The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy / 대한외과학회지

PURPOSE: The purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip. METHODS: From May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed. RESULTS: A total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group. CONCLUSION: The use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.

Comparison of Clinical Outcomes between the Hem-o-lok Clip and Endoloop Ligature in Securing the Base of the Appendix

PURPOSE: There are various techniques for securing the base of the appendix during performance of laparoscopic appendectomy. Many studies have reported that Endo-GIA is useful for securing the base of the appendix; however, it is costly. Many hospitals now use Endoloop ligature (ELL) for securing the base of the appendix. Many studies have demonstrated the many advantages of the Hem-o-lok clip (HLC) for securing the base of the appendix. The aim of this study is to compare the surgical outcomes of securing the base of the appendix between HLC and ELL during performance of laparoscopic appendectomy. METHODS: A retrospective cohort study was conducted for comparison between HLC and ELL for securing the base during performance of laparoscopic appendectomy. From May 2008 to October 2011, 102 patients underwent laparoscopic appendectomy performed by a single surgeon. Thirty one patients were excluded for various reasons. In 38 patients, the base of the appendix was secured by HLC, and in 33 patients, ELL was applied. Data included age, sex, body mass index (BMI), cost of materials, preoperative white blood count (preoperative WBC), preoperative c-reactive protein (preoperative CRP), preoperative fever, operation time, hospital days, diameter of the appendiceal base, number of perforated appendicitis, and intraoperative or postoperative complication. RESULTS: HLC was used in 38 patients, with a meanage of 36.4 years old. ELL was applied in 33 patients, with a meanage of 19.3 years old. Significant difference in age of patients was observed between the groups (p<0.001). The groups were comparable with regard to sex, BMI, preoperative WBC, preoperative CRP, preoperative fever, operation time, hospital stay, diameter of the appendiceal base, perforated appendicitis, and intraoperative or postoperative complication. The cost of six HLCs was 32,940 won, and that for one ELL was 29,610 won, therefore, there was no significant difference in the cost of material between the tw o groups of patients. CONCLUSION: Except for age, no difference was observed between the two groups. If a single HLC set is available for securing the base of the appendix, there will be a significant difference of the material cost between the two groups. ELL is more useful for securing the appendiceal base, with a larger diameter, which is inappropriate for use of HLC.

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

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.