title: The use of a single Hem-o-lok clip in securing the base of the appendix during laparoscopic appendectomy.
abstract: BACKGROUND
  During laparoscopic appendectomy, the standard technique in securing the base of the appendix is by endoloop ligatures or a stapler. We earlier demonstrated the possibility of the application of a double Hem-o-lok(®) clip in securing of the base of the appendix. The application of only one plastic clip would, however, lower the cost of the laparoscopic procedure even further and shorten the surgery time. The objective of this prospective study was to evaluate the possible advantages of securing of the base of the appendix using only one Hem-o-lok clip.
  
  
  METHODS
  The 90 patients with acute appendicitis were randomly divided into three groups: In the first group, the base of the appendix was secured using one endoloop ligature, in the second group using a 45-mm stapler, and in the third group using only one nonabsorbable Hem-o-lok clip. The data collected included age, gender, surgery time, time of endoloop/stapler/clip application, hospital stay, costs associated with these, and intra- and postoperative complications.
  
  
  RESULTS
  There were no significant differences in hospital stay among the three groups of patients; but the average time of the operation was significantly longer in the endoloop group than in the stapler group (P=.002), whereas the endoloop and Hem-o-lok groups were not statistically different (P=.22). The time of application of the endoloop was significantly longer than for the stapler (P<.0001) and Hem-o-lok (P<.0001) groups. The time of application of the stapler was significantly shorter than that of the Hem-o-lok (P<.0001). However, the price of one endoloop is €28.85, for the stapler is €230.7, and for one Hem-o-lok clip is €2.35.
  
  
  CONCLUSIONS
  The use of one Hem-o-lok clip is as safe as an endoloop and/or stapler; however, the time of the laparoscopic procedure using the Hem-o-lok was shorter in comparison with the use of an endoloop, with the cost of the procedure being the lowest.
authors.affiliation: Department of Surgery, University Clinic Center Tuzla, Tuzla, Bosnia and Herzegovina. delibegovic.samir@gmail.com
authors.forename: Samir
authors.initials: S
authors.lastname: Delibegović
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D017522:Bosnia and Herzegovina; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D017792:Surgical Stapling / Q000191:economics; D055815:Young Adult