Appendix Stump Closure Research Articles

Is LigaSure Alone Sufficient for the Closure of the Appendix Stump?

Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump. Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment. The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (P > .05). The operation time of group I was longer than group II (P < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (P = .76, P = .99, respectively). Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.

Comparison of three different methods for stump closure in laparoscopic appendectomy: Endoloop, Hem-o-lok clip, and endostapler.

Acute appendicitis is a common surgical emergency that causes acute abdominal pain and affects approximately 7-8% of the population during their lifetime. The closure of the appendix stump during laparoscopic appendectomy is one of the most critical steps of the surgery to prevent life-threatening complications such as postoperative fistula, peritonitis, and sepsis. The mate-rial chosen for appendix stump closure must be effective, safe, and economical. However, there is still no consensus on the optimal method for stump closure. In this study, we aimed to compare the advantages and reliability of three different methods used for appendix stump closure. At Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Department of General Surgery, cases that underwent laparoscopic appendectomy for acute appendicitis between January 2022 and April 2024 were retrospectively analyzed using the hospital's data system. The patients' demographic data, laboratory values, pathology reports, surgical notes, duration of hospital stay, duration of surgery, total hospital costs, complications related to the surgery within 30 days postoperatively, and the management of these complications were examined. The study included a total of 150 individuals, with 83 (55.33%) males and 67 (44.67%) females. The average age of the participants was 38.45±14.48 years. In terms of the materials used for stump closure, endoloop was used in 82 (54.67%) cases, Hem-o-lok clip in 30 (20.00%) cases, and endostapler in 38 (25.33%) cases. In 144 (96%) cases, no Clavien-Dindo (CD) complications were observed, while complications occurred in six (4%) cases. These six complications included two intra-abdominal abscesses (CD Grade 3), two wound infections (CD Grade 1), one case of bleeding (CD Grade 2), and one pulmonary embolism (CD Grade 4). The use of endoloop, polymeric clips, and endostapler in laparoscopic appendectomy is safe and effective for appendectomy. All three methods can be successfully applied without an increase in intraoperative or postoperative complications. However, due to the higher treatment costs associated with endostapler, its use should be reserved for situations where securing the appendix stump cannot be achieved with endoloop or Hem-o-lok clip.

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

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.

Comparison of Two Stump Closure Techniques in Laparoscopic Appendicectomy: A Single-Centre Prospective Cohort Study.

IntroductionAcute appendicitis is a frequent illness that manifests as an emergency and most of the cases necessitate surgical intervention. One of the most critical processes in a laparoscopic appendicectomy is the closure of the appendicular stump. For the closure of the stump of the appendix, several approaches have been employed and explored, but the one with the best outcomes has yet to be proved. The purpose of this study was to evaluate the medical results and cost analyses of laparoscopic appendicectomy with two of the commonly used stump closure techniques - ENDOLOOP® and Hem-o-lok®.Materials and methodsA two-year prospective hospital-based cohort study was conducted from June 2019 to July 2021. All the patients in the study were randomly assigned to one of two experimental arms (ENDOLOOP® and Hem-o-lok®). The clinical and follow-up data of these patients were collected and tabulated into a data sheet and analyzed.ResultsIn total, 180 individuals were included in the research (90 in each arm). No statistically significant difference was found in comparing the age, gender or diameter of the appendix among the two groups. The time taken for surgery showed significant differences among the two study groups. The time taken for the procedure in the Hem-o-lok® group was significantly lower than the ENDOLOOP® group (40.3 ± 12.3 minutes vs 50.83 ± 10.5 minutes, p < 0.001). No intraoperative or immediate postoperative complications were noted in either of the groups. The average duration of hospital stay was 2.7 ± 0.9 days in the Hem-o-lok® group, while it was 3.1 ± 0.8 days in the ENDOLOOP® group (p = 0.986). The material cost for the stump ligation with Hem-o-lok® was Rs. 310 ± Rs. 76 while that using ENDOLOOP® was Rs. 630 ± Rs. 118 (p < 0.001). In the Hem-o-lok® subset of patients, the mean direct expenses of laparoscopic appendicectomy were considerably lower. During the 12-week follow-up period, none of the patients had any post-operative complications.ConclusionAccording to the results of this study, both the technical variations of appendix stump closure are equal in terms of postoperative complications. When compared to the ENDOLOOP® group, the Hem-o-lok® group had a shorter duration of surgery and ended up spending less money. Hem-o-lok® clips have the potential to become the preferred way of anchoring the appendix base during laparoscopic appendicectomy.

