Nonabsorbable Polymeric Clips for Appendicular Stump Closure during Laparoscopic Appendectomy.

Abstract

Background: Acute appendicitis is the most frequent cause of emergency surgical procedures performed worldwide. Laparoscopic appendectomy (LA) has gained considerable popularity in the last decades. However, the ideal method for appendicular stump closure during LA is still debatable and depends on the surgeon's preference and intraoperative judgment. The endoloop ligatures (EL) is the most used method but its application is quite challenging. The efficacy of nonabsorbable polymeric clip (PC) has been proven and it was first described for appendicular stump closure in 2007.

Methods: A retrospective comparative cohort study was conducted including all consecutive patients who underwent LA from January 2017 to the end of 2023 in a tertiary university hospital. Data were retrieved from their electronic medical files. The patients were classified into 2 groups. The appendicular stump was closed using EL, in the first group, and using PC, in the second group. The calculated operative time started from the patient's entry to the operating theatre till transfer to the recovery room.

Results: Out of 556 patients who underwent LA, 483 patients were included and classified into Group I (313 patients with EL), and Group II (170 patients with PC). Intraoperatively, complicated acute appendicitis was found in 27.8% and 36.5% and the median diameter of the appendix was reported 10 and 11.4 millimeters, respectively. The procedure was significantly shorter using PC (70 minutes vs 75 minutes, P = .03) and the cost was lower using PC ($42.6 vs $95.8). Intra-abdominal collection was reported in 1.6% and 0.6%, localized abscess was reported in 1% and 0.6%, and the hospital readmission rate was 3.19% and 1.18%, respectively.

Conclusion: The use of nonabsorbable PCs is safe and feasible for appendicular stump closure during LA for acute appendicitis.