SP3.1.12 A Comparison of Polymeric Clips vs Endoloops to Secure Appendicular Stump in Adult Emergency Laparoscopic Appendicectomy

Abstract Aims To assess the use of polymeric clips (PC) as an alternative to Endoloops (EL) to secure appendicular stump in adult emergency laparoscopic appendicectomy. Method A retrospective analysis of all patients who underwent emergency laparoscopic appendicectomy from 1/11/19 to 31/10/20, following introduction of polymeric clips in our institute as a safe alternative to endoloops to secure appendicular stump in October 2019. Patient demographics, operative duration, intraoperative findings, methods to control the appendicular mesentery and stump, post-operative length of stay, complications and grade of operating surgeon were compared in both groups (PCvsEL) and data analysed using SPSS. Results A total of 333 patients were included, who underwent laparoscopic appendicectomy and satisfied the inclusion criteria. PC were used in 160 (48%) patients and EL in 173 (52%). Patient demographics, surgeon grade and intra-operative severity of disease were statistically similar between both groups. Mean operative time was 10 minutes shorter in PC group (71 vs 81minutes, p = 0.001). Mesoappendix was ligated by applying laparoscopic titanium clips in EL group 25%, vs 6% PC group (p < 0.001), while 42% of the PC group, used PC on mesoappendix, which was without any additional cost. Post-operative complication rates were similar in both groups, apart from post-operative ileus, which was more in EL group (p = 0.003). Conclusion The use of PC in emergency laparoscopic appendicectomy is a safe and effective way to secure the appendicular stump, which results in, not only reduced operating time, but also a significant cost saving (£49/3x Endoloops vs £21/pack of 6x Polymeric clips) to NHS.

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Two-port vs. conventional (three-port) laparoscopic appendicectomy: a new technique in laparoscopic appendicectomy

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20150893 ◽

2015 ◽

Vol 1 (5) ◽

pp. 215

Author(s):

Hemant P. Mhatre ◽

Vijay B. Kanake ◽

Vipul V. Nandu

Keyword(s):

Iliac Fossa ◽

Length Of Hospital Stay ◽

Laparoscopic Group ◽

Study Data ◽

Laparoscopic Appendicectomy ◽

Complication Rates ◽

Camera Port ◽

A New Technique ◽

Appendicular Stump ◽

The Right

Background: Three-port laparoscopic appendicectomy has proven its worth in the management of appendicitis. From a cosmesis, the umbilical and suprapubic portsites are hidden by natural camouflages, the Right Iliac Fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. Methods: 58 patients were studied for this study. Data was collected prospectively. The two port appendicectomy was performed with 10 mm umbilical working port and 5 mm supra-pubic camera port. A stitch was taken transparietaly in RIF which was under camera guidance passed through the tip of appendix and held with suture to retract the appendix. The base was ligated with an intra-corporeal knot and appendix cut and delivered out. Three port appendicectomy was performed via the 10 mm umbilical, 5 mm supra-pubic and 5mm right iliac fossa ports. The appendicular stump was ligated with an endoloop or an intra-corporeal knot, appendix cut and delivered outResults: 58 patients underwent surgery over the one year period for appendicitis. Out of 26 cases attempted, the two port appendicectomy was successful in 21 cases, with conversion to the three-port technique in 4 and conversion to open in 1 case. The complication rates, return to work were comparable between the two groups. Duration of operation was more whereas length of hospital stay was less in two port appendicectomy group as compared to conventional laparoscopic group.Conclusions: Patients who underwent two port appendicectomy had a cosmetically better appearing scar than compared to three port appendicectomy cases.

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Single Incision Laparoscopic Cholecystectomy Performed via the “Marionette” Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population

The American Surgeon ◽

10.1177/000313481508101021 ◽

2015 ◽

Vol 81 (10) ◽

pp. 1015-1020 ◽

Cited By ~ 1

Author(s):

Maryam N. Saidy ◽

Sunal S. Patel ◽

Mark W. Choi ◽

Mohammed Al-Temimi ◽

Deron J. Tessier

Keyword(s):

Multivariate Analysis ◽

Laparoscopic Cholecystectomy ◽

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Single Incision ◽

Univariate Analysis ◽

Operating Time ◽

Complication Rates ◽

Single Incision Laparoscopic Cholecystectomy

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the “marionette” technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the “marionette method” as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the “marionette” technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC.

