Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump

World Journal of Emergency Surgery, Jan 2016

Background Nowadays 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. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C). Methods Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males,129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department 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 in all analyzed groups. Results There were 102 patients in group A (mean age = 35.8;SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age =37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis. Conclusions Laparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures.

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Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump

Strzałka et al. World Journal of Emergency Surgery Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump Marcin Strzałka 0 Maciej Matyja 0 Kazimierz Rembiasz 0 0 2nd Department of General Surgery, Jagiellonian University , Kraków , Poland Background: Nowadays 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. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and invaginating sutures (group C). Methods: Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males,129 females) operated on laparoscopically for acute appendicitis from January 2010 to December 2014 at our department 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 in all analyzed groups. Results: There were 102 patients in group A (mean age = 35.8;SD = 15.4; 57 males, 45 females). The average hospital stay in this group was 4.3 days (SD = 1.7), average operation time was 62.0 min (SD = 15), postoperative complication rate was 5.9 %. There were 160 patients in group B (mean age = 35.0; SD = 16.3; 96 males, 64 females). The average hospital stay in this group was 3.6 days (SD = 1.4), average operation time was 62.9 min (SD = 13.5), postoperative complication rate was 5.6 %. There were 45 patients in group C (mean age =37.3; SD = 15.8; 25 males, 20 females). The average hospital stay in this group was 4.6 days (SD = 2.0), average operation time was 73.9 min (SD = 20.8), postoperative complication rate was 6.7 %. There were no intraoperative complications and no mortality in all compared groups of patients operated on laparoscopically for acute appendicitis. Conclusions: Laparoscopic appendectomies with application of different techniques for closure of the appendicular stump are useful and safe. In our study the shortest hospital stay and lowest complication rate were observed in patients operated with the use of titanium endoclips. The longest hospital stay and operation time and the highest complication rate was associated with the use of invaginating sutures. Laparoscopic appendectomy; Results; Outcome; Techniques; Titanium clips; Staplers; Purse string suture Background Nowadays laparoscopy is used frequently not only in elective surgery but also in abdominal emergencies, including acute appendicitis [ 1–3 ]. Laparoscopic appendectomy is currently a well-established and widely accepted method [ 3, 4 ]. It has a lot of advantages as compared with open approach technique, including less pain in the postoperative period, faster return to normal activity and work, shorter hospital stay and lower percentage of wound infections. However some authors point out a slightly higher rate of intra-abdominal abscesses and higher cost of laparoscopic procedure as compared with the open approach operation [ 5, 6 ]. It seems that both of these factors unfavorable for laparoscopy are influenced by the applied method of the appendicular stump closure. There are several techniques used to close the appendicular stump during laparoscopic appendectomy. The most commonly used surgical methods are connected with the use of endo-loop ligature, laparoscopic staplers, metal or polymer clips or application of purse string suture with the invagination of the appendicular base into the cecum, as in the classic surgery [ 7–12 ]. However, the optimal technique of the appendicular stump closure still seems to be controversial. The aim of the study was to present and compare the results of minimally invasive appendectomies performed with the use of endoscopic staplers (group A), titanium endoclips (group B) and purse string invaginating sutures (group C). Methods Three hundred seven patients (mean age = 35.6; SD = 15.9; 178 males, 129 females) who underwent laparoscopic appendectomies from 2010 to 2014 at our department were included in the study. Depending on the appendicular stump closure technique our patients were divided into 3 subgroups: A (endoscopic staplers), B (titanium endoclips), C (purse string invaginating sutures). We reviewed retrospectively patients’ data including: age, sex, duration of the surgical procedure and hospital stay, mortality, intraoperative and postoperative complication rates in all analyzed groups. Laparoscopic appendectomy was performed using classic three port technique. During the procedure the patient was lying on his/her back, the operating and assisting surgeons were standing at the left side and the laparoscopy unit with the monitor were placed at the right side of the pat (...truncated)


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Marcin Strzałka, Maciej Matyja, Kazimierz Rembiasz. Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump, World Journal of Emergency Surgery, 2016, pp. 4, 11, DOI: 10.1186/s13017-015-0060-3