Comparison of Stump Closure Techniques of the Base of the Appendix in Laparoscopic Appendectomy

Abstract

BACKGROUNDAppendicitis remains one of the most common surgical diseases. Open or laparoscopic appendectomy remains the gold standard treatment for acute appendicitis. The technique of appendectomy may vary from surgeon to surgeon or from centre to centre, starting from skin incision to ligation and invagination of appendiceal stump. However, concerns still exist regarding appendiceal stump closure.The present study was conducted to compare the stump closure techniques of Endoloop versus Intracorporeal Transfixation of the base of the appendix in laparoscopic appendectomy to demonstrate the safety and feasibility in this surgery. MATERIALS AND METHODSThis prospective, non-randomised, controlled study was conducted on 60 patients with appendicitis. The patients from same population were assigned to one of the two groups alternatively; A and B, each consisting of 30 patients. The patients in Group A underwent laparoscopic appendectomy with simple endoloop ligation of the base of appendix, whereas the patients in Group B underwent laparoscopic appendectomy with intracorporeal transfixation of the base of appendix. The findings of subgroups were compared and results were evaluated by IBM-Statistical Package Social Sciences (SPSS) statistical methods. RESULTSPosition and diameter of appendix did not affect the feasibility of stump ligation with both techniques. Both techniques were comparable in terms of post-operative complications and time of appearance of bowel activity. Operative time was significantly more in intracorporeal transfixation technique. CONCLUSIONBoth the techniques are safe, sure and reliable methods for stump closure. Hence, appendix stump ligation should be left to preference of the operating surgeon.

Comparative Study Between Appendiceal Base Ligation with Hand-Made Endoloop Knot Pusher Versus Standard Endoloop in Laparoscopic Appendectomy

“…Our result is similar to Chand Prem et al, 2017, who reported in their study comparing Intracorpor-eal knot with endoloop that the mean age of all patients was 29.01 years, and they explained the cause of high incidence of appendicitis in the second and third decade of life is considerably due to hyperplasia of lymphoid tissue in the appendix, which reaches its peak at 20 years of age and thereafter atrophy of the lymphoid tissue begins [9] . Nadeem et al, 2016 reported in their study comparing Endoloop (sliding knot) that (36 patients) with metallic endoclip (32 patients), that the mean age of Endoloop group was 24 ±7.78 years [10] .…”

“…Time was significantly longer because invaginating suture was also used in the study [14] . Chand, Prem, et al, 2017, reported in their study on 60 patients that the bowel sounds in patients of sliding knot group (30 patients) returned after 18.80 ±8.14 hours [9] . Regarding postoperative complications: Only one patient (5.0%) in group (I) developed superficial wound infection, while two patients (10.0%) in group (II) had wound infection and regarding intra-abdominal abscess there was one patient only in group (II) that has postoperative abscess in the right iliac fossa (5.0%),only one patient in group (I) (5.0%) developed port site hernia at 3 rd month and one patient in group (II) (5.0%) developed adhesions (adhesive intestinal obstruction) at 6 th month.…”

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

“…19,20 Closure with endoloop is commonly done due to its lower cost compared to stapler. 21 The use of endoloop is less expensive but needs trained surgeon and stapler is safe and fast but expensive. The disadvantage of clips being spilled into abdominal cavity may cause peritoneal adhesion and intestinal obstruction.…”