Two-port retrograde laparoscopic appendicectomy for complicated pediatric appendicitis using a single Hem-O-Lock clip for the closure of the appendicular stump

Objective
The aim of this study was to assess the safety and the technical feasibility of retrograde laparoscopic appendicectomy for the pediatric population with complicated appendicitis (gangrenous, perforated, or forming mass) and to evaluate the security and advantages of closing the appendicular stump with a single Hem-O-Lock polymer clip.
Materials and methods
This is a prospective review of 82 pediatric patients presenting with acute appendicitis, of whom 50 patients were selected, according to computed tomographic abdomen and pelvis, to have a complicated appendicitis. All the data were collected and interventions were performed in Zagazig University Hospitals during the period from December 2012 to August 2014. All cases were operated by two-port retrograde appendicectomy using single Hem-O-Lock polymer clips to close the appendicular stump. The age, the sex of the patients, and complications were evaluated. Treatment complications and outcomes were recorded for all cases.
Results
Four of the 50 patients (8%) had postoperative complications; four patients developed intra-abdominal abscess postoperatively: two of them underwent laparoscopic drainage during the same admission and the other two patients were readmitted after 1 and 2 weeks, respectively, when one of them underwent ultrasound-guided drainage and the other one improved within 48 h by medical treatment. No other complications were noted apart from one case that converted to open surgery due to a large cecal mass with a gangrenous cecal wall. The cases of postoperative abscess occurred early during our initial experience, with laparoscopic appendectomy for complicated cases.
Conclusion
Retrograde appendicectomy allows easy access to operate complicated appendicitis. The use of two ports adds an advantage to the procedure by decreasing postoperative pain. The use of a single polymer clip is as secure as two clips for the closure of the appendicular stump even for a complicated appendix.