Loop Knots Versus Harmonic Scalpel in Laparoscopic Appendectomy

Abstract

Background: Acute appendicitis is the most common indication for intra-abdominal emergency surgery, and appendectomy is one of the most commonly performed procedures in abdominal surgery. Although laparoscopic appendectomy (LA) has not yet achieved the status of a “Gold Standard” treatment, it is being progressively accepted as the treatment of choice for acute appendicitis. Numerous studies have shown many benefits of LA, including a faster recovery, less postoperative pain, reduced wound infections, shorter hospital stay and earlier return to work. Aim of the Work: To assess the feasibility of using the ultrasonic-activated device (harmonic) scalpel in sealing and division of the appendicular stump during laparoscopic appendectomy. Patients and Methods: This prospective study was carried out at the surgical department of Al Hussein University hospital during the period from June 2016 to April 2018. 40 patients diagnosed as acute appendicitis were included And divided into two groups: group 1 containing 20 patients using loop knots and group 2 containing 20 patients using harmonic scalpel (as a method of appendicular stump sealing. A comparative analysis was done for both techniques considering the post-operative leakage, the post-operative pain, hospital stay, surgery time, post-operative bleeding (if), and post-operative infection. Results: A total of 40 patients were included in this study, 20 in the loop knots group and 20 in the harmonic scalpel group. An analysis of the patients data showed that there was no significant difference between the first group and the second group with respect to difference in either age or gender. There was no mortality occurred in this study. There was no significant difference in the overall complication rates (10% in the LOOP group versus 10% in the harmonic group). Conclusion: Harmonic scalpel and loop knots tying are two promising techniques to secure the appendix stump in laparoscopic appendectomy with similar complication rates. Harmonic scalpel costs were higher than loop knots tying but has shorter operative times. Because of the simplicity of techniques, we highly recommend using of the harmonic scalpel especially by surgeons learning laparoscopic procedures.