K Kliuchanok1, W Keßler2, I Partecke2, U Walschus2, T Schulze2, C D Heidecke1, M Patrzyk3. 1. Department of Surgery, Ameos Hospital, 17373, Ueckermünde, Germany. 2. Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald; Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. 3. Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald; Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. patrzyk@uni-greifswald.de.
Abstract
PURPOSE: The aim of this long-term study was the comparison of appendiceal stump closure with polymeric clips or staplers with respect to perioperative costs and surgical outcome under routine conditions in a university centre. METHODS: For this retrospective chart review, a total of 618 patients undergoing laparoscopic appendectomy for suspected acute appendicitis between 2010 and 2017 were reviewed: 410 patients in the stapler group and 208 patients in the clip group. The database contained demographic data, operation time, inflammation parameters, closure method of the stump, surgeon status, length of hospital stay, and complications as well as histology reports. The costs were also compared. RESULTS: Clip application was more likely among younger patients (mean age 33.6 years vs. 41.7 years). Histopathological evidence for appendiceal pathology was found in 96.6% of patients in the clip group and 99.5% of patients in the stapler group. Laparoscopic appendectomy in the clip group was more frequently performed by resident physicians (69.2%) than in the stapler group (57.8%). The mean postoperative stay was 2.9 days in the clip group and 3.7 days in the stapler group. The use of the polymeric clip resulted in considerable cost savings (19.94€ vs. 348.70€). CONCLUSIONS: The use of polymeric clips for appendiceal stump closure during appendectomy is safe and effective. The base of the appendix is amenable to clipping in 32% of appendectomies in adult patients. This study supports the use of polymeric clips over staplers to decrease cost and environmental impact.
PURPOSE: The aim of this long-term study was the comparison of appendiceal stump closure with polymeric clips or staplers with respect to perioperative costs and surgical outcome under routine conditions in a university centre. METHODS: For this retrospective chart review, a total of 618 patients undergoing laparoscopic appendectomy for suspected acute appendicitis between 2010 and 2017 were reviewed: 410 patients in the stapler group and 208 patients in the clip group. The database contained demographic data, operation time, inflammation parameters, closure method of the stump, surgeon status, length of hospital stay, and complications as well as histology reports. The costs were also compared. RESULTS: Clip application was more likely among younger patients (mean age 33.6 years vs. 41.7 years). Histopathological evidence for appendiceal pathology was found in 96.6% of patients in the clip group and 99.5% of patients in the stapler group. Laparoscopic appendectomy in the clip group was more frequently performed by resident physicians (69.2%) than in the stapler group (57.8%). The mean postoperative stay was 2.9 days in the clip group and 3.7 days in the stapler group. The use of the polymeric clip resulted in considerable cost savings (19.94€ vs. 348.70€). CONCLUSIONS: The use of polymeric clips for appendiceal stump closure during appendectomy is safe and effective. The base of the appendix is amenable to clipping in 32% of appendectomies in adult patients. This study supports the use of polymeric clips over staplers to decrease cost and environmental impact.
Authors: Gurdeep S Mannu; Maria K Sudul; Joao H Bettencourt-Silva; Elspeth Cumber; Fangfang Li; Allan B Clark; Yoon K Loke Journal: Cochrane Database Syst Rev Date: 2017-11-13
Authors: Anna Lasek; Michał Pędziwiatr; Jakub Kenig; Maciej Walędziak; Michał Wysocki; Judene Mavrikis; Piotr Myśliwiec; Maciej Bobowicz; Kamil Astapczyk; Mateusz Burdzel; Karolina Chruściel; Rafał Cygan; Wojciech Czubek; Natalia Dowgiałło-Wnukiewicz; Jakub Droś; Paulina Franczak; Wacław Hołówko; Artur Kacprzyk; Wojciech Konrad Karcz; Paweł Konrad; Arkadiusz Kopiejć; Adam Kot; Karolina Krakowska; Maciej Kukla; Agnieszka Leszko; Leszek Łozowski; Piotr Major; Wojciech Makarewicz; Paulina Malinowska-Torbicz; Maciej Matyja; Maciej Michalik; Adam Niekurzak; Damian Nowiński; Radomir Ostaszewski; Małgorzata Pabis; Małgorzata Polańska-Płachta; Mateusz Rubinkiewicz; Tomasz Stefura; Anna Stępień; Paweł Szabat; Rafał Śmiechowski; Sebastian Tomaszewski; Victor von Ehrlich-Treuenstätt; Maciej Wasilczuk; Anna Wojdyła; Jan Wojciech Wroński; Leszek Zwolakiewicz Journal: Medicine (Baltimore) Date: 2018-12 Impact factor: 1.889