Invagination Of Stump Research Articles

Outcomes of Open Appendicectomy by Simple Ligation versus Invagination in Acute Appendicitis- A Prospective Observational Study

Introduction: Surgical techniques in open appendicectomy has been evolving with most centers following simple ligation of appendix stump as the most preferred approach including the laparoscopic approach. Invagination of stump of the appendix is also practiced as a traditional approach. Aim: To compare and evaluate the outcomes and postoperative morbidity of simple ligation and invagination appendicectomy techniques. Materials and Methods: This was a prospective observational study conducted from October 2016 to July 2018 and included a total of 100 patients of acute appendicitis undergoing emergency open appendectomy surgery. The method of surgery of simple ligation and invagination appendectomy was allotted alternatively with 50 patients in each category. Both techniques of surgery were compared in terms of operating time, duration of hospital stay and postsurgical complications. Relevant data was collected and entered in Microsoft excel and p-value was calculated using Chi-square test. Results: A total of 100 patients were included with a mean age of 27 years. Both the groups with 50 patients each, were equivalent with age and gender distribution. It was observed that both the techniques had similar outcomes in respect to mean duration of surgery, duration of hospital stay and morbidities (p-value>0.05) with no statistically significant difference. The morbidity and the rate of postoperative complications were similar in both the groups. Conclusion: Appendicular stump management after appendectomy can be treated either by simple ligation or by invagination method, both techniques being equally effective and safe. Hence, it is surgeons preference to choose among the two techniques.

Validation of appendiceal stump invagination in laparoscopic appendectomy.

There are various methods for appendiceal stump dissection, but the necessity for stump invagination remains unclear. This study aimed to assess the efficacy of appendiceal stump invagination in patients with acute appendicitis after laparoscopic appendectomy (LA). We enrolled 327 patients with acute appendicitis who underwent LA between 2012 and 2020. Perioperative variables and surgical outcomes were analyzed between the invagination of the appendiceal stump and noninvagination groups. Propensity score-matched analysis (PSM) was performed. More patients experienced severe inflammation and severe intra-abdominal contamination in the noninvagination group than in the invagination group. Patients in the noninvagination group had an older age, higher body mass index, and poorer American Society of Anesthesiologists physical status than the invagination group. Severe inflammation in the noninvagination group was associated with longer hospital stays and poorer postoperative complications than in the invagination group. PSM analysis was performed to minimize bias in the two groups. After PSM analysis, there were no significant differences in surgical site infection, postoperative intra-abdominal abscess, Clavien-Dindo class ≥IIIa, or postoperative stay between the two groups. During the follow-up period, the postoperative adhesive ileus was not significantly different between the invagination and noninvagination groups. Invagination of the appendiceal stump during LA is not necessary to prevent short- and long-term complications. Even in cases dissected using a laparoscopic endostapler, the appendiceal stump per se is not related to postoperative adhesive ileus.

Comparison of Simple Ligation versus stump Invagination in open Appendectomy

Background: Acute appendicitis (AA) is one of the most prevalent abdominal crises and faced by the surgeon in practice. The best treatment for the appendicular stump during open appendectomy is unknown. This is a randomized controlled trial comparing simple ligation with appendicular stump invagination. Materials and Methods: The MASS (Modified Alvarado Score System) test was used to confirm the diagnosis of acute appendicitis. When necessary, an ECG & a chest X-ray were taken. All of the patients were put under spinal anesthesia for the procedure. Findings: The appendicular stump of 305 patients were treated with simple ligation (161 patients) in group I, and ligation and invagination (144 patients) in group II. “Pyrexia, vomiting, serous discharge, wound infection, peritonitis, residual abscess, and post-operative pain in the right iliac fossa are all comparable after surgery. Paralytic ileus occurred in 2 (1.24%) of patients in groups I and 7(4, 36%) patients in group II, respectively, and was statistically significant. Conclusion: Easy ligation of the appendicular stump after open appendectomy is advised since it is safe, simple, and takes less time.

