Re-evaluation of purse string suture in laparoscopic appendectomy

Shadhu, Kamleshsingh; Ramlagun, Dadhija; Wang, Yao; Ping, Xiaochun; Chen, Tao; Zhu, Yanhui; Xu, Zekuan

doi:10.1007/s00464-019-06828-5

Cited by 6 publications

(8 citation statements)

References 23 publications

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“…16 However, Shadhu et al showed that the operation time can be comparable despite performing the purse-string suture. 17 Moreover, from our experience, we were able to finish the procedure without giving up, and no intraoperative complications occurred because of the use of purse-string suture. The addition of a purse-string suture can overcome the demerits of using the endoloop alone.…”

Section: Discussionmentioning

confidence: 75%

Purse‐string suture after ligating by endoloop for closing of the appendiceal stump is an alternative for endostapler in selected cases: A propensity score‐matched study

Okamoto

Otowa

Fujinaka

et al. 2021

Asian J Endoscop Surgery

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Introduction: The closure of the appendiceal stump is a crucial part of a laparoscopic appendectomy, and an endoloop or endostapler is generally used. The endoloop can be more cost effective than the endostapler. However, reports have shown that the endoloop has a higher postoperative abdominal abscess rate than the endostapler in complicated appendicitis. At our institution, we perform a purse-string suture after ligating by endoloop to reduce postoperative abdominal abscess risk. This study aimed to clarify whether this method could reduce the incidence of postoperative abdominal abscess compared with the endostapler.Methods: Patients with acute appendicitis were classified into the purse-string suture group (n = 149) and the endostapler group (n = 82). Postoperative outcomes were compared after propensity score matching (n = 47).Results: No significant difference was found between the two groups in terms of the patient characteristics and postoperative complications, including abdominal abscess. However, the purse-string suture group had more drain placement and a shorter hospital stay than the endostapler group (P = .04 and P = .02, respectively). In patients with complicated appendicitis, there was less drain placement and a shorter hospital stay in the purse-string suture group than in the endostapler group (P < .01 and P < .01, respectively). This might have reflected the difficulty of the operation. All postoperative abdominal abscesses occurred in complicated appendicitis cases.Conclusions: Endoloop with additional purse-string suture had a lower incidence of abscess than previous reports of using endoloop alone. Moreover, the postoperative abdominal abscess rate is similar between the two closure methods.

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Section: Discussionmentioning

confidence: 75%

Purse‐string suture after ligating by endoloop for closing of the appendiceal stump is an alternative for endostapler in selected cases: A propensity score‐matched study

Okamoto

Otowa

Fujinaka

et al. 2021

Asian J Endoscop Surgery

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“…Our technique provides a safe closure in cases with appendix radix necrosis, which is defined as 3D in the classification made by Gomez et al We defined the LPS technique in our clinical study in 2017 [26]. In a similar study, Shadhu et al compared the intracorporeal knot, Hem-o-lok clip, and laparoscopic purse string suture techniques and stated that all techniques are safe in cases of complicated appendicitis [17].…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective clinical study by Shadhu et al there was no significant difference in the duration of surgery in the intracorporeal knot, Hem-o-lok clip, and LPS techniques. It is much more difficult to apply LPS near the appendicular stump during LA, and it requires some experience in laparoscopic suturing [17].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of three techniques for appendiceal stump closure during laparoscopy

Gemici¹,

Dönmez²,

Sürek³

et al. 2020

Journal of Surgery and Medicine

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Ethics Committee Approval: Ethics committee approval was not received due to the retrospective design of the study. All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Etik kurul onayı çalışmanın retrospektif dizaynından dolayı alınmamıştır. İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

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“…Anyway, using endo-loops can reduce the cost of the surgery about 10 times, and also eliminates the risk of creating ileus from staples slipped into the abdomen (11,21,23) . Some studies have also reported that in open appendectomy closure of AS is successfully applied in the laparoscopy technique by ligating AS with a suture, passing it through PSS in the cecum and inverting it into the cecum (24,25) . In our retrospective clinical study, the AS was safely closed using this method, and no stump leak was observed in any of our patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Stump Burying using Laparoscopic and Open Methods in Complicated Acute Appendicitis

Ferahman¹,

Dönmez²,

Yılmaz³

et al. 2020

BMJ

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Objective: The choice of laparoscopic technique in the treatment of complicated acute appendicitis (CAA) harbours debatable evidence because of higher rates of surgical complications such as postoperative intraabdominal abscess (POIIA). The aim of this study is to compare postoperative results of appendiceal stump (AS) ligation and its burial into the cecum using laparoscopic or open surgical techniques in patients with CAA. Method: This is a single-center and retrospective analysis of patients with CAA operated between May 2018 and April 2020. AS was intracorporeally knotted with silk and buried in the cecum with a purse-string suture (PSS). The patients were divided into open appendectomy (OA) and laparoscopic appendectomy (LA) groups. Data concerning demographic characteristics, intraoperative variables, hospital stay, surgical complications, morbidities, and postoperative findings were compared. Results: A total of 66 patients including 36 patients (54.54%) underwent LA and 30 patients had OA were enrolled in the study. Partial resection of cecum was performed in one patient in the OA group and two patients in the LA group with the help of a stapler due to cecal floor necrosis. The operative time and duration of hospital stay were significantly shorter in the LA group compared to the OA group. Surgical site infection and POIAA were significantlymore frequent in the OA group (p<0.001). Conclusion: In acute complicated appendicitis, laparoscopic method can be applied as an effective method by closing the appendiceal stump and burying into the cecum with a purse-string suture.

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Re-evaluation of purse string suture in laparoscopic appendectomy

Cited by 6 publications

References 23 publications

Purse‐string suture after ligating by endoloop for closing of the appendiceal stump is an alternative for endostapler in selected cases: A propensity score‐matched study

Purse‐string suture after ligating by endoloop for closing of the appendiceal stump is an alternative for endostapler in selected cases: A propensity score‐matched study

Comparison of three techniques for appendiceal stump closure during laparoscopy

Comparison of Stump Burying using Laparoscopic and Open Methods in Complicated Acute Appendicitis

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