Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Zorzetti, Noemi; Lauro, Augusto; Bellini, Maria Irene; Vaccari, Samuele; Via, Barbara Dalla; Cervellera, Maurizio; Cirocchi, Roberto; Sorrenti, Salvatore; D’Andrea, Vito; Tonini, Valeria

doi:10.4240/wjgs.v14.i9.1060

Cited by 3 publications

(3 citation statements)

References 54 publications

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“…Several reports have discussed methods of appendectomy in laparoscopic surgery [ 21 – 23 ]. Zorzetti N et al suggested the routine use of endloop for appendectomy even in case with complicated appendicitis because of cost effectivity and lower complications [ 21 , 22 ]. Bao W et al reported that purse-string sutures effectively reduced the incidence of postoperative complications after a laparoscopic appendectomy for CA [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

et al. 2023

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Purpose The treatment strategies for acute appendicitis differ depending on the facility, and various studies have investigated the usefulness of conservative treatment with antibiotics, laparoscopic surgery, and interval appendectomy (IA). However, although laparoscopic surgery is widely used, the clinical strategy for acute appendicitis, especially complicated cases, remains controversial. We assessed a laparoscopic surgery-based treatment strategy for all patients diagnosed with appendicitis, including those with complicated appendicitis (CA). Methods We retrospectively analysed patients with acute appendicitis treated in our institution between January 2013 and December 2021. Patients were classified into uncomplicated appendicitis (UA) and CA groups based on computed tomography (CT) findings on the first visit, and the treatment course was subsequently compared. Results Of 305 participants, 218 were diagnosed with UA and 87 with CA, with surgery performed in 159 cases. Laparoscopic surgery was attempted in 153 cases and had a completion rate of 94.8% (145/153). All open laparotomy transition cases (n = 8) were emergency CA surgery cases. No significant differences were found in the incidence of postoperative complications in successful emergency laparoscopic surgeries. In univariate and multivariate analyses for the conversion to open laparotomy in CA, only the number of days from onset to surgery ≥ 6 days was an independent risk factor (odds ratio: 11.80; P < 0.01). Conclusion Laparoscopic surgery is preferred in all appendicitis cases, including CA. Since laparoscopic surgery is difficult for CA when several days from the onset have passed, it is necessary that surgeons make an early decision on whether to operate.

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Section: Discussionmentioning

confidence: 99%

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

et al. 2023

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“…In addition, only if the appendix is mobilized, a clip, loop, or stapler can be used depending on the base thickness [ 17 ]. A recently performed meta-analysis showed that endoloops and endostaplers are safe for appendix stump closure and have no difference in postoperative complication rate [ 31 ]. While self-locking polymeric clips (also known as Hem-o-Lok clips) are a less prevalent option in laparoscopic appendectomy for stump closure and are more used for the closure of bleeding vessels or tissue structures [ 16 ], they were also proven to have advantages: They are safe, cheap, and easy to use [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

et al. 2023

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Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.

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“…Appendectomy techniques in laparoscopic surgery have been covered in a number of studies. Because endloop surgery is less expensive and has fewer problems than open surgery, Zorzetti N et al recommended using it routinely for surgery, especially in cases of severe appendicitis (13) (14) . Pursestring sutures have been shown by Bao W et al to be an effective way to lower the incidence of postoperative problems after a laparoscopic appendectomy for CA (15) .…”

Section: Laparoscopic Appendectomymentioning

confidence: 99%

Efficacy and Safety of Minimally Invasive Surgery Techniques in The Treatment of Acute Appendicitis: A literature review.

Tapia,

Coba,

Demera

et al. 2024

ijmsdh

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An appendectomy is often used to treat acute appendicitis, which is characterized by inflammation of the vermiform appendix. Techniques in minimally invasive surgery (MIS), such as endoscopic retrograde appendicitis therapy (ERAT), single-incision laparoscopic surgery (SILS), and laparoscopic appendectomy, have become popular substitutes for open surgery. The purpose of this review is to assess the safety and effectiveness of MIS methods for treating acute appendicitis. A comprehensive analysis of English-language literature from 2019 to 2024 was carried out to evaluate the safety and efficacy of MIS procedures for acute appendicitis. Research that satisfied the inclusion requirements was examined for pertinent information on SILS, ERAT, and laparoscopic appendectomy. Compared to open surgery, laparoscopic appendectomy showed shorter hospital stays, less pain after surgery, and quicker recovery rates. Comparable to traditional laparoscopic methods in terms of effectiveness, SILS and TULS provide potential advantages in terms of cosmesis and patient satisfaction. With faster recovery durations and fewer complications, ERAT showed encouraging results; nonetheless, questions about long-term effectiveness and recurrence rates were raised. In order to treat acute appendicitis, MIS procedures provide viable options that may shorten hospital stays, ease postoperative pain, and increase patient satisfaction. More investigation is necessary to improve patient selection criteria and operative approaches in order to maximize the efficacy of MIS in the therapy of appendicitis.

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Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis

Cited by 3 publications

References 54 publications

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

Efficacy and Safety of Minimally Invasive Surgery Techniques in The Treatment of Acute Appendicitis: A literature review.

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