Method for appendix stump closure during laparoscopic appendectomy (literature review)

Currently, the laparoscopic appendectomy is the preferred method for treatment of acute appendicitis. Laparoscopic approach resulted in a decrease of postoperative morbidity (especially for reducing the frequency of surgical site infection), allows to faster postoperative recovery of patients. The method of closure of the appendix stump is the main step of laparoscopic appendectomy. The risk of intra-abdominal complications is considered high during this step. Therefore, it is important to choose the safest method of closure of the appendix stump among the number of available options. The four prominent management options are endoloops, staplers, endoclips and inversion of appendix stump with intracorporal sutures. This literature review presents the advantages and disadvantages of these methods. The results of randomized studies and meta-analysis comparing the methods are also presented. It is shown that there is no evidence pointing to any of the existing methods to be a safer option. It is suggested that factors such as anatomy features, cost efficiency and personal experience of the surgeon using these methods are considered to determine the choice.

A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis

BackgroundClosure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure.MethodsThis was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler).ResultsIn total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was—104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072).ConclusionsThe present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 (http://www.clinicaltrials.gov).

Comparative Study for Appendix Stump Closure Using Metallic Clipping Versus Extracorporeal Knotting during Laparoscopic Appendectomy

Comparative Study for Appendix Stump Closure Using Metallic Clipping Versus Extracorporeal Knotting during Laparoscopic Appendectomy

Comparison of three techniques for appendiceal stump closure during laparoscopy

Aim: Laparoscopic appendectomy is the gold standard treatment of acute appendicitis. However, there is no consensus about the technique to apply when closing the appendix stump. This study compares three techniques to close the appendix stump: Laparoscopic purse-string suture (LPS), metal clips, and Hem-o-lok clips. The aim is to evaluate the advantages, safety, and costs of these three methods. Methods: We conducted a retrospective cohort study which included 220 patients who underwent laparoscopic appendectomy operations for acute appendicitis between May 2017 and December 2019. The cases were divided into three groups and evaluated. Group A received LPS, group B received metal clips, and group C received Hem-o-lok clips. The demographic features of the patients, American Society of Anesthesiology (ASA) scores, duration of surgery, postoperative complications, hospital stay, and cost were evaluated retrospectively from patient files. Results: There were 79 patients in group A, 91 patients in group B, and 50 patients in group C. There was no difference between the groups with respect to demographic features, ASA physiological state scores, and laboratuary values. The operation time and postoperative complication rates did not differ between groups (P>0.05). Group C had longer hospital stays (P=0.001), and group A had lower costs (P=0.001). Conclusion: In the laparoscopic appendectomy technique, the use of LPS for appendix stump closure is safe and effective. Furthermore, technical consumables and hospital treatment costs are significantly reduced.

Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis – results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study

Background: In general, the three main options for stump closure in laparoscopic appendectomy are clips, endoscopic staplers and endoloops. However, there is no gold standard, especially regarding complicated acute appendicitis which is generally associated with worse outcomes.Objectives: We aimed to assess the outcomes of different stump closure techniques during laparoscopic appendectomies for complicated appendicitisMethods: Our multicenter observational study of 18 surgical units assessed the outcomes of 1269 laparoscopic appendectomies for complicated appendicitis that used the three main stump closure techniques: clips, staplers and endoloops. Groups were compared in terms of peri- and postoperative outcomes.Results: Staplers were superior in terms of overall morbidity (9.79 vs. 3.29% vs. 7.41%, p = .017) and length of stay (4 vs. 3 vs. 4 days, p < .001) respectively for clips, staplers and endoloops. However, no differences in major complication rates, postoperative intraabdominal abscess formation, reintervention rates and readmission rates were found.Conclusion: Although our results show some clinical benefits of staplers for appendix stump closure, they are based on a non-randomized group of patients and are therefore prone to selection bias. Further well-designed trials taking into consideration not only the clinical benefits, but also, the economic aspects of the surgical treatment of complicated acute appendicitis are needed to confirm our results.

Comparison of methods for closure of appendix stump during laparoscopic appendectomy using endoloops: Single surgeon experience.

