Comparison of hand-made extracorporeal knotting and Hem-o-lok clip in laparoscopic appendectomy

Year 2025, Volume: 50 Issue: 1, 56 - 62, 31.03.2025

Cumhur Özcan , Muhanned Alkhatıb , Sami Benli , Hilmi Bozkurt , Tahsin Çolak , Elif Ertaş

https://doi.org/10.17826/cumj.1579843

Abstract

Purpose: This study aims to compare the extracorporeal knotting technique and the Hem-o-lok clip technique among patients who underwent laparoscopic appendectomy.
Materials and Methods: This study is a retrospective evaluation of prospectively acquired data from patients in a single-center setting. Patients were divided into two groups: group 1 was hand-made extracorporeal knotting group and group 2 was Hem-o-lok clip group. A total of 150 patients were included in the study. 81 patients were in Group 1 and 69 patients were in Group 2.
Results: No significant difference was found between demographic characteristics and clinical features for two groups. The incidence of surgical site infection was similar between the two groups (Grup 1: %3.7, Grup 2: %5.8). Postoperative complications were seen in 2 patients (2.9%) in the Hem-o-lok group and 3 patients (3.7%) in the extracorporeal knotting group. The mean operation time was group 1 54.2±7.9 minutes, group 2 52.3±10.7 minutes. The mean hospital stay of the patients was 1.2±0.7 days in group 2 and 1.3±0.8 days in the grouıp 1. The cost analysis revealed that the Hem-o-lok technique was more expensive than the hand-made extracorporeal knotting method.
Conclusion: Both hand-made extracorporeal knotting and Hem-o-lok clips are effective and safe methods for closing the appendix stump in laparoscopic appendectomy.

Keywords

Laparoscopic appendectomy, Hem-o-lok clips, Extracorporeal knotting.

Laparoskopik apendektomide el yapımı ekstrakorporeal düğüm atma tekniği ile Hem-o-lok klipsin karşılaştırılması

Abstract

Amaç: Bu çalışma, laparoskopik apandektomi uygulanan hastalar arasında ekstrakorporeal düğüm atma tekniği ile Hem-o-lok klips tekniğini karşılaştırmayı amaçlamaktadır.
Gereç ve Yöntem: Bu çalışma, tek bir merkezde prospektif olarak toplanan verilerin retrospektif olarak değerlendirilmesidir. Hastalar iki gruba ayrılmıştır: grup 1, el yapımı ekstrakorporeal düğüm atma grubunu ve grup 2, Hem-o-lok klips grubu oluşturmaktadır. Çalışmaya toplamda 150 hasta dahil edilmiştir. 81 hasta grup 1'de, 69 hasta ise grup 2'de yer almıştır.
Bulgular: İki grup arasında demografik özellikler ve klinik özellikler açısından anlamlı bir fark bulunmamıştır. Cerrahi alan enfeksiyonu insidansı iki grup arasında benzerdi (Grup 1: %3.7, Grup 2: %5.8). Hem-o-lok grubunda 2 hastada (%2.9), ekstrakorporeal düğüm grubunda ise 3 hastada (%3.7) postoperatif komplikasyonlar görüldü. Ortalama operasyon süresi Grup 1'de 54.2±7.9 dakika, Grup 2'de ise 52.3±10.7 dakika olarak saptanmıştır. Hastaların ortalama hastanede yatış süresi Grup 2'de 1.2±0.7 gün, Grup 1'de ise 1.3±0.8 gündür. Maliyet analizi, Hem-o-lok tekniğinin el yapımı ekstrakorporeal düğüm atma yöntemine göre daha pahalı olduğunu ortaya koymuştur.
Sonuç: Elle yapılan ekstrakorporeal düğümleme ve Hem-o-lok klipslerinin laparoskopik apendektomide apendiks güdüğünün kapatılması için her ikisi de etkili ve güvenli yöntemlerdir.

