler B, Hausser L, Witte J (1997) Laparoscopically placed clips on the human cystic duct—an experimental comparison of dislocation between resorbable and titanium clips. Chirurg 68:244–246

    Article  CAS  PubMed  Google Scholar 

  16. Beldi G, Muggli K, Helbling C, Schlumpf R (2004) Laparoscopic appendectomy using endoloops: a prospective, randomized clinical trial. Surg Endosc 18:749–750

    Article  CAS  PubMed  Google Scholar 

  17. Binnebosel M, Otto J, Stumpf M, Mahnken AH, Gassler N, Schumpelick V, Truong S (2009) Acute appendicitis. modern diagnostics–surgical ultrasound. Chirurg 80:579–587

    Article  CAS  PubMed  Google Scholar 

  18. Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20:495–499

    Article  CAS  PubMed  Google Scholar 

  19. Yagmurlu A, Vernon A, Barnhart DC, Georgeson KE, Harmon CM (2006) Laparoscopic appendectomy for perforated appendicitis: a comparison with open appendectomy. Surg Endosc 20:1051–1054

    Article  CAS  PubMed  Google Scholar 

  20. Pedersen AG, Petersen OB, Wara P, Ronning H, Qvist N, Laurberg S (2001) Randomized clinical trial of laparoscopic versus open appendicectomy. Br J Surg 88:200–205

    Article  CAS  PubMed  Google Scholar 

  21. Milewczyk M, Michalik M, Ciesielski M (2003) A prospective, randomized, unicenter study comparing laparoscopic and open treatments of acute appendicitis. Surg Endosc 17:1023–1028

    Article  CAS  PubMed  Google Scholar 

  22. Ignacio RC, Burke R, Spencer D, Bissell C, Dorsainvil C, Lucha PA (2004) Laparoscopic versus open appendectomy: what is the real difference? Results of a prospective randomized double-blinded trial. Surg Endosc 18:334–337

    Article  CAS  PubMed  Google Scholar 

  23. Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–448, discussion 448–450

    PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Sebastian Peters for his kind and most valuable support.

Authors' contributions

Lars Ivo Partecke: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

Wolfram Kessler: Study conception and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript.

Wolfram von Bernstorff: Analysis and interpretation of data, drafting of manuscript, critical revision of manuscript.

Stephan Diedrich: Acquisition of data, critical revision of manuscript.

Claus-Dieter Heidecke: Critical revision of manuscript

Maciej Patrzyk: Study conception and design, critical revision of manuscript

Disclosure

Drs. Lars Ivo Partecke, Wolfram Kessler, Wolfram von Bernstorff, Stephan Diedrich, Claus-Dieter Heidecke, and Maciej Patrzyk have no corporate, commercial, or financial relationship that might pose a conflict of interest.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital, Ernst-Moritz-Arndt-University, Greifswald, Germany

    Lars Ivo Partecke, Wolfram Kessler, Wolfram von Bernstorff, Stephan Diedrich, Claus-Dieter Heidecke & Maciej Patrzyk

  2. Department of General, Visceral, Thoracic, and Vascular Surgery, Universitätsklinikum Greifswald, Friedrich-Loeffler-Str. 23b, 17475, Greifswald, Germany

    Lars Ivo Partecke

Authors
  1. Lars Ivo Partecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wolfram Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolfram von Bernstorff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephan Diedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claus-Dieter Heidecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maciej Patrzyk
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Ivo Partecke.

Additional information

Lars Ivo Partecke and Wolfram Kessler contributed equally to this work and share first authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Partecke, L.I., Kessler, W., von Bernstorff, W. et al. Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump. Langenbecks Arch Surg 395, 1077–1082 (2010). https://doi.org/10.1007/s00423-010-0671-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0671-9

Keywords

Search

Navigation