[Use of polymeric clips in laparoscopic appendectomy].

Unlabelled: The aim of this study was to evaluate efficiency and safety of using non-absorbable polymeric clips in securing the stump of appendix during laparoscopic appendectomy.

Patients And Methods: We have analyzed patients of Surgical Clinic of 4th Military Clinical Hospital in Wrocław, who underwent laparoscopic appendectomy from 2006 to 2010. Patients were divided into 3 groups regarding to the way of securing stump of appendix: in group one non-absorbable polymeric clips Hem-o-lok were used, in group two endostaplers Endostapler Flexi and in group three endoloop ligatures or traditional ligatures. Evaluated data included operative time, intra- and postoperative complications, hospital stay and costs of used materials.

Results: There were performed 90 laparoscopic appendectomies between 2006 and 2010 in Surgical Clinic of 4th Military Clinical Hospital in Wrocław. Non-absorbable polymeric clips Hem-o-lok were used in 30 patients, endostaplers in 27 and endoloop ligatures in 33 cases. There were no intra- and perioperative complications such as bowel injury, appendix stump leak or early bowel obstruction. Two cases of postoperative pericaecal (perityphlic) abscess (1 in group one, 1 on group two) were observed, in both cases antibiotic therapy was successive, patients didn't require surgery. Wound infection was observed in 3 cases (2 in group one, 1 in group three). Mean operative time was 70,5 min. in group one (from 40 to 115 min.), in group two 58,5 min. (from 25 to 110 min.), and in group three 76,3 min. (from 40 to 120 min.). Mean hospital stay was 2,6 days in group one (from 2 to 4 days), in group two 2,9 days (from 2 to 7 days.), and in group three 2,88 days (from 2 to 8 days).

Conclusions: Using of non-absorbable polymeric clips Hem-o-lok is an efficient and safe way of securing the stump of appendix during laparoscopic appendectomy, comparing to other methods (endostapler and Endoloop ligature). Advantages of polymeric clips are facility of application (most of surgeons have experience in clips application during performed for many years laparoscopic cholecystectomies) and low cost (comparing to endostaplers).