Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump

Abstract

BackgroundNowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C).MethodsThree hundred seven patients (mean age = 35.6; SD = 15.9; 178 males,129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department were included in the study. We reviewed retrospectively patients’ data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates in all analyzed groups.ResultsThere were 102 patients in group A (mean age = 35.8;SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age =37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis.ConclusionsLaparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures.

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

“…In several studies the duration of surgery and mean duration of hospital stay for closure of appendicular stump in laparoscopic appendicectomy was between 45-60 minutes and 1-7 days respectively, current data correlate well with these studies. 13,23 In present study, the complication rates observed correlate well with similar studies. 13,23,24 According to recent studies the lack of evidence of superiority of the technique the surgeon should choose suitable technique for him as well as the patient.…”

“…13,23 In present study, the complication rates observed correlate well with similar studies. 13,23,24 According to recent studies the lack of evidence of superiority of the technique the surgeon should choose suitable technique for him as well as the patient. 13 The optimum technique should have safety and least complication rate and should be cost effective.…”

Use of Polymeric Clip (Hem-O-Lock) for Appendiceal Stump Ligation as a Favorable Technique in Laparoscopic Appendectomy

“…But, it has some disadvantages, such as longer duration of operation, increased cost and more incidence of intraabdominal abscess (2,5,11).…”

“…Advantages of LA, include, shorter hospitalization, faster recovery, less postoperative pain, less analgesic necessity, less surgical site infection and better cosmetic results (2,3,5,(7)(8)(9)(10)(11)(12).…”

“…There are some methods for appendiceal stump closure, that all are safe, such as metallic clips (1,6,11,14,16,18,20,22), polymeric clips (Hem-o-lock) (4,8,10,14,18,22,23), endo loop (2,5,7,13,14,(16)(17)(18)(19)(21)(22)(23)(24)(25), endo stapler (5,8,11,13,(19)(20)(21)(22)24), intra corporeal knot (3,7,11,20,22) and bipolar and vessel sealing devices (15,22,26).…”