Keywords

Laparoskopik apandektomi, Hem-o-lok klips, Ekstrakorporeal düğüm

References

• Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101:e9-22.
• Shaikh AH, Tandur AE, Sholapur S, Vangal G, Bhandarwar AH, Ghosh A et al. Laparoscopic versus open appendectomy: a prospective comparative study and 4-year experience in a tertiary care hospital. Surg J (N Y). 2022;8:e208-14.
• Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011;25:1199-208.
• Liu Z, Zhang P, Ma Y, Chen H, Zhou Y, Zhang M et al. Laparoscopy or not: a meta-analysis of the surgical effects of laparoscopic versus open appendicectomy. Surg Laparosc Endosc Percutan Tech. 2010;20:362-70.
• Sporn E, Petroski GF, Mancini GJ, Astudillo JA, Miedema BW, Thaler K. Laparoscopic appendectomy--is it worth the cost? Trend analysis in the US from 2000 to 2005. J Am Coll Surg. 2009;208:179-85.e2.
• Köckerling F, Schug-Pass C, Grund S. Laparoskopische appendektomie. der neue standard? Chirurg. 2009;80:594-601.
• Takami T, Yamaguchi T, Yoshitake H, Hatano K, Kataoka N, Tomita M et al . A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study. Eur J Trauma Emerg Surg. 2020;46:847-51.
• Zhang G, Wu B. Meta-analysis of the clinical efficacy of laparoscopic appendectomy in the treatment of acute appendicitis. World J Emerg Surg. 2022;17:26.
• Brügger L, Rosella L, Candinas D, Güller U. Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients. Ann Surg. 2011;253:309-13.
• Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg. 2015;31:229-31.
• Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M et al. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg. 2022;14:1060-71.
• Soll C, Wyss P, Gelpke H, Raptis DA, Breitenstein S. Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses. Langenbecks Arch Surg. 2016;401:661-6.
• Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy?. Best Pract Res Clin Gastroenterol. 2014;28:211-24.
• van Rossem CC, van Geloven AA, Schreinemacher MH, Bemelman WA; snapshot appendicitis collaborative study group. Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis: No difference in infectious complications. Surg Endosc. 2017;31:178-84.
• Miyano G, Urao M, Lane GJ, Kato Y, Okazaki T, Yamataka A. A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children. J Laparoendosc Adv Surg Tech A. 2011;21:177-9.
• Delibegović S, Matović E. Hem-o-lok plastic clips in securing of the base of the appendix during laparoscopic appendectomy. Surg Endosc. 2009;23:2851-4.
• Ates M, Dirican A, Ince V, Ara C, Isik B, Yilmaz S. Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 2012;22:226-31.
• Kiudelis M, Ignatavicius P, Zviniene K, Grizas S. Analysis of intracorporeal knotting with invaginating suture versus endoloops in appendiceal stump closure. Wideochir Inne Tech Maloinwazyjne. 2013;8:69-73.
• Lucchi A, Berti P, Grassia M, Siani LM, Gabbianelli C, Garulli G. Laparoscopic appendectomy: Hem-o-lok versus Endoloop in stump closure. Updates Surg. 2017;69:61-65.
• Erdoğan A, Türkan A. Comparison of handmade endoloop versus polymeric endoclip for stump closure in laparoscopic appendectomy. Cureus. 2021;13:e16302.
• Arer IM, Avci T, Yabanoglu H. Hand-made extracorporeal knotting versus hem-o-lok clip for stump closure in laparoscopic appendectomy. J Coll Physicians Surg Pak. 2019;29:1203-6.
• Colak E, Kement M, Ozlem N, Mutlu T, Yildirim K, Gurer A, Aktimur R. A comparison of nonabsorbable polymeric clips and endoloop ligatures for the closure of the appendicular stump in laparoscopic appendectomy: a prospective, randomized study. Surg Laparosc Endosc Percutan Tech. 2013;23:255-8.
• Mayir B, Bilecik T, Ensari CO, Oruc MT. Laparoscopic appendectomy with hand-made loop. Wideochir Inne Tech Maloinwazyjne. 2014;9:152-6.