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Complications of Diagnostic Arteriography Performed by a Vascular Surgeon in a Recent Series of 558 Patients

Vascular ◽

10.2310/6670.2007.00022 ◽

2007 ◽

Vol 15 (2) ◽

pp. 92-97 ◽

Cited By ~ 6

Author(s):

Ali F. AbuRahma ◽

Michael Elmore ◽

John Deel ◽

Bandy Mullins ◽

John Hayes

Keyword(s):

Operative Time ◽

Perioperative Complications ◽

Operating Time ◽

Major Complication ◽

Aortic Aneurysms ◽

Complication Rates ◽

Vascular Surgeon ◽

Technical Success Rate ◽

Abdominal Aortic ◽

The Mean

This article analyzes the complication rates of diagnostic arteriographies performed by a single vascular surgeon and compares them to those previously published by interventional radiologists. Five hundred fifty-eight consecutive patients who underwent diagnostic arteriographies were analyzed. A modification of one study's criteria was used to compile perioperative complications. The technical success rate was 99%. These included 345 aortoiliofemoral arteriograms with runoff, 64 aortoiliofemoral arteriograms for abdominal aortic aneurysms, 83 aortoiliofemoral arteriograms with contralateral selective iliacs, 35 aortoiliofemoral arteriograms with carotids, and 27 aortoiliofemoral arteriograms with selective visceral/renal. Femoral artery puncture was used in 93%, and left brachial artery in 7%. The mean amount of contrast was 97 cc and the mean operative time was 25 minutes. The overall complication rate was 3.8% (1.3% major), which was comparable to what was published previously (1.9% and 2.9%) but superior to what we published previously as performed by our radiologists (7%, p <.001). A logistic regression could not find any variables that were significant for the prediction of a major complication. However, increased age, a longer operating time (≥ 30 minutes), and smoking were associated with an increase in overall complications. It was determined that diagnostic arteriography can be done safely by experienced vascular surgeons with low complication rates that compare favorably with what was published by interventional radiologists.

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Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0036 ◽

2018 ◽

Vol 100 (6) ◽

pp. 454-458 ◽

Cited By ~ 3

Author(s):

MSJ Wilson ◽

P Maniam ◽

A Ibrahim ◽

N Makaram ◽

SR Knight ◽

...

Keyword(s):

Body Mass Index ◽

Hospital Stay ◽

Body Mass ◽

Operative Time ◽

Controlled Trial ◽

Operating Time ◽

Antibiotic Use ◽

Laparoscopic Appendicectomy ◽

Duration Of Surgery ◽

Appendiceal Stump

Introduction The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of polymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. Materials and methods Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendicectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. Results A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postoperative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. Discussion Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.

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Bone Morphogenic Protein for Upper Extremity Fractures: A Systematic Review

Hand ◽

10.1177/1558944721990805 ◽

2021 ◽

pp. 155894472199080

Author(s):

Alexis B. Sandler ◽

John P. Scanaliato ◽

Sorana Raiciulescu ◽

Leon Nesti ◽

John C. Dunn

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Upper Extremity ◽

Surgical Correction ◽

Complication Rates ◽

Inclusion Criteria ◽

Significant Similarity ◽

Patient Demographics ◽

Effective Adjunct ◽

Radiographic Union

Purpose This review discusses success, time to healing, and complications of bone morphogenic proteins (BMPs) 7 and 2 in treating upper extremity nonunions. Methods Systematic review identified 26 of 479 studies that met inclusion criteria. Publications described application of BMPs to acute and chronic upper extremity delayed unions/nonunions. Unions, complications, patient demographics, and fracture/healing patterns were pooled and analyzed. Results Nonunions treated with BMP-7 (n=302) involved the humerus (64%), forearm (22%), clavicle (11%), and hand/wrist (3%), with prior surgical correction attempted in 84%. Nonunions treated with BMP-2 (n=96) involved the humerus (58%), hand/wrist (27%), forearm (14%), and clavicle (1%), with prior surgical correction attempted in all. Most nonunions (80%) were present for over 12 months before BMP application. Union rates of BMP-7 varied according to site: hand/wrist (95%), humerus (74%), forearm (29%), and clavicle (6.2%) nonunions achieved union as defined by study authors in 232 days (confidence interval=96-369, Q<0.001) on average. While not significant across studies, BMP-2 union rates were 71% of hand/wrist and 75% of humerus nonunions. Comparison of the BMPs demonstrates different proportions of success in humerus and hand/wrist fractures ( P<.001) but not forearm fractures ( P<.77) and longer time to radiographic union with BMP-7 ( P<.011). Conclusions Most hand/wrist and humerus nonunions treated with BMP-7 and BMP-2 achieved union, with significant similarity among BMP-7 studies not observed in BMP-2 studies. Nonunions treated with BMP-7 have longer healing times yet similar complication rates compared with BMP-2. Overall, BMPs are an effective adjunct to fracture healing with acceptable complication profile.

