Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses.
OBJECTIVE
Polymeric clips (hem-o-lok ligation system) are a novel alternative for securing the base of the appendix during laparoscopic appendectomy. There is a lack of systematic evaluation of polymeric clips to close the appendiceal stump with regard to postoperative intra-abdominal abscesses. The aim of this study was to compare the hem-o-lok ligation system with conventional devices.


METHODS
The outcome of 813 consecutive patients, operated between 2009 and 2013 receiving laparoscopic appendectomy either with hem-o-look or endoloop for acute appendicitis, was analysed. The risk of postoperative intra-abdominal abscesses was investigated for two different techniques to close the appendiceal stump using univariate and multivariate analyses.


RESULTS
Hem-o-lok clips were used in 54 % (n = 435) and endoloop sutures were applied in 46 % (n = 378) of the patients. Based on the multivariate analysis, the postoperative lack of antibiotics as well as the application of endoloop was identified as an independent predictive factor for the development of postoperative intra-abdominal abscesses. Comparing the closure techniques, the odds ratio (OR) was 0.25 (95 % CI 0.09-0.69; p < 0.008).


CONCLUSIONS
Closure of the appendiceal stump using the non-absorbable hem-o-lok ligation system did result in a reduced rate of intra-abdominal surgical abscesses as compared to the application of endoloops.
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. christopher.soll@ksw.ch.
Christopher
http://orcid.org/0000-0003-3398-7385
C
Soll
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Paloma
P
Wyss
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Hans
H
Gelpke
Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
Dimitri Aristotle
DA
Raptis
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Stefan
S
Breitenstein
D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000009:adverse effects / Q000295:instrumentation*; D001064:Appendicitis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation; D008026:Ligation / Q000295:instrumentation; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013525:Surgical Instruments; D058106:Wound Closure Techniques / Q000295:instrumentation*; D055815:Young Adult
Abscess; Appendectomy; Clip