title: Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis.
abstract: BACKGROUND
  Closure of appendicular stump has been performed in different ways; however, the use of the metal endoclip in complicated grades of acute appendicitis, has not been evaluated yet in a prospective way.
  
  
  OBJECTIVE
  To establish the effectiveness of appendiceal stump closure by metal endoclip for complicated appendicitis.
  
  
  METHODS
  From January 2009 to January 2011 were evaluated 131 consecutive patients who underwent a laparoscopic appendectomy for complicated acute appendicitis. From those, 118 underwent appendiceal stump closure by metal endoclip. The patient's age ranged from 12 to 75 years old (31.7 ± 13.3) and 52.7% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix, which may lead to abscess formation and degrees of peritonitis. The outcomes viability, operative time, infection complication, operative complications, and conversion rate were chosen to evaluate the procedure.
  
  
  RESULTS
  The appendiceal stump closure by metal endoclip was used in 90% of cases. The presence of appendix base necrosis was the most important factor involved in failure of the procedure. Laparoscopic knot (1.5%), laparoscopic endo-suture (3.8%) and video assisted laparotomy (4.7%) were the alternatives used in difficult cases. The mean operative time was (67.54 ± 28.13 minutes). The wound and intra-abdominal infection rates were 2.54% and 5.08%, respectively. There were no operative complications and the conversion rate was 0.85%.
  
  
  CONCLUSIONS
  The appendiceal stump closure by metal endoclip, in complicated grades of acute appendicitis, is a safe and effective procedure. In patients with appendix base necrosis it should be avoided in favor of other alternatives.
authors.affiliation: Department of Surgery, Hospital Universitário (HU), Universidade Federal de Juiz de Fora (UFJF) - Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA) -Brasil, Bairro Bom Pastor, Minas Gerais, Brasil. caxiaogomes@terra.com.br.
authors.forename: Carlos Augusto
authors.initials: CA
authors.lastname: Gomes
authors.forename: Cleber Soares
authors.initials: CS
authors.lastname: Junior
authors.forename: Rodrigo Oliveira
authors.initials: RO
authors.lastname: de Peixoto
authors.forename: Jose Murillo Bastos
authors.initials: JM
authors.lastname: Netto
authors.forename: Camila Couto
authors.initials: CC
authors.lastname: Gomes
authors.forename: Felipe Couto
authors.initials: FC
authors.lastname: Gomes
references.citation: Tech Coloproctol. 2012 Apr;16(2):139-41
references.pmid: 21984051
references.citation: Eur J Surg. 1998 Nov;164(11):833-40; discussion 841
references.pmid: 9845129
references.citation: World J Surg. 2010 Sep;34(9):2026-40
references.pmid: 20549210
references.citation: Langenbecks Arch Surg. 2010 Nov;395(8):1077-82
references.pmid: 20577759
references.citation: Br J Surg. 2001 Aug;88(8):1132; author reply 1133
references.pmid: 11488809
references.citation: Surg Laparosc Endosc Percutan Tech. 2012 Oct;22(5):463-6
references.pmid: 23047394
references.citation: Surg Endosc. 2004 Jun;18(6):969-73
references.pmid: 15095081
references.citation: World J Surg. 2002 Dec;26(12):1485-8
references.pmid: 12297916
references.citation: Am J Surg. 2000 Dec;180(6):456-9; discussion 460-1
references.pmid: 11182397
references.citation: Aust N Z J Obstet Gynaecol. 1990 Aug;30(3):231-3
references.pmid: 2147847
references.citation: Adv Surg. 2006;40:1-19
references.pmid: 17163092
references.citation: J Gastrointest Surg. 2006 Jun;10(6):906-10
references.pmid: 16769550
references.citation: Surg Endosc. 2001 Jul;15(7):660-2
references.pmid: 11591963
references.citation: Endoscopy. 1983 Mar;15(2):59-64
references.pmid: 6221925
references.citation: Surg Endosc. 1991;5(4):176-8
references.pmid: 1839575
references.citation: World J Surg. 2009 Feb;33(2):208-14
references.pmid: 19067040
references.citation: Am Surg. 1999 Oct;65(10):965-7
references.pmid: 10515544
references.citation: Surg Laparosc Endosc Percutan Tech. 2004 Aug;14(4):201-3
references.pmid: 15472547
references.citation: Br J Surg. 1985 Dec;72(12):971-2
references.pmid: 3910160
references.citation: J Laparoendosc Adv Surg Tech A. 2012 Apr;22(3):231-5
references.pmid: 22145572
references.citation: JSLS. 2007 Jan-Mar;11(1):59-62
references.pmid: 17651557
references.citation: Br J Surg. 1992 Aug;79(8):818-20
references.pmid: 1393483
references.citation: Br J Surg. 2006 Nov;93(11):1390-3
references.pmid: 16862615
references.citation: Can J Surg. 1999 Apr;42(2):138-42
references.pmid: 10223076
references.citation: Surg Endosc. 2006 Oct;20(10):1526-30
references.pmid: 16897293