The Effects of LigaSure on the Laparoscopic Management of Acute Appendicitis

Abstract

A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.

Comparison of Various Methods of Mesoappendix Dissection in Laparoscopic Appendectomy

“…The various instruments used for this stage include EC, HS, LigaSure, ME, and endostapler. [3][4][5][6][7] Because instrument failure at this stage can cause massive bleeding and conversion to open surgery, instrument choice is an important issue. 14 Endostaplers are one of the instruments used to divide the mesoappendix.…”

“…Studies have compared procedural variations including method of access into the peritoneum, 1,2 dissection of the mesoappendix, [3][4][5] and closure of the appendicular stump. [6][7][8] A superior method has yet to be found.…”

Does the Use of Newer Technology to Divide the Mesoappendix Result in Less Bleeding? A Retrospective Analysis

“…Although the literature has shown the utility of using energy sources, both the Endo-GIA stapling device and endoloops are valid and acceptable options [4,5]. When operating for early acute appendicitis, there is minimal inflammation and edema of the surrounding tissue, thus gaining control of the mesoappendix can be accomplished easily using endoloops or an Endo-GIA stapler with minimal manipulation of the tissues.…”

“…When dealing with an extremely inflamed, gangrenous, or perforated appendix, using an energy source might intuitively seem to be advantageous; however, our data seem to demonstrate otherwise. The surgeon can use either of these energy sources to divide the mesoappendix without excessive dissection or isolation of the appendicular artery, leading to quicker division with minimal bleeding [4,5,9]. Using an Endo-GIA stapler, endoloops, or endoclips may require more meticulous dissection to safely isolate and divide the mesoappendix.…”

“…Meta-analyses of randomized-controlled trials have shown that laparoscopic appendectomy has several advantages over the open approach, including faster convalescence, less postoperative pain, better cosmetic results and fewer wound infections [1][2][3]. Prior studies have shown that the most common reason to convert to an open appendectomy is bleeding, specifically bleeding during the dissection and sealing of the mesoappendix [1][2][3][4][5][6][7][8]. As new technology emerges, it is imperative to examine and critically appraise new technology in terms of efficiency, quality and cost effectiveness.…”