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Why Hem-o-lok is Superior to the Other Methods of Securing the Base of Appendix in Complicated Appendicitis of Children?

1 Department of Surgery, Faculty of Medicine, University Clinical Center, University of Tuzla, Tuzla, Bosnia and Herzegovina
*Corresponding author: Samir Delibegovic, Department of Surgery, Faculty of Medicine, University Clinical Center, University of Tuzla, Tuzla, Bosnia and Herzegovina. Tel: +387-35303279, Fax: +387-35250474, E-mail:
Annals of Colorectal Research. 2014 June; 2(2): e21508 , DOI: 10.17795/acr-21508
Article Type: Letter; Received: Jun 30, 2014; Accepted: Jul 2, 2014; epub: Jun 30, 2014; ppub: Jun 30, 2014

Keywords: Appendix; End Loop; Stapler; Titanium; Clip

See the commentary-article "Laparoscopic Appendectomy in Complicated Appendicitis of Children" in volume 2, 16599.

Dear Editor

Recently, I have read the excellent article, entitled “Laparoscopic Appendectomy in Complicated Appendicitis of Children” by Mohajerzadeh et al. (1). The authors had concluded that laparoscopic approach was the method of choice for all children presenting with complicated appendicitis. In comparison with patients who had open appendectomy, laparoscopic approach has been associated with less postoperative pain, lower incidence of infectious complications, and reduced length of hospital stay (2).

It was interesting that the base of appendix in this study had been secured by Hem-o-lok plastic clip. They did not mention what size of clip they had used, and whether they had used one or two clips on the base of appendix. We have shown the safety of using only one Hem-o-lok clip of XL size in our previous works (3, 4). It is important to note that biocompatibility of plastic clip is better than Vicryl or PDS endoloops (5), the application is very simple, and can be done by every surgeon without any previous training (3). Even the development of adhesion after laparoscopic appendectomy is lower in Hem-o-lok than in the endoloop (6). The titanium stapler line shows the best biocompatibility and the lowest rate of formation of adhesions (7). Although appendectomy is linked with a low percentage of re-hospitalization due to adhesion (0.9%), it contributes to more than 7% of the total re-hospitalizations for surgical procedures in the lower abdomen (8). On the other hand, the price of stapler is dramatically higher in comparison to Hem-o-lok (4) as a disadvantage, the hem-o-lok cannot encircle the base of appendix in adult population in rare situation (3, 4). Nevertheless, because of the smaller diameter of appendix in the pediatric population, it cannot happen. Titanium DS-clip, which is designed for securing the base of appendix, has been recently introduced (9). It consolidates the advantages of titanium regarding biocompatibility and is cheaper than stapler is. However, the price is still higher than Hem-o-lok XL-sized clips. Nevertheless, searching for the best method of securing the appendix will be continuous.


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