Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis – results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study

Lasek, Anna; Wysocki, Michał; Mavrikis, Judene; Myśliwiec, Piotr; Bobowicz, Maciej; Dowgiałło-Wnukiewicz, Natalia; Kenig, Jakub; Stefura, Tomasz; Pędziwiatr, Michał

doi:10.1080/00015458.2019.1573527

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Data from Polish multicenter cohort study (1269 patients from 18 surgical unites) revealed superior outcomes of endostapler in terms of overall postoperative morbidity and length of hospital stay. However, authors conclude that clinical benefits of staplers for appendix stump closure are based on a non-randomized group of patients and are therefore prone to selection bias [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

et al. 2021

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Background Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. Methods This was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler). Results In total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was—104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072). Conclusions The present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 (http://www.clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 99%

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

et al. 2021

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“…Gangrenous and/or perforated appendicitis causing intraabdominal abscesses or peritonitis is called complicated appendicitis [4,8,10,11]. According to the classification defined by Gomes et al, Stage 3A (segmental necrosis/perforation), 3B (base necrosis/ perforation), 4A (abscess), 4B (local peritonitis) and 5 (generalized peritonitis) appendicitis are classified as complicated [10].…”

Section: Discussionmentioning

confidence: 99%

“…There are many studies on the closure of the appendix stump in uncomplicated and complicated appendicitis, and there is no consensus in the litera-ture on the advantages of the techniques over each other [6][7][8][9]. Although the methods of closure of the appendix stump with metal clips, hem-o-lock clips, endoloop, intracorporeal knot and endostapler in complicated appendicitis are reported in the literature [8,10,11], the technical issue of stump closure in patients with necrosis or perforation in the base of the appendix is still controversial [11].…”

Section: Introductionmentioning

confidence: 99%

Partial cecum resection using endostapler in acute complicated appendicitis with appendiceal base necrosis

Yılmaz¹,

Dönmez²,

Ferahman³

et al. 2022

wiitm

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Introduction:The method of stump closure is controversial in complicated patients, especially with appendix base necrosis or perforation. Aim: To evaluate the efficacy and safety of partial cecum resection technique with an endostapler in patients with appendix base necrosis or perforation. Material and methods: Thirty-six patients who underwent laparoscopic partial cecum resection due to appendix base necrosis or perforation between 2015 and 2020 were retrospectively analyzed. In acute complicated appendicitis with appendiceal base necrosis or perforation, it was performed by laparoscopic partial cecum resection using an endostapler within a safe surgical margin. Demographic characteristics, duration of operation, days of hospital stay, and intra-and post-operative complications were evaluated. Results: The mean age of the patients is 42.72 ±16.69, female/male ratio was 19/17 (52.8%/47.2%). No intraoperative complications developed. Mean operative time and hospital stay were 104.75 ±34.96, 4.58 ±2.82 days, respectively. Post-operative complications developed in 5 (13.7%) patients. One of them was wound infection (2.7%), 2 of them were ileus (5.5%) and 2 patients had an intraabdominal abscess (5.5%). Stapler line leak was not observed in any of the patients. Conclusions: The use of an endostapler in laparoscopic appendectomy is a safe and effective technique in cases where appendix base necrosis, appendix perforation or severe inflammation affects the base of the cecum.

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“…Among these, LPC and LL are the most commonly used methods for appendiceal stump closure due to their cost-effectiveness and ease of application. However, it is still unclear which method is better [10][11][12]. Therefore, this study aimed to investigate the safety and usefulness of LPC for appendiceal stump closure during LA and to compare these data with those of LL.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature

et al. 2022

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This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure. Methods: Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups. Results: LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P = 0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P = 0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P = 0.082 and 2.8% vs. 0%, P = 0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P = 0.012). Conclusion: Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

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Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis – results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study

Cited by 10 publications

References 25 publications

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

Partial cecum resection using endostapler in acute complicated appendicitis with appendiceal base necrosis

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature

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