NONINVAGINATION VS. INVAGINATION OF APPENDICULAR STUMP: A RETROSPECTIVE STUDY

Appendicitis is the most common abdominal surgical emergency. The standard treatment of acute appendicitis is appendicectomy which can be performed by either open or laparoscopic approach. While during laparoscopic approach the stump is mostly not invaginated, in open method management of stump remains debatable- simple ligation or ligation and invagination of the stump. Aim of the study was to compare results of simple ligation alone or ligation and invagination of the appendicular stump during appendicectomy. Materials And Methods: Altogether 74 patients were included in this study and divided into two groups. Group I ligation and invagination of the stump with purse string suture and Group II simple ligation of the stump. The two methods were compared with respect to operative time, intraoperative and post-operative complications. Results: There was no signicant difference in either the rate of post-operative complication and post-operative hospital stay between the two groups. The average operative time was shorter in group without invagination. Conclusion: simple ligation of appendicular stump is a safe, simpler good technique associated with shorter operative time.

METHOD OF FORMING OF RESERVOIR PANCREATOANASTOMOSIS IN PANCREATODUODENAL RESECTION

The method based on formation of ileal reservoir with following invagination of pancreas stump inside it. A presence of the ileal reservoir with regulated vertical incision of the intestine excepted the possibility of compression of the pancreas stump by the intestine wall in glands invagination to the lumen. The method could be used in the existence of main risk factors: soft tissues of the gland and the diameter less than 3 mm. This means was applied in 19 patients. There was noted inconsistence of pancreatoanastomosis in 3 (15,8%) patients. One female patient died (5,3%). The reason of death wasn’t associated with features of anastomosis forming. The results obtained indicated about good preventive properties of the proposed pancreatoanastomosis in relation to complication development in case of unfavorable conditions for anastomosis formation.

Appendicectomy; non-invaginaton vs. invagination of Appendicular stump

Objective: To find out the benefits of invagination of stump during appendicetomy. Acute appendicitis is the most common abdominal emergency requiring emergency surgery. Design: A prospective randomized clinical trail. Period: From June 2003 - May 2005. Setting: Mayo Hospital & Sir Ganga Ram Hospital, Lahore. Patients & methods: A prospective randomized study including 200 patients undergoing appendicectomy was carried out to see any advantage of invagination of appendicular stump. Results: A total of 200 operated cases of appendicitis divided in two groups of 100 cases each. In Group, a there were 59 males and to 2nd and 3rd decade. I Group there were 63 males and females. The youngest patient was 5 year old while the eldest was 57 year old. Maximum patients belonged to 2nd and 3rd decade. Conclusion: It was that there was no added benefit of invagination of appendicular stump, rather it took more operative time, and times, it was hazardous to do so

Best evidence topic: What is the best management of the appendix-stump in acute appendicitis: Simple ligation or stump invagination?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: for patients undergoing appendicectomy for complicated acute appendicitis is simple ligation or invagination of the appendix-stump safer? Using the reported search, 587 papers were found. Five studies were deemed to be suitable to answer the question. In conclusion, the literature is more in favour of the appendix stump being managed with simple ligation rather than stump invagination. All 5 studies assessed are prospective, randomised studies, though overall the quality of these studies is poor. The outcomes assessed were incidence of post-operative complications (pyrexia, wound infection, abscess, caecal fistula and post-operative ileus), post-operative length of stay and mean operating time. The analysis indicates no significant difference between the groups in rates of post-operative pyrexia, intra-abdominal abscess or caecal fistula. Only one study showed a significant difference in rates of wound infection in favour of simple ligation. One study demonstrated a significant difference in favour of simple ligation when comparing rates of post-operative ileus. Overall, simple ligation was found to reduce patient length of stay when compared with stump invagination; one study found this difference to be significant. Simple ligation also produced shorter operating times compared with stump invagination – a risk factor for the development of post-operative ileus.All studies suffered limitations that make the quality of the evidence assessed poor. Although this evidence does favour simple ligation of the stump as compared to invagination, higher quality randomised studies are needed to answer the question definitively.

Pancreatic cancer: does irreversible electroporation improve the quality of life and the survival in local advanced pancreatic adenocarcinoma? Report of a pilot case

Pancreatic cancer: does irreversible electroporation improve the quality of life and the survival in local advanced pancreatic adenocarcinoma? Report of a pilot case

The Practice to Invaginate Appendicular Stump after Appendectomy.

