Comparison of Two Stump Closure Techniques in Laparoscopic Appendicectomy: A Single-Centre Prospective Cohort Study

Abstract

IntroductionAcute appendicitis is a frequent illness that manifests as an emergency and most of the cases necessitate surgical intervention. One of the most critical processes in a laparoscopic appendicectomy is the closure of the appendicular stump. For the closure of the stump of the appendix, several approaches have been employed and explored, but the one with the best outcomes has yet to be proved. The purpose of this study was to evaluate the medical results and cost analyses of laparoscopic appendicectomy with two of the commonly used stump closure techniques -ENDOLOOP ® and Hem-o-lok ® . Materials and methodsA two-year prospective hospital-based cohort study was conducted from June 2019 to July 2021. All the patients in the study were randomly assigned to one of two experimental arms (ENDOLOOP ® and Hem-olok ® ). The clinical and follow-up data of these patients were collected and tabulated into a data sheet and analyzed. ResultsIn total, 180 individuals were included in the research (90 in each arm). No statistically significant difference was found in comparing the age, gender or diameter of the appendix among the two groups. The time taken for surgery showed significant differences among the two study groups. The time taken for the procedure in the Hem-o-lok® group was significantly lower than the ENDOLOOP® group (40.3 ± 12.3 minutes vs 50.83 ± 10.5 minutes, p < 0.001). No intraoperative or immediate postoperative complications were noted in either of the groups. The average duration of hospital stay was 2.7 ± 0.9 days in the Hem-o-lok® group, while it was 3.1 ± 0.8 days in the ENDOLOOP® group (p = 0.986). The material cost for the stump ligation with Hemo-lok® was Rs. 310 ± Rs. 76 while that using ENDOLOOP ® was Rs. 630 ± Rs. 118 (p < 0.001). In the Hem-olok ® subset of patients, the mean direct expenses of laparoscopic appendicectomy were considerably lower. During the 12-week follow-up period, none of the patients had any post-operative complications. ConclusionAccording to the results of this study, both the technical variations of appendix stump closure are equal in terms of postoperative complications. When compared to the ENDOLOOP ® group, the Hem-o-lok® group had a shorter duration of surgery and ended up spending less money. Hem-o-lok® clips have the potential to become the preferred way of anchoring the appendix base during laparoscopic appendicectomy.

Hand Assisted versus Intracorporeal Ligation of Appendicular Base During Laparoscopic Appendicectomy

“…The postoperative complications of intracorporeal ligation versus hand-assisted ligation of the appendix base are compared in Table (3). With a significant difference (p=0.013), port site infection occurred in 10% (n=2) of Group A and 45% (n=9) of Group B.…”

“…Different methods are existed and include clips, staples and hand assisted ligation. If there is any doubt about the stump another seromuscular suture is taken, (3)(4)(5) . However, its methods had advantages and disadvantages.…”