Effective Appendix Stump Closure Using the Doubleshanked Titanium Ligation Clip (DS Clip): A Case Report

Imaoka Kouki

Fujisaki Seiji

Fukuhara Sotaro

Ono Kosuke

Sawada Hiroyuki

Shishida Masayuki

Hirata Yuzo

Fukuda Saburo

Takahashi Mamoru

Sakimoto Hideto

Hiroshima Journal of Medical Sciences

[PISSN] 0018-2052

[EISSN] 2433-7668

[NCID] AA00664312

Background: During laparoscopic appendectomy, several methods and devices can be used to close the appendicular stump, such as endoloops, linear staplers, clips, and open purse-string sutures. The Double-shanked Titanium Ligation Clip® (DS clip; B. Braun Aesculap, Tuttlinger, Germany), a new device that can be used to close the appendicular stump, was approved for use in Japan in March 2015. We report a case of effective appendix stump closure using DS clips.
Case presentation: An 81-year-old man was admitted to our hospital with complaints of severe pain in the right lower quadrant of the abdomen. Abdominal contrast-enhanced computed tomography showed a thickened appendix (1.7 cm in diameter) with fecal stones, while acute inflammatory signs were visible around the appendix. He was diagnosed with acute appendicitis for which laparoscopic appendectomy was performed with a curative intent. It was difficult to mobilize the cecum because of inflammation, so we attempted to use DS clips instead of linear staplers. A histological examination revealed gangrenous appendicitis. The patient’s postoperative course was uneventful and he was discharged 10 days postoperatively. We also used DS clips to close the appendicular stump in 12 other cases. We observed no intra- or postoperative complications and no cases of mortality.
Conclusion: The management of an appendicular stump using DS clips during laparoscopic appendectomy was simple, safe, and cost-effective. DS clips may be an alternative method to linear staplers.

Double-shanked Titanium Ligation Clip

laparoscopic appendectomy

acute appendicitis

Medical sciences [ 490 ]

eng

Hiroshima University Medical Press

Copyright (c) 2018 Hiroshima University Medical Press

[ISSN] 0018-2052

[ISSN] 2433-7668

[NCID] AA00664312

[DOI] 10.24811/hjms.67.1_31

[DOI] https://doi.org/10.24811/hjms.67.1_31