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Laparoscopic versus conventional open appendicectomy: a prospective comparative analytical study in a tertiary care set up

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192578 ◽

2019 ◽

Vol 7 (7) ◽

pp. 2536

Author(s):

Anurag Shrivastava ◽

Anurag Jain ◽

Rajiv Jain

Keyword(s):

Operative Time ◽

Tertiary Care ◽

Operating Time ◽

Open Appendectomy ◽

Laparoscopic Appendicectomy ◽

Open Appendicectomy ◽

Open Procedure ◽

Diagnostic Potential ◽

Operative Complications ◽

Set Up

Background: Present study outlines the outcomes of laparoscopic appendicectomy compared to open conventional appendicectomy in a tertiary care set up with aim to validate advantages and shortcomings of both procedures.Methods: A series of 80 cases above 18 years of age with clinical diagnosis of appendicitis having Alvarado score of seven and above were studied prospectively under the two groups after proper written consent: Open appendectomy-40 cases, Laparoscopic appendectomy-40 cases. Both groups were compared on grounds of intra-operative complications, additional diagnostic potential, operative time, postoperative analgesia, post-operative complications, length of hospital stay, subjective cosmesis, and return to routine normal activities. Values obtained were statistically analyzed.Results: The median operative time in Laparoscopic Appendicectomy was 58.22 minutes (range 32.68-85.46 min) as compared to open procedure which took 43.65 minutes (30.36-65.48min) (P<0.05). Conversion to open procedure was done in 10% (n=4) of laparoscopic cases. Mean value of postoperative pain by visual analogue scale was low in Laparoscopic Appendicectomy (LA) compared to Open Appendicectomy (OA) (P<0.05). Mean post-operative stay (3.2±0.34 days versus 2.3±0.24 days) and surgical site infection was recorded in 10 patients (25%) in OA group and 5 (13.9%) in LA group (P<0.05).Conclusions: It can be concluded that laparoscopic surgery is safe with greater diagnostic potential for additional pathologies and better Subjective cosmesis . But all these merits were at the price of longer operating time and a specialized set up needed for laparoscopy.

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Comparison of clinical outcomes of open, laparoscopic and single port appendicectomies

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960049397 ◽

2013 ◽

Vol 95 (7) ◽

pp. 468-472 ◽

Cited By ~ 3

Author(s):

X Jiang ◽

HB Meng ◽

DL Zhou ◽

WX Ding ◽

LS Lu

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Clinical Outcomes ◽

Operative Time ◽

Single Port ◽

Length Of Hospital Stay ◽

Laparoscopic Appendicectomy ◽

Suspected Appendicitis ◽

Patient Demographics ◽

Chinese Yuan

Introduction Appendicectomy is the most common surgical procedure performed in general surgery. This study aimed to compare the outcomes of open appendicectomy (OA), laparoscopic appendicectomy (LA) and single port laparoscopic appendicectomy (SPLA). Methods Fifty consecutive patients with suspected acute appendicitis were studied (OA: n=20, LA: n=20, SPLA: n=10). Clinical outcomes were compared between the three groups in terms of operative time, blood loss, postoperative complications, length of hospital stay and cost. Results Patient demographics were similar among groups (p>0.05). SPLA was characterised by longer operative time (88.1 minutes vs 35.6 minutes in OA and 33.4 minutes in LA) and higher costs (12.84 thousand Chinese yuan [RMB] vs 8.41 thousand RMB in LA and 4.99 thousand RMB in OA). OA was characterised by more blood loss (9.8ml vs 7.5ml in SPLA and 6.8ml in LA), longer hospital stay (7.5 days vs 3.5 days in LA and 3.4 days in SPLA) and lower costs. The total number of complications was higher for OA (n=2) than for LA and SPLA (n=0) although this was not statistically significant. Conclusions Where feasible, LA should be undertaken as the initial treatment of choice for most cases of suspected appendicitis.

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Wound Complications With Posterior Midline and Posterior Medial Leg Incisions

Foot & Ankle Specialist ◽

10.1177/1938640011418488 ◽

2011 ◽

Vol 4 (6) ◽

pp. 361-369 ◽

Cited By ~ 15

Author(s):

Peter Highlander ◽

Robert M. Greenhagen

Keyword(s):

Wound Healing ◽

Wound Complication ◽

Wound Complications ◽

Complication Rates ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Patient Demographics ◽

