Comparison between Endoloop ligature and Hem-o-lok clip (Polymer ligation) for appendiceal stump closure during laparoscopic appendicectomy

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing laparoscopic appendicectomy is Hem-o-lok clip safer than Endoloop ligature for closure of appendiceal stump?

The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the safety and cost effectiveness of Hem-o-lok clip (Polymer ligation) versus Endoloop ligature for appendiceal stump closure during laparoscopic appendicectomy. We concluded that Hem-o-lok clip is a safe and feasible tool for appendiceal stump closure. It's also a cost-effective way and could be a cheaper option compared to other measures.

Bladder Neck Contracture with Hem-o-Lok Clips Migration after Robotic-Assisted Radical Prostatectomy: A Case Report and Literature Review

Hem-o-lok clips are widely used in robotic-assisted radical prostatectomy (RARP). However, clips-related complications have been reported, including intravesical migration. Here, we share a 60-year-old male case with newly diagnosed prostatic adenocarcinoma. With an unfavorable intermediate risk, he was admitted for RARP. He was discharged from hospital without any immediate complications. However, he reported progressive dysuria and slow urine stream 6 months after surgery. Cystoscopy showed severe bladder neck contracture (BNC), and 2 Hem-o-lok clips were found intravesically and removed during bladder neck incision. Subsequently, fiberocystoscopy revealed another 2 clips near the bladder neck with mild BNC after another 6 months. These 2 clips were also removed during bladder neck dilatation. His urination status then improved without further obstruction. Clip migration after RARP is uncommon; however, clinicians must keep this in mind when patients present with new complaints such as lower urinary tract symptoms, hematuria, and recurrent urinary tract infections.

Usefulness of repair using Hem-o-lok™ for peritoneal tear as a complication of totally extraperitoneal repair: Case series

Introduction

Peritoneal tear (PT) is a frequent intraoperative event during totally extraperitoneal repair (TEP). We aimed to introduce our surgical technique for PT during TEP to avoid the more difficult TEP procedure.Methods

One surgeon with 10 years of experience performed our TEP method in 147 TEP cases from January 2012 to June 2019. We investigated the repair time of each repair technique using endoscopic suturing (suturing group, SG) and endoscopic Hem-o-lok stapling (CG).

Results

Twenty-three (15.6%) PT cases occurred as TEP complication. The mean repair times (with standard deviation) of the PT were 16.2 ± 13 and 7.6 ± 7.0 min in the SG and CG, respectively, indicating a significant difference (P = 0.043). The repair time of the PT using Hem-o-lok (Teleflex, Wayne, PA, USA) stapling was shorter than that using endoscopic suturing, which was significantly different despite the length of the PT.

Conclusion

Hem-o-lok stapling is feasible in case of PT during TEP.

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The peritoneal tear repair time when using Hem-o-lok stapling was shorter than that using endoscopic suturing.

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Hem-o-lok stapling is very effective for peritoneal tear during extraperitoneal repair.

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The technique is simple and can possibly replace metal stapling.

Transmural migration of azygous vein Hem-O-lok clip causing food bolus 3 months following uneventful minimally invasive oesophagectomy

BACKGROUND

Hem-o-lok clips are widely deployed in various laparoscopic and robotic operations. Their migration is not very common and majority of reported cases are limited to biliary, prostatic and vesico-urethral cases.

METHODS

Herein, we would like to report the first case of transmural migration of Hem-o-lok clip from azygous vein stump following totally minimally invasive two-stage oesophagectomy for squamous cell carcinoma of the distal oesophagus, into the gastric conduit 3-months following uneventful discharge. The patient presented with 5-days history of worsening dysphagia.

RESULTS

The subsequent gastroscopy revealed normal gastric conduit with two Hem-o-lok clips containing the azygous vein stump within its lumen at the level of the oesophago-gastric anastomosis, propagating a food bolus obstruction. The foreign body was successfully removed and the patient was discharged the same day without any complications at 5 months follow up.

CONCLUSION

Hem-o-lok clip migration trends to be a well-established event. However, their mechanism and exact incidence remains elusive to this date. To the best of our knowledge, their migration in oesophageal cancer surgery has not been reported.

Laparoscopic appendectomy: Hem-o-lok versus Endoloop in stump closure

There are several techniques described to close the appendicular stump during laparoscopic appendectomy. The aim of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stump, comparing these data with those concerning the endo-loop. We conducted a retrospective study that compared two groups of patients who underwent laparoscopic appendectomy from 2010 to 2015 at our institution. We used the Endoloop to close the stump in the first group (group I) and the Hem-o-lok in the second group (group II). We reviewed patient's data including: complications, operative time, length of stay, costs. There were 121 patients in group I and 138 patients in group II. The mean operative times were 40.5 min in group I and 36.4 min in the group II. No intraoperative complications and no mortality were observed in either group. The mean postoperative length of hospital stay was similar for both groups. There was no rehospitalization after discharge. The complication rate did not reach statistical significance between the groups. The cost of the procedure using the Hem-o-lok has been lower than using the Endoloop. Both the Endoloop and Hem-o-lok are safe for the closure of the appendicular stump. Hem-o-lok appears to be superior than Endoloop in terms of easeness of use and cheapness, maintaining the same safety.