A study to evaluate the safety and cost effectiveness of preformed catgut endoloops and polyglactin 910 extracorporeal ligation in the management of appendicular stump closure in laparoscopic appendicectomy

Abstract

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

“…A sliding knot can be formed using a simple tie, and inserted through a 5 mm trocar, 31 and can then be manipulated by two instruments, rather than one. 32,33 There are no RCTs assessing the difference between an ECK and other closure methods. However, a combination of retrospective and prospective studies have shown that the tying of an extracorporeal knot is not associated with increased operative time compared to polymeric clip 34 or stapler.…”

“…A sliding knot can be formed using a simple tie, and inserted through a 5 mm trocar, 31 and can then be manipulated by two instruments, rather than one. 32,33…”