Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy: an experience

Akhilesh Kumar Yadav, Sankalp Dwivedi, Rahul Ranjan, Naveen Yadav


Background: The objective of the study was to devise a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy.

Methods: This prospective study was conducted in MMIMSR Ambala from September 2016 to August 2018. 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 conventional graspers.

Results: Around 50 patients were included in the study. The time spent for preparing and tying one 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.

Conclusions: 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.


laparoscopy, appendectomy, endoloop

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