Objectives: To determine whether invagination of stump after appendectomy is necessaryStudy design: Comparative studyPlace and duration of study: Surgical unit 3, Liaqat University Hospital Hyderabad, from 1-7-2007 to 30-6-2009.Methodology:112 patients who underwent appendectomy were included on the basis of no probability convenient sampling. Irrespective of age and sex. These patients were diagnosed by clinical examination and lab investigations. Patients were divided in 2 groups alliteratively. Group 'A consisting of 56 patients with invagination ofappendicular stump and group B consisting 56 patients without invagination of stump. Both groups were lookedafter for post-surgical complications.Results: Age of patients ranged from 1266 years (men age 28.4 years), 71 patients were males (37 in group 'A,34 in group B') 41 were females (19 in group 'A' and 22 in group 'B): Paralytic ileus was observed in 4 patients(7,2%) in group 'A' and 2 patients (3.6%) in group 'B'. Wound infection was observed in 6 patients (10.76) ingroup 'A' while in group B' it was observed in 2 patients (3,6%). Remaining post operative complications and hospital stay was identical in both groups.Conclusion: There is no benefit of invagination of appendicular stump over non invagination, rather invaginationof stump-increases operating time and prolonged anesthesia un-necessarily.Key words: Acute Appendicitis, Appendectomy, Appendicular stump invagination.

Management of appendix stump: The technique

<b>Introduction:</b> Time and again the technique of appendectomy for acute appendicitis has been debated, and optimal management of the stump is still a matter of discussion. Thus, a study was proposed to compare two techniques of management of the stump i.e., simple ligation alone vs. ligation and invagination of the stump with purse string sutures. <b>Aim:</b> To compare and evaluate simple ligation alone with ligation and invagination of the stump during appendectomy. <b>Materials and Methods:</b> A total of 102 patients were included in this study. Each patient was alternately divided under two groups (Group A: Simple ligation of the stump and Group B: Ligation and invagination of the stump with purse string sutures). The two techniques were compared with respect to duration, intra-operative and post-operative complications. <b>Results:</b> It was observed that simple ligation is not only an equally safe a procedure, but is also better in terms of duration of the procedure, which was seen to be less in the case of simple ligation alone. Post-operative course as well as duration of hospital stay was similar in both the groups. <b>Conclusion:</b> Simple ligation is as good a technique as ligation and stump invagination with purse string sutures with respect to the results of the procedure.

APPENDICECTOMY

Objective: To evaluate the usefulness of invagination/burial of appendicular stump after removal of appendix. Design: A prospective, non randomized comparative study. Setting: CMH Kharian and PAF Hospital Mianwali. Period: 2005-2007. Patients and Methods: Three hundred patients were included in this study. Appendicectomy was performed through Lanz incision .After removal of the appendix stump was buried/ invaginated in 150 patients while it was not buried in other 150 patients. 198 patients were males and 102 patients were females. The youngest patient was 14 years old and the eldest was 55 years old. Perforated and gangrenous appendices were not included in this study. Results: There was hardly any difference in outcome of patients in both groups except that 10 patients in first group had longer hospital stay due to symptoms like more pain, fever and infection. Conclusion: Burial or otherwise of appendicular stump does not make much difference. It was concluded that there was no added benefit of invagination of appendicular stump rather it takes more operative time and at times it has negative implications too.

Assessment of stump invagination versus simple ligation in open appendicectomy

Introduction: Operation of appendix is very common abdominal surgery that is done by general surgeons. Some surgeon prefer to invaginate the appendix stump while others don&rsquo;t. Aim of the study was to compare the technique of ligation and invagination of the appendix stump with simple ligation of the appendix stump during appendicectomy for acute appendicitis. Methods: A prospective comparative study of 150 appendicectomies were done in the Department of General Surgery, Nepalgunj medical college (NGMC),Nepalgunj,Nepal from June 2001-May 2007in unit III. All patients with uncomplicated and complicated acute appendicitis who underwent open appendicectomy and had appendicular stump for ligation and invagination or simple ligation, were divided into two groups. In group-I ligation with invagination and in group-II, simple ligation of appendix stump was carried out. Patients were followed up for 3-6 months to check the development of complications Results: Both groups were similar with respect to age and sex. Invagination of the stump after ligation of the stump was done in 70 patients while simple ligation was done in 80 cases. The incidence of postoperative pyrexia (18.57% and 22.5%), wound infection (27.15% and 30.0%) and postoperative paralytic ileus (25.71% and 27.5%) was in group-I and group-II respectively. Conclusions: Simple ligation of appendix stump is as safe a procedure as ligation and invagination of appendix stump during appendicectomy. DOI: http://dx.doi.org/10.3126/joim.v32i1.3994Journal of Institute of Medicine, April, 2010; 32:1 pp.7-10

