The use of polymeric clips in securing the appendiceal stump during laparoscopic appendicectomy: a systematic review

Stephen Robert Knight, Abdulla Ibrahim, Nav Makaram, Pradeep Patil, Michael Samuel James Wilson (Lead / Corresponding author)

    Research output: Contribution to journalReview article

    4 Citations (Scopus)

    Abstract

    Purpose: A key step during laparoscopic appendicectomy is securing the appendiceal stump. This has traditionally been achieved using vicryl endoloops, but increasing evidence suggests that the use of polymeric clips (Hem-o-lok) may be a safe and viable method. Current evidence for its clinical use in laparoscopic appendicectomy is unknown. We performed a systematic review of the literature examining the clinical outcomes of laparoscopic appendicectomy using polymeric clips compared to other methods of stump closure.

    Methods: A systematic literature review based on PRISMA guidelines was performed using MEDLINE, PubMed, EMBASE and Cochrane library databases between 2000 and 2017. All studies analysing appendiceal stump closure during laparoscopic appendicectomy using polymeric clips compared to other methods of stump closure were included. The methodological quality of the included studies was assessed using the Cochrane Handbook for Systematic Reviews. The review was registered with the PROSPERO register of systematic reviews.

    Results: Ten studies were included, involving 702 patients, 7 of which were prospective studies and 1 a randomised control trial. Polymeric clips were found to be the cheapest method (€20.47 average per patient) and also had the lowest rate of complications (2.7%) compared to other commonly used closure methods. Meanwhile, operative time and duration of in-patient stay were similar between groups.

    Conclusions: Current evidence suggests that polymeric clips are an effective and cost-efficient method for stump closure in laparoscopic appendicectomy for acute appendicitis. Further high-quality evidence is required before polymeric clips can be recommended as the gold standard for appendiceal stump closure.

    Original languageEnglish
    Pages (from-to)665-670
    Number of pages6
    JournalEuropean Journal of Trauma and Emergency Surgery
    Volume45
    Issue number4
    Early online date28 Feb 2019
    DOIs
    Publication statusPublished - Aug 2019

    Keywords

    • Appendicectomy
    • Polymeric clips
    • Stump closure

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