Comparison of methods for closure of appendix stump during laparoscopic appendectomy using endoloops: Single surgeon experience

Abstract

BACKGROUND: In this study, using single or double endoloops, with reference to the literature, we aimed to retrospectively assess the results for patients in our clinic who underwent a laparoscopic appendectomy. METHODS: This study included 251 patients who were operated on by a single surgeon; 137 of the patients were male (54.6%) and 114 were female (45.4%). Patients were divided into two groups based on the type of endoloop procedure that was used. Group 1 included 107 patients for whom a single endoloop was used. Group II included 144 patients for whom double endoloop was used. Age, sex, duration of operation, length of hospital stay, pathological findings, perioperative appendix findings, perioperative abdominal findings, post-operative complications requiring hospitalization and wound infections were assessed for each patient. Patients were also assessed statistically for complications. RESULTS: There were no significant differences in the demographic characteristics, perioperative surgery findings, pathological findings or duration of hospital stays between the two groups of the patients. However, the duration of operation was shorter in Group I (54.9±16.1 min) as compared to Group II (61.2±18.8 min). The incidence of complications requiring rehospitalization was statistically significantly lower in Group I (1.9%; n=2) as compared to Group II (9%; n=13) (p=0.018). There were no complications requiring reoperation for patients in Group I. In Group II, four patients (2.8%) required re-operation; however, this difference was not statistically significant. Concerning wound infection, there was also no significant difference between Group I (7.5% n=8) and Group II (4.9% n=7). CONCLUSION: Using a double endoloop does not decrease the risk of post-operative complications, but it does increase the cost and the duration of the operation. We have concluded that using a single endoloop in a laparoscopic appendectomy may be more appropriate.

Proper use of appendiceal stump closure methods for surgical site infection in laparoscopic appendectomy

“…A comparison between single and double loops is also important for appendiceal stump closure with EL. Previous reports have shown that double loops did not contribute to the reduction of postoperative complications, and that a single loop led to a shorter operative time 18,19 . In the future, the indications for appendiceal stump closure using a single loop may be expanded.…”

“…Previous reports have shown that double loops did not contribute to the reduction of postoperative complications, and that a single loop led to a shorter operative time. 18,19 In the future, the indications for appendiceal stump closure using a single loop may be expanded. Additionally, although this study currently compares only highly versatile EL and ES, clipless surgery, new techniques, such as harmonic scalpel LA have also appeared.…”

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

“…18 There remains debate as to whether one or two endoloops is required for the appendiceal stump, with some surgeons favouring the use of a double endoloop approach when a single loop has been shown to be as effective. 30…”

“…18 There remains debate as to whether one or two endoloops is required for the appendiceal stump, with some surgeons favouring the use of a double endoloop approach when a single loop has been shown to be as effective. 30 Ligature in the form of an extracorporeal knot (ECK) is an alternative approach to appendiceal stump closure. 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.…”