Surgical Endoscopy

, Volume 32, Issue 5, pp 2295–2299 | Cite as

The influence of the different forms of appendix base closure on patient outcome in laparoscopic appendectomy: a randomized trial

Article

Abstract

Background

During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method.

Patients and methods

The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome.

Results

No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044).

Conclusion

All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.

Keywords

Laparoscopic appendectomy Acute appendicitis Loop ligatures Stapling device Hem-o-lok clip DS clip 

Notes

Compliance with ethical standards

Disclosures

Samir Delibegovic and Zlatan Mehmedovic have no conflicts of interest of financial ties to disclosure.

References

  1. 1.
    Neugebauer EAM, Troidl H, Kum CK, Eypasch E, Miserez M, Paul A (2006) The EAES clinical practice guidelines on laparoscopic cholecystectomy, appendectomy, and hernia repair. In: Neugebauer EAM, Sauerland S, Fingerhut A, Millat B, Buess G (eds) EAES guidelines for endoscopic surgery. Springer, Berlin, pp 265–289CrossRefGoogle Scholar
  2. 2.
    Wagner M, Aronsky D, Tschudi J, Metzger A, Klaiber C (1996) Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases. Surg Endosc 10:895–899CrossRefPubMedGoogle Scholar
  3. 3.
    Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11:59–62PubMedPubMedCentralGoogle Scholar
  4. 4.
    Delibegovic S, Matovic E (2009) Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy. Surg Endosc 23:2851–2854CrossRefPubMedGoogle Scholar
  5. 5.
    Delibegovic S (2012) The use of a single Hem-o-lok clip in securing the base of the appendix during laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 22:86–87CrossRefGoogle Scholar
  6. 6.
    Delibegović S, Iljazović E, Katica M, Koluh A (2011) Tissue reaction to absorbable endoloop, nonabsorbable titanium staples, and polymer Hem-o-lok clip after laparoscopic appendectomy. JSLS 15:70–76CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rickert A, Krüger CM, Runkel N, Kuthe A, Köninger J, Jansen-Winkeln B, Gutt CN, Marcus DR, Hoey B, Wente MN, Kienle P (2015) The TICAP-Study (titanium clips for appendicular stump closure): a prospective multicentre observational study on appendicular stump closure with an innovative titanium clip. BMC Surg 15:85CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Dai L, Shuai J (2017) Laparoscopic versus open appendectomy in adults and children: a meta-analysis of randomised trials. United Eur Gastroenterol J 4:542–553CrossRefGoogle Scholar
  9. 9.
  10. 10.
    Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393CrossRefPubMedGoogle Scholar
  11. 11.
    Lin HF, Lai HS, Lai IR (2014) Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 20:14338–14347CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Delibegovic S, Mehmedovic Z (2016) The influence of appendiceal base diameter on appendix stump closure in laparoscopic appendectomy. World J Surg 40:2342–2347CrossRefPubMedGoogle Scholar
  13. 13.
    Kwaznenski D, Six C, Stahfeld K (2013) The unacknowledged incidence of laparoscopic stapler malfunction. Surg Endosc 27:86–89CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Colorectal Surgery, Clinic for SurgeryUniversity Clinical CenterTuzlaBosnia and Herzegovina
  2. 2.Faculty of MedicineUniversity of TuzlaTuzlaBosnia and Herzegovina

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