Journal
ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND
Volume 100, Issue 6, Pages 454-458Publisher
ROYAL COLL SURGEONS ENGLAND
DOI: 10.1308/rcsann.2018.0036
Keywords
Appendicitis; Laparoscopic appendicectomy; Polymeric clips; Endoscopic ligature; Endoloop
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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 pound compared with 49 pound for endoloops per operation, which rose to 70 pound 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.
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