In this study, using single or double endoloops, with reference to the literature, we aimed to retrospectively assess the results for patients in our clinic who underwent a laparoscopic appendectomy. This study included 251 patients who were operated on by a single surgeon; 137 of the patients were male (54.6%) and 114 were female (45.4%). Patients were divided into two groups based on the type of endoloop procedure that was used. Group 1 included 107 patients for whom a single endoloop was used. Group II included 144 patients for whom double endoloop was used. Age, sex, duration of operation, length of hospital stay, pathological findings, perioperative appendix findings, perioperative abdominal findings, post-operative complications requiring hospitalization and wound infections were assessed for each patient. Patients were also assessed statistically for complications. There were no significant differences in the demographic characteristics, perioperative surgery findings, pathological findings or duration of hospital stays between the two groups of the patients. However, the duration of operation was shorter in Group I (54.9±16.1 min) as compared to Group II (61.2±18.8 min). The incidence of complications requiring rehospitalization was statistically significantly lower in Group I (1.9%; n=2) as compared to Group II (9%; n=13) (p=0.018). There were no complications requiring re-operation for patients in Group I. In Group II, four patients (2.8%) required re-operation; however, this difference was not statistically significant. Concerning wound infection, there was also no significant difference between Group I (7.5% n=8) and Group II (4.9% n=7). Using a double endoloop does not decrease the risk of post-operative complications, but it does increase the cost and the duration of the operation. We have concluded that using a single endoloop in a laparoscopic appendectomy may be more appropriate.

Update on Transumbilical Single-Incision Laparoscopic Assisted Appendectomy (TULAA) - Which Children Benefit and What are the Complications?

Transumbilical laparoscopic-assisted appendectomy (TULAA) is fast and cost-effective since no endoloops, staplers or wound protection devices are used. We analyzed the effects of TULAA as first approach for perforated (PA) and non-perforated (NPA) appendicitis in children. We performed a retrospective analysis of 181 children for whom TULAA was the first approach for appendicitis between October 2010 and March 2016. Morbidity, additional laparoscopic instrument insertion (AI), conversions to open extraumbilical appendectomy (OC), and complications were evaluated. TULAA was initiated in 181 (87.4%) children (113 boys: 68 girls). Median age was 10.3 years (3.3-13.9 years) and BMI 16.8 kg/m2 (12.4-30.8). Appendicitis was non-perforated in 157 (86.7%) and perforated in 24 (13.3%) patients. TULAA was finalized in 142 (78.5%) patients, AI were inserted in 20 (11%) and OC were performed in 19 (10.5%) patients. Duration of surgery did not exceed 20 min for 12.8%, and 30 min for 43.6% of patients with TULAA and NPA. The rate of wound infections did not differ between procedures (TULAA 3/142 (2.1%), AI 0 (0%), OC 1/19 (5.3%), P=1.000). Further postoperative course was uneventful in 179 (98.9%) patients. TULAA can be used as first approach for appendicitis in all children with a low rate of complications. Extracorporeal appendix stump closure can be safely achieved in the majority of children without using laparoscopic disposable devices.

Comparison of the methods of intracorporeal knot and hem-o-lok clip to cover the stumps in laparoscopic appendectomy

Aim: Laparoscopic appendectomy (LA) is used in acute appendicitis treatment in many centers today. Various methods such as intracorporeal knot, endoloop, stapler and hem-o-lok clip are used to close of the appendix stump during LA. All of these methods has several advantages and disadvantages. In this study, we aimed to compare the effect of the intracorporal knot method with hem-o-lok clip method to close of the appendix stump in LA. Material and Methods: Operative data, complications and follow-up results of 143 patients which treated with LA between January 2012 and December 2017 were evaluated retrospectively. Results: Sixty-four patients (44.7%) were males and 79 (55.2%) were females. Seventy-five patients (52.4%) were treated with 2/0 polyglactin (coated vicyrl, ethicon) sutures and 68 patients (47%) were treated with hem-o-lok clip XL (weck hem-o-lok polymer ligation system) for intracorporeal knot to close of the appendix stump. Patients were compared according to the duration of operation, the duration of hospitalization and postoperative complications and there were no statistically significant difference between the data of the cases according to the groups (p = 0.197, p = 0.902, p = 0.503, respectively). Conclusion: We identified that both techniques for appendix stump closure are effective and safe methods in LA.