Assessment of stump invagination versus simple ligation in open appendicectomy

Introduction: Operation of appendix is very common abdominal surgery that is done by general surgeons. Some surgeon prefer to invaginate the appendix stump while others don&rsquo;t. Aim of the study was to compare the technique of ligation and invagination of the appendix stump with simple ligation of the appendix stump during appendicectomy for acute appendicitis. Methods: A prospective comparative study of 150 appendicectomies were done in the Department of General Surgery, Nepalgunj medical college (NGMC),Nepalgunj,Nepal from June 2001-May 2007in unit III. All patients with uncomplicated and complicated acute appendicitis who underwent open appendicectomy and had appendicular stump for ligation and invagination or simple ligation, were divided into two groups. In group-I ligation with invagination and in group-II, simple ligation of appendix stump was carried out. Patients were followed up for 3-6 months to check the development of complications Results: Both groups were similar with respect to age and sex. Invagination of the stump after ligation of the stump was done in 70 patients while simple ligation was done in 80 cases. The incidence of postoperative pyrexia (18.57% and 22.5%), wound infection (27.15% and 30.0%) and postoperative paralytic ileus (25.71% and 27.5%) was in group-I and group-II respectively. Conclusions: Simple ligation of appendix stump is as safe a procedure as ligation and invagination of appendix stump during appendicectomy. DOI: http://dx.doi.org/10.3126/joim.v32i1.3994Journal of Institute of Medicine, April, 2010; 32:1 pp.7-10

Surgical Morphology of the Pancreatic Isthmus

Background: Pancreatic isthmus method anastomosis following pancreatic resection is an important factor of postoperative fistula formation. While the anatomy and vascular supply of the pancreatic head have been studied in detail, little is known about the morphology of the pancreatic isthmus. The authors determine the anatomy and morphology of the pancreatic isthmus. Methods: 99 consecutive cadaveric pancreatic specimens were taken during standard autopsy. Organs were transected at the isthmus and pancreatograms and microscopic specimens of the transection plane were analyzed. Results: The mean size of the Wirsung duct at the isthmus was 2.89 mm (±0.87 mm, from 1.4 to 6 mm). The main pancreatic duct was located approximately in the middle of the pancreatic cross-section plane in almost all specimens. The total number of second-degree pancreatic ducts visible on pancreatograms within the isthmus was 1.77 (±1.00, from 0 to 4) and 1.83 (±1.4, from 0 to 5) on microscopic analysis. Conclusions: The presence of seconddegree pancreatic ducts at the transection site might favor the use of a pancreaticoenteric anastomosis with stump invagination to reduce the risk of anastomotic leakage.

Appendicectomy: an assessment of the advisability of stump invagination.

Seven hundred and thirty-two cases of appendicectomy performed over a period of 5 years are reviewed to compare the incidence of complications and the length of the postoperative stay in hospital, depending on whether the appendix stump was simply ligated or was invaginated by purse string suture following ligation. No detrimental effects are noted following simple ligation, whereas patients who had stump invagination remained in hospital on average more than a day longer, mainly owing to a higher incidence of wound infection (16 per cent as against 6 per cent).

Appendicectomy: An assessment of the advisability of stump invagination: A. P. Sinha. Br J Surg 64:499–500 (July), 1977

Appendicectomy: An assessment of the advisability of stump invagination: A. P. Sinha. Br J Surg 64:499–500 (July), 1977

Treatment of sigmoid volvulus.

Summary(a) Seventeen cases of sigmoid volvulus are reviewed.(b) The various methods of treatment are considered.(c) The mechanism of torsion is studied.(d) The clinical picture is carefully outlined showing its characteristic course.(e) It is shown that there are fairly definite indications of the suspicion or presence of gangrene.(f) A conservative emergency approach of intubation is favoured.(g) It is suggested that in the presence of gangrene the Mikulicz procedure be replaced by resection with closure and invagination of the distal stump and proximal terminal colostomy.

Studies regarding silk and catgut in invagination of the appendicial stump; and regarding non-invagination technique

Studies regarding silk and catgut in invagination of the appendicial stump; and regarding non-invagination technique