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

Abstract

BACKGROUND: Stump closure is the most important part of a laparoscopic appendectomy (LA). Closing the appendix base with knot tying is the most cost-effective method. The defined risk factor for surgical site infection (SSI) after LA is the contamination of trocar entry area by inflamed appendicitis. This study aims to compare the single and double knot technique for stump control and specimen removal methods in LA. METHODS:The data of patients who underwent LA between January 2015 and January 2017 were obtained from prospectively collected database. Single and double knot technique, specimen removal method, operation duration, hospital stay, and perioperativepostoperative complications were compared. RESULTS:Extracorporeal double knot was used in 134 patients (63%), and single knot was used in 79 patients (37%). There was no difference between operation duration in the two groups (p=0.97). No stump leakage was observed in any patient. Intraabdominal abscess developed in three patients (1.4%). Appendix was removed from the abdomen directly in 101 patients (47%) and using specimen retrieval bag in 112 (53%). SSI developed in five patients (2.3%), and appendices of all of these five patients were removed from abdomen without using specimen retrieval bag. No SSI was detected in the group that used the specimen retrieval bag (p=0.02). CONCLUSION:Single or double knot(s) tying can be defined as safe and cost-effective stump closure method. The risk of developing SSI can be reduced using specimen retrieval bag.

Comparación de los desenlaces clínicos con cuatro técnicas de apendicetomía laparoscópica tras la implementación de políticas de reúso de dispositivos médicos

“…Evidencia preliminar soporta desenlaces clínicos favorables con esta técnica, que son equivalentes a otras técnicas que involucran diferentes recursos tecnológicos. Por ejemplo, se han reportado tasas de ISO órgano/espacio de 1,4% con el uso de endonudos y nudos extracorpóreos, así como tiempos quirúrgicos similares 22,30 .…”

“…Palabras clave: apendicectomía laparoscópica; reúso; reprocesamiento; dispositivos médicos; desenlaces clínicos; Colombia. la intervención, y se sustentaron en la literatura disponible, la cual demuestra resultados clínicos equivalentes (complicaciones, reintervención y estancia hospitalaria) cuando se utilizan dispositivos de energía ultrasónica y bipolar avanzada versus la electrocoagulación monopolar o bilopar convencional, ligadura o clips de titanio en el mesenterio apendicular o cuando el muñón apendicular se cierra con diferentes recursos (nudos, suturas, clips) [21][22][23][24] .…”

Evidence-Based Surgery for Laparoscopic Appendectomy: A Stepwise Systematic Review

“…Agalar et al [49] conducted a retrospective analysis of 213 patients with acute appendicitis treated with LA (54% female, median age 33.5 ± 13.8 years old, 23% complicated appendicitis) at a Turkish academic medical center from January 1, 2015, to January 1, 2017. In 112 patients, the specimen was removed using a retrieval bag, whereas the appendix was directly removed through a reusable trocar in the remainder (n = 101).…”

Is it necessary to use specimen retrieval bag for reducing surgical site infection in laparoscopic appendectomy?: A randomized controlled trial

“…[4][5][6] In laparoscopic appendectomy, there are studies suggesting the use of SRB to prevent SSI, whereas studies revealing that the extraction of the specimen directly from the trochar without the use of a SRB is an applicable method are also present. [7][8][9][10] Large-scale retrospective studies conducted to investigate the effects of SRB use on SSI have not reached a consensus. In two retrospectives using the same database and conducted only 1 year apart, one has emphasized that the use of SRBs decreased the risk of intra-abdominal abscess formation, while the other study has revealed that their use had no effect on the development of SSIs including intra-abdominal abscess.…”