1. THE EFFICIENCY OF NONABSORBABLE POLYMER CLIPS IN LAPAROSCOPIC CHOLECYSTECTOMY AND APPENDECTOMY
- Author
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Kraljević, Jasenka, Grandić, Leo, Perko, Zdravko, Barčot, Ognjen, Krnić, Dragan, Stipić, Radoslav, and Majerovic, Mate
- Subjects
cholecystectomy ,appendectomy ,laparoscopic ,polymer clips ,surgical procedures, operative ,cardiovascular diseases - Abstract
Objective: The key step during laparoscopic appendectomy and cholecystectomy is the occlusion of vascular structures, cystic duct and appendiceal stump. It may be performed using different techniques that affect the outcome and cost of the surgery. The objective here is to analyze outcomes and costeffectiveness of nonabsorbable polymer clips in laparoscopic appendectomy and cholecystectomy. Methods: We evaluated data of 85 patients who underwent laparoscopic appendectomy and 136 who underwent laparoscopic cholecystectomy. The patients who underwent laparoscopic appendectomy were divided in groups where the appendiceal stump occlusion was performed using an endocutter (n=17 ; Ethicon Endo-Surgery, USA), endoloops (n=38 ; Covidien, USA), and nonabsorbable polymer clips (n=30 ; Grena, UK), respectively. In laparoscopic cholecystectomy group titanium clips (Ethicon Endo- Surgery, USA) were used in one group (n=83) while in other (n=53) we used polymer clips (Grena, UK). The data on patients demographics, intra- and postoperative complications, hospital stay and costs were analyzed. Results: The baseline clinical and demographic characteristics were similar among the groups. All costs used in this study reflect the direct costs of key steps of each procedure. The cost of two types of clips slightly varied for both procedures (titanium clips cartridge €10.99, nonabsorbable polymeric clips cartridge €16.48). The effectiveness of nonabsorbable polymer clips seem to be comparable to that of titanium clips. Treatment of the appendiceal stump by nonabsorbable polymeric clips decreases the expense associated with the use of a endostapler and endoloop. The cost of the 45 mm endocutter and cartridge is €371.45, for one endoloop is €30.66, and for nonabsorbable polymeric clips cartridge €16.48. The type of device applied had no influence on early postoperative complications. Conclusion: Nonabsorbable polymer ligating clips may provide safe and effective alternative for endostaplers, endoloops and titanium clips during laparoscopic cholecystectomy and appendectomy. They provide some technical advantages, including feature of low interference with CT, MRI and X- ray, while in the same time ensure substantial cost saving.
- Published
- 2015