Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy- personal experience

Abstract

Abstract:Aim: to devises a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy. Material and methods: This prospective study was conducted in MMIMSR Ambala from January 2015 to august 2017. All operations were performed by the same surgical team. Mesoappendix was coagulated with bipolar cautery and cut with scissors. Two handmade Meltzer loops were placed on base of appendix and tightened using conventionalgraspers. Results: 53 patients were included in the study. The time spent for preparing and tyingone loop was approximately 20-25 seconds. None of the patients had leakage from the appendicular stump. Only one polyglactin suture was used to make three loops. Knot pusher was not used in any of the patients. Conclusion: handmade endoloop used in this prospective study for securing appendicular stump using conventional laparoscopic graspers was found to be equally safe and can be easily mastered by any laparoscopic surgeon, which will reduce his dependency upon preformed endoloops making the procedure cost effective.

Laparoscopic appendectomy for acute appendicitis: an observational study from a peripheral hospital with limited facilities in Kashmir, India

“…11,12 These devices may not be necessary in laparoscopic appendectomies, which can be performed by using reusable trocars, routine electrosurgical device, readily available LT clips and self-made endo-loops, thus reducing the overall cost of the procedures. 13,14 The closure of the appendiceal stump is an important step during a LA, because most of the postoperative complications are caused by its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis and sepsis is included in these complications.…”

“…Duration of hospital stay ranged between 1-5 days (mean 1.7 days) in the present study which is consistent with various studies irrespective of the technique of securing the base in laparoscopic appendectomy. 8,[11][12][13][14]18 There was no mortality during this study. This is consistent with the majority of previous research studies carried on the same topic.…”