Evaluation of intracorporeal knotting and endoloop closure in laparoscopic appendicectomy

Abstract

Background

Laparoscopic appendicectomy has become popular nowadays, especially among laparoscopic surgeons, due to the benefits of minimal invasive surgery and the simplicity of this technique. Some laparoscopic surgeons apply ligatures owing to their lower cost and feasibility while others use endoloops and clips. The ideal method should be safe, applicable and cheap. The most appropriate method remains controversial. In this study, we applied intracorporeal ligature (knotting) during laparoscopic appendicectomy for secure closure of the base of the appendix and mesoappendix in one group of patients, and used endoloops in the second group of patients.

Aim and objectives

The aim of this work was to evaluate the application of both techniques, i.e. the use of knotting and endoloops, and record any specific complications related to each.

Settings and design

This was a prospective, randomized, double-blinded study.

Patients and methods

One hundred laparoscopic appendicectomy patients, of whom 64 were female and 36 male, were included in this study from February 2013 to January 2015 at MMIMSR Hospital. Their overall average age was 27.4 years. Patients were divided into two equal groups (group A and group B): group A underwent intracorporeal knotting of the base of appendix with silk while in group B, the appendix base was secured with the use of endoloops.

Results

The mean operative time was 45 min for group A and 37 min for group B (P < 0.05). The mean hospital stay was 2.07 days and 2 days, respectively, which was not statistically significant (P > 0.05). No major complications were recorded for either of the two groups. The technique used in group A was more cost-effective than that applied to group B.

Conclusion

In our study, both the intracorporeal knotting and endoloop closure technique were safe, successful and feasible. We concluded that if the patient cannot afford the harmonic-like material, silk could be used for the base of the appendix. Hence, in rural locations or where instruments are not affordable to the surgeon, or in financially compromised patients, silk can be used without any complication.

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