Technical modifications of appendiceal transection during laparoscopic appendectomy

Introduction: Appendiceal transection is the most critical part of laparoscopic appendectomy (LAPPE). The aim of our study was to evaluate postoperative and economic outcomes of laparoscopic appendectomy with different technical modifications of transection of the appendix. Methods: This was a prospective, randomized, unicenter clinical study comparing different techniques of appendiceal transection in patients with acute appendicitis during the study period (18 months). The patients were randomized to one of three arms – endoloop, hem-o-lok clips and the stapler. Results: In total, 120 patients were enrolled in the study. The shortest operative time was noted in the hem-o-lok arm (37.3 minutes); mean length of hospital stay (3.7 days) was comparable in all study arms. Postoperative morbidity was 6.6%; all recorded complications were SSIs (Surgical Site Infections). The number of postoperative complications was comparable in all study arms. Mean direct costs of laparoscopic appendectomy were lowest in the hem-o-lok arm. According to our findings, LAPPE is not a profit making surgery irrespective of the type of appendiceal transection (mean profit in the study patients was CZK -4019). Conclusion: The rate of postoperative complications was similar for all the technical modifications of appendiceal stump closure. As indicated by the study outcomes, hem-o-lok clips have the potential of becoming the method of choice in securing the appendix base during LAPPE.

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Mastering the learning curve significantly reduces operative time for laparoscopic treatment of complicated appendicitis

Archives of Public Health ◽

10.3889/aph.2021.6000 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Andrej Nikolovski ◽

Aleksandar Otljanski ◽

Rexhep Seljmani ◽

Svetozar Antovic ◽

Nikola Jankulovski

Keyword(s):

Learning Curve ◽

Laparoscopic Appendectomy ◽

Postoperative Morbidity ◽

Operative Time ◽

Length Of Hospital Stay ◽

Laparoscopic Group ◽

Complicated Appendicitis ◽

Intraabdominal Abscess ◽

Laparoscopic Treatment ◽

Operative Method

Laparoscopic appendectomy is the preferred operative method for acute appendicitistreatment. In terms of complicated appendicitis it can be effective in hands of an experiencedlaparoscopist that overwhelmed the learning curve for the method. Aim: Тhis retrospectivestudy examines whether the operative time for laparoscopic appendectomy for complicatedappendicitis is shortened after mastering the learning curve. Material and methods: A totalnumber of 196 patients were operated for the diagnosis of acute appendicitis, of whom 77were diagnosed with complicated appendicitis. They were subsequently divided in two groups(laparoscopic and open). Operative time in both groups was measured and the conversionand postoperative complications were noted. Results: Conversion rate was 2.3%. Operativetime was shorter in the laparoscopic group (67.4 ± 22.9 vs. 77.9 ± 17.9 minutes; p = 0.033).Overall postoperative morbidity was 25.97% with wound infection present only in the opengroup (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopicgroup (0.38%). Length of hospital stay was shorter in the laparoscopic group (4.3 ± 2.2 vs. 5.7 ± 2.1, p = 0.0052).

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Cost Effectiveness of Different Methods of Appendiceal Stump Closure during Laparoscopic Appendectomy

The American Surgeon ◽

10.1177/000313481808400847 ◽

2018 ◽

Vol 84 (8) ◽

pp. 1329-1332 ◽

Cited By ~ 4

Author(s):

Samuel Kim ◽

Leonard Weireter

Keyword(s):

Laparoscopic Appendectomy ◽

Care Center ◽

Tertiary Care ◽

Complication Rates ◽

Price Difference ◽

Procedure Time ◽

Stump Closure ◽

Appendiceal Stump ◽

Appendiceal Stump Closure ◽

Room Time

There is no standard method for closure of an appendiceal stump during laparoscopic appendectomy. This study compares stump closure using a stapler with closure using an Endoloop ligature. The charts of all patients who underwent laparoscopic appendectomy at a single tertiary care center over a two-year period were reviewed for demographics, comobidities, operative details and costs, and outcomes. There were 325 patients who underwent a laparoscopic appendectomy. The majority, 250 (77%), underwent stump closure with a stapler. They were equivalent in demographics and postoperative complication rates. Cases using an Endoloop were slightly faster in terms of procedure time and room time, and less expensive in terms of operative supply cost. The price difference is not explained by time saved in the operating room and more likely by the equipment price.