Closure methods of the appendix stump for complications during laparoscopic appendectomy.

Laparoscopic appendectomy is amongst the most common general surgical procedures performed in the developed world. Arguably, the most critical part of this procedure is effective closure of the appendix stump to prevent catastrophic intra-abdominal complications from a faecal leak into the abdominal cavity. A variety of methods to close the appendix stump are used worldwide; these can be broadly divided into traditional ligatures (such as intracorporeal or extracorporeal ligatures or Roeder loops) and mechanical devices (such as stapling devices, clips, or electrothermal devices). However, the optimal method remains unclear. To compare all surgical techniques now used for appendix stump closure during laparoscopic appendectomy. In June 2017, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6) in the Cochrane Library, MEDLINE Ovid (1946 to 14 June 2017), Embase Ovid (1974 to 14 June 2017), Science Citation Index - Expanded (14 June 2017), China Biological Medicine Database (CBM), the World Health Organization International Trials Registry Platform search portal, ClinicalTrials.gov, Current Controlled Trials, the Chinese Clinical Trials Register, and the EU Clinical Trials Register (all in June 2017). We searched the reference lists of relevant publications as well as meeting abstracts and Conference Proceedings Citation Index to look for additional relevant clinical trials. We included all randomised controlled trials (RCTs) that compared mechanical appendix stump closure (stapler, clips, or electrothermal devices) versus ligation (Endoloop, Roeder loop, or intracorporeal knot techniques) for uncomplicated appendicitis. Two review authors identified trials for inclusion, collected data, and assessed risk of bias independently. We performed the meta-analysis using Review Manager 5. We calculated the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, with 95% confidence intervals (CIs). We included eight randomised studies encompassing 850 participants. Five studies compared titanium clips versus ligature, two studies compared an endoscopic stapler device versus ligature, and one study compared an endoscopic stapler device, titanium clips, and ligature. In our analyses of primary outcomes, we found no differences in total complications (OR 0.97, 95% CI 0.27 to 3.50, 8 RCTs, very low-quality evidence), intraoperative complications (OR 0.93, 95% CI 0.34 to 2.55, 8 RCTs, very low-quality evidence), or postoperative complications (OR 0.80, 95% CI 0.21 to 3.13, 8 RCTs, very low-quality evidence) between ligature and all types of mechanical devices. However, our analyses of secondary outcomes revealed that use of mechanical devices saved approximately nine minutes of total operating time when compared with use of a ligature (mean difference (MD) -9.04 minutes, 95% CI -12.97 to -5.11 minutes, 8 RCTs, very low-quality evidence). However, this finding did not translate into a clinically or statistically significant reduction in inpatient hospital stay (MD 0.02 days, 95% CI -0.12 to 0.17 days, 8 RCTs, very low-quality evidence). Available information was insufficient for reliable comparison of total hospital costs and postoperative pain/quality of life between the two approaches. Overall, evidence across all analyses was of very low quality, with substantial potential for confounding factors. Given the limitations of all studies in terms of bias and the low quality of available evidence, a clear conclusion regarding superiority of any one particular type of mechanical device over another is not possible. Evidence is insufficient at present to advocate omission of conventional ligature-based appendix stump closure in favour of any single type of mechanical device over another in uncomplicated appendicitis.

Erratum to: The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy.

Erratum to: The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy.

Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis

BackgroundAn adequate closure of the appendiceal stump is vital to minimize intra-abdominal and surgical site infections. There are various techniques for the closure of base of appendix while performing a laparoscopic appendectomy like endoloops, knotting, clips and staplers. ObjectiveTo compare the extracorporeal knot-tying suture with metallic endoclips in laparoscopic appendiceal stump closure in terms of complications, operative time, hospital stay and cost. MethodologyThis study was conducted as a single-blinded randomized controlled trial. Patients undergoing laparoscopic appendicectomies in three tertiary care hospitals of Peshawar, i.e. Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex from June 1, 2013 to June 1, 2014 were included in the study and randomized into two groups – extra-corporeal knotting group and the metallic endoclip group. Data on demographics, complications, operative time, hospital stay and cost for the two techniques were collected and analyzed. Statistics analyses were done with IBM SPSS v19 (IBM Corp., Armonk, NY, USA). T-test was use for comparison of continuous data; Chi-square test was used for comparison of categorical data. P < 0.05 was considered statistically significant. ResultsA total of 68 patients were enrolled in the study and randomized into two groups: metallic endoclip group n = 32 (47.1%), extracorporeal knot group n = 36 (52.9%). The two groups didn't significantly differ in age (P = 0.9). There were no statistically significant differences between the two groups in terms of complication rates (P > 0.05) and hospital stay (P > 0.05). The mean operative time for the endoclip group was shorter (mean 42.1 ± 7.4 min) as compared to the extracorporeal knot group (mean 48.3 ± 8.4 min) (P = 0.002). The cost of endoclip group was higher (800PKR = 8.10US$) as compared to the extracorporeal knot group (220PKR = 2.23US$). ConclusionThe use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it's a useful alternative to the extracorporeal knotting especially for learners.

