Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy

Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The prim...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2018-07, Vol.100 (6), p.454-458
Main Authors: Wilson, Msj, Maniam, P, Ibrahim, A, Makaram, N, Knight, S R, Patil, P
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Antibiotics
Appendectomy
Appendectomy - economics
Appendectomy - instrumentation
Appendectomy - methods
Appendicitis
Appendicitis - economics
Appendicitis - surgery
Body mass index
Cameras
Child
Endoscopy
Female
Hospital Costs - statistics & numerical data
Hospitals
Humans
Laparoscopy
Laparoscopy - economics
Laparoscopy - instrumentation
Laparoscopy - methods
Length of Stay - economics
Length of Stay - statistics & numerical data
Ligation
Lower GI surgery
Male
Methods
Middle Aged
Operative Time
Patient Readmission - statistics & numerical data
Postoperative Complications - economics
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Retrospective Studies
Surgery
Treatment Outcome
Young Adult
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Summary:Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. Results A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postoperative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2018.0036