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A Prospective Study Comparing Appendiceal Stump Closure Techniques with Liga Clips v/s Hem-o-Lok in Laparoscopic Appendectomy: Our Experience at a Single Institute

Indian Journal of Surgery ◽

10.1007/s12262-020-02650-9 ◽

2020 ◽

Author(s):

Pronoti Patil ◽

Abhijit S. Gogate

Keyword(s):

Prospective Study ◽

Laparoscopic Appendectomy ◽

Stump Closure ◽

Appendiceal Stump ◽

Appendiceal Stump Closure ◽

A Prospective Study

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Laparoscopic Appendectomy with Immersive Appendiceal Stump Closure in Patient with Vermiform Appendix Abnormality

Creative Surgery and Oncology ◽

10.24060/2076-3093-2020-10-2-149-153 ◽

2020 ◽

Vol 10 (2) ◽

pp. 149-153

Author(s):

S. P. Muzhikov ◽

M. Yu. Eremenko ◽

V. V. Shefer ◽

E. E. Selezneva

Keyword(s):

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Clinical Case ◽

Vermiform Appendix ◽

Treatment Alternative ◽

Stump Closure ◽

Appendiceal Stump ◽

Laboratory Examinations ◽

Appendiceal Stump Closure ◽

Emergent Surgery

Background. Acute appendicitis is a common emergency surgical pathology, with laparoscopic appendectomy being the “gold standard” in its treatment.Aim. We report a clinical case of laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix abnormality.Materials and methods. Patient K. was emergently admitted to the Surgical Hospital of Ekaterininskaya Clinic in June 2019 with a clinical picture of acute appendicitis. Symptoms, disease anamnesis, instrumental and laboratory examinations conformed to acute appendicitis.Results and discussion. The patient was rendered an emergent surgery. Intraoperative picture corresponded to acute phlegmonous appendicitis with malformation (a wide conical base) of the vermiform appendix. Immersive appendiceal stump closure was chosen as treatment. Alternative opinions coexist on justifying a particular appendiceal stump closure strategy. Immersive treatment is our method of choice in terms of implementation and safety in the particular clinical case. Th is method requires the surgeon’s technical experience.Conclusion. A clinical case is reported of performing laparoscopic appendectomy with immersive appendiceal stump closure in a patient with vermiform appendix malformation. Despite the appendix abnormality, immersive treatment of the appendiceal stump was justified as safe in this case and entailed no complications in postoperative period.

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

BMC Surgery ◽

10.1186/s12893-021-01279-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Peter Ihnát ◽

Milan Tesař ◽

Lubomír Tulinský ◽

Lucia Ihnát Rudinská ◽

Okaikor Okantey ◽

...

Keyword(s):

Clinical Trial ◽

Surgical Site Infection ◽

Randomized Clinical Trial ◽

Laparoscopic Appendectomy ◽

Surgical Site Infections ◽

University Hospital ◽

Site Infection ◽

Stump Closure ◽

Technical Modifications ◽

The Mean

Abstract Background Closure 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. Methods This 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). Results In 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). Conclusions The 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).

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Preventing clinically relevant pancreatic fistula with combination of linear stapling plus continuous suture of the stump in laparoscopic distal pancreatectomy

BMC Surgery ◽

10.1186/s12893-020-00876-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Takeshi Aoki ◽

Doaa A. Mansour ◽

Tomotake Koizumi ◽

Kazuhiro Matsuda ◽

Tomokazu Kusano ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Laparoscopic Distal Pancreatectomy ◽

Triple Combination ◽

Continuous Suture ◽

Remnant Pancreas ◽

Stump Closure ◽

Suture Group

Abstract Background Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate. Methods Twenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups. Results POPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group. Conclusions The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF. Trial registration The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.

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