Methods for closure of appendix stump during laparoscopic appendectomy procedure.

The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others.

The feasibility of bipolar tissue sealer for appendix stump closure

Background: Appendiceal stump closure is a highly important step in laparoscopic appendectomy, especially for post-operative complications. The aim of this study is to compare the effects of suture ligation and bipolar tissue sealer techniques on burst pressure using flesh appendectomy specimens. Material and methods: Appendectomy specimens of 32 patients with grade I-II disease were included in the study. Perforated or necrotic appendices and specimens ineligible for pressure measurement were excluded from the study. Appendiceal stumps of 16 patients in group 1 were double-ligated with 2/0 polyglactin sutures, then appendectomy was performed between these sutures. In group 2, the management of the stump was performed through single ligation with polyglactin suture, followed by appendectomy using a bipolar tissue sealing device. Burst pressures were recorded for all specimens. Results: There were no differences between groups in terms of age and sex. There was no significant difference between the two groups in terms of burst pressure (p = 0.92). Also, no significant difference was found between groups in terms of localization of the perforation (p > 0.05). Conclusion: Bipolar tissue sealer achieves safe stump closure with satisfactory burst pressure values. Based on this, using bipolar tissue sealer for appendiceal stump closure in appendicitis may be safe and reliable.

Laparoscopic appendectomy with hand-made loop.

IntroductionAcute appendicitis is the most common abdominal pathology requiring emergent surgical procedure. For treatment, laparoscopic surgery is commonly performed. For appendix stump closure different procedures are used.AimEvaluation of the results of patients in whom the stump of the appendix was closed with a hand-made loop during laparoscopic appendectomy (LA).Material and methodsPatients in whom the stump of the appendix was closed with a hand-made loop during LA were included in the study. Reports of patients were collected from patient files retrospectively. Laparoscopic appendectomy was applied through 3 ports. Two loops were placed in the stump of the appendix. Loop was a modification of the Roeder loop that has been described in the literature and has been shown to be safe.ResultsSixty-one patients were included in the study. Twenty-four of them (39%) were female, 37 of them (61%) were male. The age range is from 13 to 60 (average age is 30) years. During the postoperative period, one surgical wound infection and two intraabdominal abscesses were detected. There was no leakage from the stump of the appendix in any patients.ConclusionsOne of the most important components of cost of LA is the technique of closure of the stump. Stapler, endoloop, various clips or a hand-made loop could be used for closure. We recommend using a hand-made loop for closure as an easy, safe and cheap method.

A Comparison of Nonabsorbable Polymeric Clips and Endoloop Ligatures for the Closure of the Appendicular Stump in Laparoscopic Appendectomy

The aim of this prospective randomized trial was to evaluate the clinical outcomes of hem-o-lok ligation system in laparoscopic appendix stump closure by comparing the endoloop ligature. A total of 53 patients were evaluated in this study (n=26 and 27 for hem-o-lok and endoloop groups, respectively). The mean operation time were shorter in hem-o-lok group than endoloop group (64.7 ± 19.2 vs. 75.4 ± 23, respectively); however, the difference was not significant. Other surgical findings were similar. There was no statistically significant difference in overall nonsurgically or surgically related complications. The mean postoperative hospitalization time was also similar in both groups. Although it is not possible to make general conclusions on basis of such a limited study, in our opinion, closure of the appendix stump with polymeric nonabsorbable clips in laparoscopic appendectomy may be a cheaper and simpler alternative to other widely used methods.

Appendix stump closure during laparoscopic appendectomy

Appendix stump closure during laparoscopic appendectomy