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

Authors

  • Khamar J. Banu Department of General Surgery, Yenepoya Medical College Hospital, Mangalore, Karnataka, India
  • Austin Titus Department of General Surgery, Yenepoya Medical College Hospital, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20200828

Keywords:

Cost effective technique, Laparoscopic appendicectomy, Stump closure

Abstract

Background: The most essential component of laparoscopic appendectomy is the closure of appendicular stump. Failure of which can result in catastrophic complications including intra-abdominal and surgical site infections and rarely faecal fistula. The aim of this study was to verify the effectiveness of preformed catgut endoloop and extracorporeal polyglactin 910 for appendicular stump closure.

Methods: This prospective study was carried out in 64 patients. We compared patient demographics, duration of surgery, intra and post-operative complications, hospital stay and cost of surgery between the two groups.

Results: A total of sixty-four patients were finally included in the analysis, catgut group (n=34), polyglactin 910 group (n=30). The demographics between the two groups were similar. The mean age in catgut group was 23.94 years and polyglactin 910 groups was 23.33 years. Mean duration of surgery was 41.6 and 41.8 minutes in catgut and endoloop group respectively. Mean hospital stay was 3 days. There was no mortality but complications were seen in 6 patients. However, there was no statistical significance in between the two groups with any of the parameters studied.

Conclusions: Multiple studies have demonstrated safety and effectiveness of various techniques of appendicular stump. The use of extracorporeal single polyglactin 910 extracorporeal suture knot is safe and cost-effective technique for closure of appendicular stump in rural and resource poor regions.

References

Nadeem M, Khan SM, Ali S, Shafiq M, Elahi MW, Abdullah F, et al. Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis. Int J Surg Open. 2016;2:11-4.

Sahm M, Pross M, Lippert H. Acute appendicitis- changes in epidemiology, diagnosis and therapy. Zentralbl Chir. 2011;136(1):18-24.

Gomes CA, Junior CS, Costa Ede F, Alves Pde A, de Faria CV, Cangussu IV, et al. Lessons learned with laparoscopic management of complicated grades of acute appendicitis. J Clin Med Res. 2014;6(4):261-6.

Boomer LA, Cooper JN, Deans KJ, Minneci PC, Leonhart K, Diefenbach KA, et al. Does delay in appendectomy affect surgical site infection in children with appendicitis? J Pediatr Surg. 2014;49(6):1026-9.

Ashraf AI, Elsayed A. Loop knots versus harmonic scalpel in laparoscopic appendectomy. Egyptian J Hosp Med. 2018;72(3):4109-12.

Hanssen A, Plotnikov S, Dubois R. Laparoscopic appendectomy using a polymetric clip to close the appendicular stump. J Soc Laparoendosc Surg. 2007;11(1):59-62.

Sauerland S, Jaschinski T, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Systemat Rev. 2010(10).

Heikkinen TJ, Haukipuro K, Hulkko A. Cost-effective appendectomy: open or laparoscopic? A prospective randomized study. Surg Endosc. 1998;12:1204-8.

Abou-Sheishaa MS, Negm A, Abdelhalim M, Abbas A, Ibrahim M, Elghadban H, et al. Ligation versus clipping of the appendicular stump in laparoscopic appendectomy: a randomized controlled trial. Ann Emerg Surg. 2018;3(1):1029.

Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg. 2015;31(4):229-31.

Palanisamy V, Vinoth S, Rajan KV, Ramananthan M. Review of techniques in occluding appendicular stump during laparoscopic appendectomy. J Surg (Jurnalul de chirurgie). 2019;15(1):1-4.

Sadat-Safavi SA, Nasiri S, Shojaiefard A, Jafari M, Abdehgah AG, Notash Jr AY, et al. Comparison the effect of stump closure by endoclips versus endoloop on the duration of surgery and complications in patients under laparoscopic appendectomy: A randomized clinical trial. J Res Med Sci. 2016;21:87.

Elshoura A, Hassan O, Saber S. Application of different methods for stump closure in laparoscopic appendectomy. Egypt J Surg. 2017;36:131-6.

Gomes CA, Nunes TA, Fonseca Chebli JM, Junior CS, Gomes CC. Laparoscopy grading system of acute appendicitis: new insight for future trials. Surg Laparosc Endosc Percutan Tech. 2012;22:463-6.

Hue CS, Kim JS, Kim KH, Nam S-H, Kim KW. The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy. J Korean Surg Soc. 2013;84:27-32.

Öz B, Emek E, Akyüz M, Sözüer E, Arıkan T, Akcan A, et al. Laparoscopic appendectomy using hem-o-lok polymer clips: a single-center experience. Int Surg. 2017;102(7-8):334-9.

Sajid MS, Rimple J, Cheek E, Baig MK. Use of endo-GIAversus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech. 2009;19(1):11-5.

Khanna S, Khurana S, Vij S. No clip, no ligature laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech. 2004;14(4):201-3.

Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc. 2007;21(10):1764-7.

Partecke LI, Kessler W, von Bernstorff W, Diedrich S, Heidecke CD, Patrzyk M. Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump. Langenbecks Arch Surg. 2010;395(8):1077-82.

Chand P, Singh G, Kahlon PS. Comparison of stump closure techniques of the base of the appendix in laparoscopic appendectomy. J Evol Med Dent Sci. 2017;6(72):5092-7.

Kuehnel F, Marusch F, Koch A, Gastinger I. Retained loose linear cutter staples after laparoscopic appendectomy as the cause of mechanical small bowel obstruction. Int J Colorect Dis. 2007;22(6):717-8.

Strzałka M, Matyja M, Rembiasz K. Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump. World J Emerg Surg. 2016;11:4.

Rickert A, Colin MK, Runkel N, Kuthe A, Köninger J, Jansen-Winkeln B, et al. The TICAP-study (titanium clips for appendicular stump closure): a prospective multicentre observational study on appendicular stump closure with an innovative titanium clip. BMC Surg. 2015;15:85.

Gomes CA, Junior CS, de Peixoto RO, Netto JM, Gomes CC, Gomes FC. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World J Emerg Surg. 2013;8(1):35.

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Published

2020-02-26

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Original Research Articles