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

Abstract

BACKGROUND: The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler. METHODS: This was a prospective study in 2 stages. In phase 1, 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups. In 14 patients, the appendicular base was occluded by using an endoscopic linear cutting stapler. In the remaining 14, the appendicular base was ligated by using nonabsorbable polymeric clips (Hem-o-lock). We compared the surgical time, hospital stay, hospital costs, and complications. In phase 2, 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the appendicular mesentery. Ligation of the appendicular stump was performed with Hem-o-lock clips. RESULTS: We found a significant difference in procedure costs, with the endoscopic staplers being more expensive. CONCLUSION: The use of polymeric clips is feasible, safe, and an economic alternative for ligation of the appendicular stump during laparoscopic appendectomies.