Naofumi Yoshida, PhD, MD1, Yusuke Watanabe, PhD, MD1, Motoya Takeuchi, PhD, MD1, Masanobu Kusano, PhD, MD1, Yuma Ebihara, PhD, MD2, Satoshi Hirano, Prof, PhD, MD2. 1Department of Gastroenterological Surgery, Sapporo Kyoritsu Gorinbashi Hospital, 2Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine
Introduction: There are various devices to close appendiceal stump in laparoscopic appendectomy (LA), such as linear stapler, endo-loop, intracorporeal ligation, polymeric clip, and bipolar endocoagulation. While these were reported to be safe for closing stump, linear stapler has some drawbacks as it costs highly and produces some infectious waste. We report our initial experience with using 16.2 mm-long double ligation clips for closing the stump compared with a linear stapler in LA.
Methods: From August 2014 to July 2016, consecutive patients undergoing LA in our hospital were included in this study. The patients were divided into two groups based on periods. Before August 2015 (pre group), the stump was closed using a linear stapler. Appendiceal artery was ligated with double clip technique with metallic clips, or ligated with vessel sealing device. In the last 12 months (post group), the closure was done using titanium double-shanked clips (DS-ClipTM: size -XL). Two groups were retrospectively compared with regard to patients’ background, clinical outcomes, procedural costs and infectious waste. The costs and waste were compared with the differences of the disposal devices used for closing the appendiceal stumps and ligating vessels between the pre group and the post group.
Results: A total of 36 consecutive patients were included for analysis (22 patients in the pre group and 14 in the post group). The median age of all patients was 35, including 19 males (53%). There were no significant differences between both groups with regard to patients’ backgrounds and clinical outcomes, except for the median age. No patient was converted to open procedure. In the post group, double ligation clips were used for 13 cases (93%) to close appendiceal stumps. One patient (7%) required a stapler for closing the stump due to severe inflammation. After application of the ligation clips, 82% reduction of procedural costs were attained and 10.2 kg of infectious waste were reduced compared to those associated with linear stapler usage.
Conclusion: Using a large double ligation clip for closing the appendiceal stump can reduce procedural costs and infectious waste in comparison with a stapler without compromising on safety in laparoscopic appendectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79968
Program Number: P427
Presentation Session: Poster (Non CME)
Presentation Type: Poster
