Comparison of endoloop and Hem-o-lok clip for stump closure in laparoscopic appendectomy: which one is more cost-effective. A retrospective study

Abstract

We aimed to show the effect of closure of the appendix stump with different methods during laparoscopic appendectomy (LA), on postoperative complications, healing process and costs. Patients who underwent LA due to acute appendicitis in the last 5 years in Rize were retrospectively analyzed. Our study includes comparative analysis on two patient groups in which we carried LA. We used endoloop (EL) in Group 1 and hem-o-lok polymeric clip (HC) in Group 2 to close the appendix stump. Patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) score, preoperative white blood cell and C-reactive protein (CRP) elevation, whether a drain was used, appendix diameter, pathological diagnosis, postoperative complications, duration of surgery and length of stay, and cost. Of 209 patients, 111 (51.2%) were male and 98 (48.8%) were female. The frequency of drain placement was higher in Group 2 (P = 0.005). No stump leakage was observed in either group, but the incidence of other postoperative complications was significantly higher in the EL group (P=0.041). The use of HC is cheaper than the use of EL. There was no significant difference in other parameters. Both EL and HC are used safely in LA. Although both methods do not have obvious advantages over each other, HC stands out one step further due to its more affordable cost and less possibility of postoperative complications.

Keywords

• appendectomy
• complications
• stump
• laparoscopy

References

1. 1. Semm K. Endoscopic appendectomy. Endoscopy 1983;15(2):59-64.
2. 2. Guller U, Hervey S, Purves H, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004;239(1):43-52.
3. 3. Mayir B, Bilecik T, Ensari CO, Oruc MT. Laparoscopic appendectomy with hand-made loop. Wideochir Inne Tech Maloinwazyjne. 2014;9(2):152-6.
4. 4. Agresta F, Arezzo A, Allaix ME, Adolfo S, Anania G. Current status of laparoscopic colorectal surgery in the emergency setting. Updates Surg.2016;68(1):47-52.
5. 5. Raptis DA, Breitenstein S. Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses. Langenbeck Arch Surg. 2016;401(5):661-6.
6. 6. Lasek A, Wysocki M, Mavrikis J, et al. Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis - results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study. Acta Chir Belg. 2020;120(2):116-23.
7. 7. Partecke LI, Kessler W, Patrzyk M, Heidecke CD, Bernstorff WV. Comparison among different closure methods of the appendicular stump in laparoscopic appendectomy. Surg Technol Int. 2011;21:85-91.
8. 8. Beldi G, Muggli K, Helbling C,Schlumpf R. Laparoscopic appendectomy using endoloops: a prospective, randomized clinical trial. Surg Endosc. 2004;18(5):749-50.

9. 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(12):2851-4.
10. 10. Gomes CA, Sartelli M, Di Saverio S, et al. Acute appendicitis: proposal of a new comprehensive grading system based on clinical, imaging and laparoscopic findings. World J Emerg Surg. 2015;10:60.
11. 11. Miyano G, Urao M, Lane GJ, et al. A prospective analysis of endoloops and endostaples for closing the stump of the appendix in children. J Laparoendosc Adv Surg Tech A. 2011;21(2):177–179.
12. 12. Colak E, Kement M, Ozlem N, et al. 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(3):255-8.
13. 13. Ortega AE, Hunter JG, Peters JH, Swanstrom LL, Schirmer B. A prospective, randomized comparison of laparoscopic appendectomy with open appendectomy. Laparoscopic Appendectomy Study Group. Am J Surg. 1995;169(2):208-12; discussion 212-3.
14. 14. Wei B, Qi CL, Chen TF, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis.Surg Endosc. 2011;25(4):1199-208.
15. 15. Loh A, Taylor RS. Laparoscopic appendectomy. Br J Surg. 1992;79(4):289-90.
16. 16. Schreiber JH. Early experience with laparoscopic appendectomy in women. Surg Endosc.1987;1(4):211-6.
17. 17. Delibegović S, Karabeg R, Simatović M. Securing the base of the appendix during laparoscopic appendectomy. Med Glas (Zenica). 2020;17(2):252-5.
18. 18. Makaram N, Knight SR, Ibrahim A, Patil P, Wilson MSJ. Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature. Ann Med Surg (Lond). 2020;57:228-35.
19. 19. Mannu GS, Sudul MK, Bettencourt-Silva JH, et al. Closure methods of the appendix stump for complications during laparoscopic appendectomy. Cochrane Database Syst Rev. 2017;11(11):CD006437.
20. 20. Gomes CA, Junior CS, de Peixoto RO, et al. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World J Emerg Surg. 2013;8(1):35.
21. 21. Bali I, Karateke F, Özyazici S, et al. Comparison of intracorporeal knotting and endoloop for stump closure in laparoscopic appendectomy. Ulus Travma Acil Cerrahi Derg. 2015;21(6):446-9.
22. 22. Rickert A, Bönninghoff R, Post S, et al. Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg. 2012;397(2):327-31.
23. 23. 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(12):1203-6.
24. 24. Akbiyik F, Senel E, Bayram-Kabacam G, et al. A comparison of polymer clips and endoloop applications for securing the appendiceal stump during laparoscopic surgery in children. Surg Laparosc Endosc Percutan Tech. 2011;21(5):349-52.
25. 25. Lucchi A, Berti P, Grassia M, et al.Laparoscopic appendectomy: Hem-o-lok versus endoloop in stump closure. Updates Surg. 2017;69(1):61-5.
26. 26. Knight SR, Ibrahim A, Makaram N, Patil P, Wilson MSJ. The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: A systematic review. Eur J Trauma Emerg Surg. 2019;45(4):665-70.
27. 27. Schick KS, Hüttl TP, Fertmann JM, et al. A critical analysis of laparoscopic appendectomy: how experience with 1,400 appendectomies allowed innovative treatment to become Standard in a university hospital. World J Surg.2008;32(7):1406-13.
28. 28. Matyja M, Strzalka M, Rembiasz K. Laparosocopic appendectomy, cost-effectiveness of three different techniques used to close the appendix stump. Pol Przegl Chir. 2015;87(12):634-7.