Group 2 ◽

Midline Approach ◽

Group 1

There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement. Materials and Methods. Four electronic databases were searched using keywords for procedures using posterior leg incisions. A total of 8724 studies were analyzed and subjected to inclusion and exclusion criteria. Once inclusion criteria were met, each article was placed in 1 of 2 groups based on incision placement: midline (group 1) or posterior medial (group 2). Study format, patient demographics, surgical indication and other details, and wound complications were recorded. The data obtained was reviewed for trends between the two groups. Results. 38 articles met the inclusion criteria. Seven articles used the midline approach (group 1) whereas 31 articles used the posterior medial incision (group 2). The 38 articles included 1287 patients, of whom 25.6% were female with an average age of 43.9 years. Group 1 included 142 patients and group 2 had 1145 patients. The total wound complication rate among all reports was determined to be 8.2%, with 7.0% and 8.3% between groups 1 and 2, respectively. Discussion. Although incision placement may influence wound healing complications, it appears that additional factors such as advanced age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols also play a role. This report suggests that a midline approach is no less precarious in avoidance of wound complications regardless of patient demographics or other surgical details in comparison with a posterior medial incision. Level of Evidence: Therapeutic, Level IV

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Results of Laparoscopic Appendectomies Performed with the Use of Titanium Clips for Closure of the Appendicular Stump

Polish Journal of Surgery ◽

10.2478/pjs-2014-0074 ◽

2014 ◽

Vol 86 (9) ◽

Cited By ~ 2

Author(s):

Marcin Strzałka ◽

Maciej Matyja ◽

Kazimierz Rembiasz

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Surgical Procedure ◽

Elective Surgery ◽

Average Length ◽

Intraoperative Complications ◽

Complication Rates ◽

Appendicular Stump ◽

Titanium Clips

AbstractNowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis. There are several techniques used to close the appendicular stump during laparoscopic appendectomy.was to present the results of minimally invasive appendectomies performed with the use of titanium clips.Patients operated on laparoscopically for acute appendicitis with the application of titanium clips between October 2012 and December 2013 were included in the study. We reviewed retrospectively patients` data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates.There were 93 patients (mean age=33.8 years, SD=15.23) in the analyzed group, including 60 men (mean age=33.5 years, SD= 15.07) and 33 women (mean age=33.9 years SD=15.26). The aver-age duration of the surgical procedure was 66 min (SD= 33.15). The average length of hospital stay was 3.38 days (SD=1.62). No intraoperative complications were observed in the analyzed group. Post-operative complication rate was low (6 cases, 6.5%). No mortality was observed.Laparoscopic appendectomy with the application of titanium clips for closure of the appendicular stump is safe, associated with low complication rates and should be considered as a routine technique in everyday surgical practice.

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Loop ileostomy closure: a retrospective comparison of three techniques

10.21203/rs.2.13283/v1 ◽

2019 ◽

Author(s):

Ian Lord ◽

Lesley Reeves ◽

Andrew Gray ◽

John Woodfield ◽

Kari Clifford ◽

...

Keyword(s):

Patient Outcomes ◽

Operative Time ◽

Loop Ileostomy ◽

Single Layer ◽

Ileostomy Closure ◽

Complication Rates ◽

Patient Demographics ◽

Retrospective Comparison ◽

Randomised Controlled ◽

Meta Analyses

Abstract Background Loop ileostomy (LI) formation is a common practice for patients undergoing low anterior resection or restorative ileo-anal pouch surgery. This can be performed using a stapled or hand-sewn technique, with or without resection. If hand-sewn, the closure can be one or two layers. Randomised controlled trials have not demonstrated one technique to be superior, and meta-analyses are limited by the heterogeneity of published studies. Our primary aim is to compare stapled ileostomy closure with single- and two-layer, hand-sewn closures.Methods This retrospective, single-centre cohort study included patients undergoing LI closure between January 1999 – April 2016. Patient demographics, anastomotic technique, operative time, and patient outcomes were collected.Results Our analysis included 244 patients (median age 67 years, 43.4% female). There were no significant differences in mean operative times (71.5, 73.1, and 88.5 minutes, for stapled, single-, and two-layer hand-sewn closures respectively, adjusted overall p=0.262), or morbidity (21.5% vs 20.4% vs 17.6%, adjusted overall p=0.934) between stapled or hand-sewn anastomoses, and no mortality. Once adjusting for age, sex, ASA, and consultant surgeon, the LOS was similar between stapled and single-layer closures (4.2 vs 5.5 days, p=0.105), but significantly different between stapled and two-layer closures (4.2 vs 8.3 days, p=0.026) (overall p=0.034). No evidence of differences in complications was found.Conclusions Stapled and single-layered hand-sewn closures are similar in length of procedure, LOS, and complication rates. A two-layer, hand-sewn technique is associated with a significant increase in stay compared to a stapled ileostomy closure.

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