Concerns About Laparoscopic Hemostatic Clips and Appendicitis Surgery

Laparoscopic hemostatic clips and issues related to appendicitis?

Hello Dr.
Chen, I recently underwent laparoscopic appendectomy.
Due to a lack of medical knowledge at the time and the urgent nature of appendicitis requiring surgery, I did not communicate properly with the physician.
I used non-absorbable metallic clips covered by health insurance.
After a postoperative X-ray follow-up, I learned that, although their safety is established, I find it psychologically difficult to accept, which has become a source of anxiety for me.
Upon reviewing relevant literature, I discovered that issues with titanium clips are not uncommon, and that the U.S.
has begun to widely use Hem-o-lok biological clips as a replacement for titanium clips.
Is there a way in Taiwan to consult a surgeon about the possibility of removing these clips? Would undergoing psychological counseling and evaluation meet the conditions for a physician to assist with the surgery? Additionally, I would like to inquire why the diagnostic certificate issued by the doctor and hospital states "acute appendicitis with generalized peritonitis," but when I checked my health records, it was listed as "unspecified acute appendicitis," which was quite surprising.

CHINGWEN, 20~29 year old female. Ask Date: 2017/12/22

Dr. Chen Jiaming reply Surgery

Titanium clips are compatible with body tissues and are still widely used in various surgical procedures today.
The number of reported cases in the literature is relatively rare compared to the actual number of surgeries performed.
In contemporary laparoscopic surgeries, the majority of smaller blood vessels are still managed using titanium clips, while larger vessels typically utilize Hem-o-lok clips.
The primary reason for this preference is the greater reliability and safety associated with the stability of vascular ligation.
There is generally no necessity or indication for removal.
Unless you are willing to cover all hospital, anesthesia, and surgical costs out-of-pocket without utilizing any health insurance resources, it is unlikely that a physician would agree to perform surgery solely for the rare occurrence of complications.
The diagnostic proof is based on actual medical records.
Health passbook inquiries can only provide an overview of international coding.
The two aspects you mentioned do not conflict in a medical context.

Reply Date: 2017/12/22

More Info

Your concerns regarding the use of laparoscopic hemostatic clips during your appendectomy are understandable, especially given the anxiety that can accompany surgical procedures and their aftermath. Let's address your questions and provide some clarity on the situation.

Firstly, it is important to note that titanium clips are widely used in laparoscopic surgeries, including appendectomies, due to their biocompatibility and effectiveness in controlling bleeding. The safety profile of these clips is well-established, and they are designed to remain in the body without causing harm. While there are occasional reports of complications associated with metallic clips, these instances are relatively rare compared to the vast number of procedures performed. The use of Hem-o-lok clips, which are absorbable and made from different materials, is indeed becoming more common in the United States, but this does not negate the effectiveness or safety of titanium clips.

Regarding your question about consulting a surgeon for the potential removal of the clips, it is essential to understand that the removal of these clips is generally not indicated unless there is a specific complication or issue directly related to them. If you are experiencing discomfort or psychological distress due to their presence, it would be beneficial to discuss these feelings with your healthcare provider. They can provide reassurance and help you understand the risks versus benefits of any potential surgical intervention.

As for psychological counseling, while it can be helpful in managing anxiety and distress related to medical procedures, it is unlikely to be a determining factor for a surgeon to agree to remove the clips. Surgeons typically base their decisions on clinical necessity rather than psychological factors alone. If you feel that your anxiety is significantly impacting your quality of life, seeking counseling or therapy may provide you with coping strategies and support.

Concerning the discrepancy in your medical records regarding the diagnosis of appendicitis, it is not uncommon for different documents to contain varying levels of detail. The term "acute appendicitis with general peritonitis" indicates a more severe condition involving inflammation of the appendix and the surrounding peritoneal cavity, while "unspecified acute appendicitis" may be a broader classification that does not detail the extent of the condition. This difference could arise from the context in which the records were created or the specific coding practices used by the healthcare facility. If this discrepancy causes you concern, it would be advisable to discuss it directly with your healthcare provider for clarification.

In summary, while your concerns about the titanium clips and the differences in medical documentation are valid, it is crucial to focus on the overall safety and effectiveness of the surgical procedures you have undergone. Open communication with your healthcare team is key to addressing any lingering worries and ensuring that you receive the support you need during your recovery. If you continue to experience significant anxiety or discomfort, consider seeking professional help to navigate these feelings.

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