Page 23 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Mini Two-port Laparoscopic Appendicectomy with Novel

Knotting Technique

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Jitendra T Sankpal , Mukund B Tayade , Ajay H Bhandarwar , Priyanka Saha , Soumya Chatnalkar , Sushrut Sankpal ,
Ameya Gadkari 7
AbstrAct
Background: In pursuit of minimizing surgical trauma and achieving better esthetics by reducing the size and number of ports, this mini
two-port technique was devised to offer an easier and safe alternative in comparison to conventional three-port technique. An easy and cost-
effective mini two-port appendicectomy is made possible with a unique intracorporeal surgical knotting through a single 5-mm port with a
single instrument, thus reducing number and size of ports and with a better cosmetic result.
Materials and methods: Total 200 patients underwent laparoscopic appendicectomy out of which, mini two-port appendicectomy (TPA) with
novel knotting technique could be successfully performed on 168 patients (84%) and remaining 32 patients (16%) required conventional three-
port technique (CLA). None of the cases were converted to open.
Results: Patient undergoing two-port laparoscopic appendicectomy had shorter operative time with better cosmetic result with no incidence
of port-site hernia. There was no difficulty in adhesiolysis and intraoperative bleeding control. Infection rate was 0.59% and 3.12% for TPA and
CLA, respectively. Incidence of intraoperative bleeding and intraoperative rupture of appendix was less in TPA (1.19% and 0%) as compared to
CLA (6.25% and 3.125%). Mean hospital stay was less in TPA (1.7 days) compared to CLA (2.1 days).
Conclusion: This mini two-port technique with novel knotting technique is easy to learn and helps to overcome the challenges and limitations
faced during two laparoscopic appendicectomies; however conversion to conventional approach in complicated cases is still advisable. It is
safe and effective intermediate option from conventional three-port to SILS/NOTES/Endo GIA staplers.
Keywords: Appendicitis, Laparoscopic appendicectomy, Novel knotting technique, Two-port laparoscopic appendicectomy.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1398

IntroductIon 1,2 Department of General and Laparoscopic Surgery, Gokuldas Tejpal
Acute appendicitis is common gastrointestinal condition in Hospital of Grant Government Medical College and Sir JJ Government
emergency surgical practice. It affects group of people irrespective Hospitals, Mumbai, Maharashtra, India
of age, nationality, and religion. The incidence of acute appendicitis 3–5,7 Department of General Surgery, Grant Government Medical
is probably lower in Asian and African countries accounting to the College and Sir JJ Hospital, Mumbai, Maharashtra, India
intake of high fiber diet by their inhabitants. Dietary fiber helps 6 Department of General and Laparoscopic Surgery, Rajiv Gandhi
decrease the viscosity of feces, decrease bowel transit time, and Medical College, Kalwa, Thane, Maharashtra, India
reduce the formation of fecolith, one of the common causes of Corresponding Author: Jitendra T Sankpal, Department of General
appendiceal lumen obstruction. and Laparoscopic Surgery, Gokuldas Tejpal Hospital of Grant
In an age group of 21–30 years, highest incidence is seen in male Government Medical College and Sir JJ Government Hospitals,
compared to female, where the highest incidence was observed Mumbai, Maharashtra, India, Phone: +91 9920527799, e-mail: drjts_
in the age group of 11–20 years. Incidence remains same for both palmbeach@yahoo.co.in
sexes after the age of 30 years. How to cite this article: Sankpal JT, Tayade MB, Bhandarwar AH, et al.
The diagnosis is done by clinical signs and symptoms, Mini Two-port Laparoscopic Appendicectomy with Novel Knotting
Mantrels score, ultrasonography, computerized tomography. Technique. World J Lap Surg 2020;13(1):21–25.

Computerized tomography being the investigation of choice. Source of support: Nil
The treatment of modality for appendicitis is appendicectomy. Conflict of interest: None
Laparoscopy is a new gold standard for treatment of acute
and chronic appendicitis. Conventional appendicectomy is by
3-port technique. But in pursuit of minimizing surgical trauma MAterIAls And Methods
and achieving better cosmetic results without compromising on A total of 200 prospective nonrandomized patients were subjected
basic principal of appendicectomy, this mini two-port technique to begin with two-port laparoscopic appendicectomy over the
is described, wherein limitations and challenges of intracorporeal period of 3 years from 2014 to 2016 for appendicitis after written,
knotting faced during two-port technique by using single 5-mm informed, and valid consent. Ethical clearance was not obtained
port are overcome by our novel knotting technique, thus to since it was a study involving variation in knotting technique. Of
make mini two-port technique feasible. This technique can be these, in 168 patients, mini two-port appendicectomy (TPA) was
considered as safe, cosmetic, and cost-effective intermediate feasible, and in remaining 32 patients, conventional laparoscopic
option between three-port technique and Stapler, SILS, NOTES appendicectomy (CLA) had to be done due to severe inflammation,
appendicectomy. adhesions, and specimen that cannot be retrieved through 5-mm

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