Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis

Abstract

Background: An adequate closure of the appendiceal stump is vital to minimize intra-abdominal and surgical site infections. There are various techniques for the closure of base of appendix while performing a laparoscopic appendectomy like endoloops, knotting, clips and staplers. Objective: To compare the extracorporeal knot-tying suture with metallic endoclips in laparoscopic appendiceal stump closure in terms of complications, operative time, hospital stay and cost. Methodology: This study was conducted as a single-blinded randomized controlled trial. Patients undergoing laparoscopic appendicectomies in three tertiary care hospitals of Peshawar, i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex from June 1, 2013 to June 1, 2014 were included in the study and randomized into two groups – extra-corporeal knotting group and the metallic endoclip group. Data on demographics, complications, operative time, hospital stay and cost for the two techniques were collected and analyzed. Statistics analyses were done with IBM SPSS v19 (IBM Corp., Armonk, NY, USA). T-test was use for comparison of continuous data; Chi-square test was used for comparison of categorical data. P < 0.05 was considered statistically significant. Results: A total of 68 patients were enrolled in the study and randomized into two groups: metallic endoclip group n = 32 (47.1%), extracorporeal knot group n = 36 (52.9%). The two groups didn't significantly differ in age (P = 0.9). There were no statistically significant differences between the two groups in terms of complication rates (P > 0.05) and hospital stay (P > 0.05). The mean operative time for the endoclip group was shorter (mean 42.1 ± 7.4 min) as compared to the extracorporeal knot group (mean 48.3 ± 8.4 min) (P = 0.002). The cost of endoclip group was higher (800PKR = 8.10US$) as compared to the extracorporeal knot group (220PKR = 2.23US$). Conclusion: The use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it's a useful alternative to the extracorporeal knotting especially for learners. Highlights:

Does the Stump Knotting Technique and Specimen Retrieval Method Effects Morbidity and Outcomes in Laparoscopic Appendectomy?

“…But these methods have not been demonstrated to be superior to each other in terms of effectiveness or safety. [4,[9][10][11][12][13][14][15][16][17] Knot tying has cost advantages over other methods, but there is no consensus about tying method (single or double) in literature.…”

Comparison of Handmade Endoloop Versus Polymeric Endoclip for Stump Closure in Laparoscopic Appendectomy

“…Nadeem et al compared extracorporeal suture and metallic endoclip in terms of postoperative ileus and found no statistically significant difference between the two groups. One patient in the metallic endoclip group and two patients from the extracorporeal suture group developed ileus [ 12 ]. In our study, one patient from the polymeric endoclip group developed ileus.…”

Primerjava laparoskopske apendektomije pri enostavnem in zapletenem vnetju slepiča

“…Mezoapendiks smo izpreparirali s harmonično kljukico in klipi, bazo slepiča pa prekinili po oskrbi s standardnimi ali zaklepnimi klipi, z zanko endoloop ali s spenjalnikom (ATS ali EndoGIA), včasih pa tudi z dodatnimi šivi. Način prekinitve baze je bil odvisen od debeline slepiča ali obsežnosti vnetja na sami bazi (16)(17)(18)(19)(20). Trebušno votlino smo izpirali s fiziološko raztopino pri hujšem peritonitisu, abscesu ali mezeči krvavitvi vstavili dren v ležišče slepiča ali Douglasov prostor, večinoma skozi suprapubič-ni port.…”

“…Diagnostične metode: ob kliničnih in laboratorijskih podatkih je danes najbolj uveljavljena in tudi povedna UZ metoda, pri zapletenih vnetjih poleg UZ še CT trebuha (9,10,11,13). Za oskrbo krna slepiča v naši seriji prevladujejo endoklipi, v zadnjih letih resorbilni, in endoskopske zanke, pri debelejši, in pri hudo vnetno spremenjeni bazi Endo Gia, kar pa je dražje (17)(18)(19)(20). Delež konverzij je bil nizek -0,80 %.…”