Page 18 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Appendicular Stump Closure by Polymer Clip vs Endoloop in

Laparoscopic Appendectomy

Vishal P Bhabhor

AbstrAct
Introduction: Several techniques are used to close the appendicular stump during laparoscopic appendectomy. This is especially important in
developing countries where resources for training with endoloop are insufficient, and the simplicity of application of polymer clips can enable
easy acceptance of laparoscopic appendectomy as a method in the treatment of acute appendicitis.
Aim: The aim of the study was to compare results of appendicular stump closure by polymer clip and endoloop with reference to
• Days of hospitalization,
• Infection rate, and
• Ease of application
Materials and methods: This is a prospective study of 70 cases of laparoscopic appendectomy operated in the Department of General Surgery,
SSG Hospital, Vadodara, from October 2016 to October 2017 (35 patients in each group i.e., polymer clip application group and endoloop
application group). Operative data were recorded, and the patients were followed up accordingly. Independent assessors were assigned to
obtain days of hospitalization, infection rate, ease of application, and other secondary outcomes.
Results: It is more feasible for surgeons to use polymer clip than endoloop to close appendicular stump as per the surgeon’s opinion taken after
each surgery. However, days of hospitalization and postoperative complication rates were not statistically significant in both groups.
Conclusion: Closure of appendix stump with a polymer clip is a simple and safe method in laparoscopic appendectomy and is comparable with
other methods of appendicular stump closure.
Keywords: Appendectomy, Ease of application, Endoloop, Polymer clip.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1374

IntroductIon

Laparoscopic appendectomy is superior or comparable to open Department of General Surgery, Baroda Medical College, SSG Hospital,
appendectomy in terms of several surgical outcome measures for Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
both uncomplicated and complicated appendicitis across most Corresponding Author: Vishal P Bhabhor, Department of General
illness severity groups. Thus, laparoscopic appendectomy may Surgery, Baroda Medical College, SSG Hospital, Maharaja Sayajirao
be the preferred technique, irrespective of appendicitis diagnosis University of Baroda, Vadodara, Gujarat, India, Phone: +91 7600543427,
1
or disease severity. Several techniques are used to close the e-mail: bhabhorvishal33@gmail.com
appendicular stump during laparoscopic appendectomy. How to cite this article: Bhabhor VP. Appendicular Stump Closure by
The most commonly used surgical methods are associated Polymer Clip vs Endoloop in Laparoscopic Appendectomy. World J Lap
with the use of endoloop ligature, laparoscopic staplers, metal Surg 2019;12(2):64–67.

or polymer clips, or application of purse-string suture with the Source of support: Nil
invagination of the base of the appendix into the cecum, as in the Conflict of interest: None
classic surgery. 2
However, the application of the endoloop demands dexterity
and short training, while polymer clips may be more advantageous Vadodara from October 2016 to October 2017 (35 patients in
to use due to their easy of application and low cost. 3 each group, i.e., polymer clip application group and endoloop
This is especially important in developing countries where application group).
resources for training with endoloop are insufficient, and the Patients were included in the study after proper clinical
simplicity of application of polymer clips can enable easy examination, laboratory findings, and ultrasonographic evidence
acceptance of laparoscopic appendectomy as a method in the of acute appendicitis in the outpatient department and emergency.
treatment of acute appendicitis. 3 The surgeon was the deciding method for closing appendicular
The objective of this study was to evaluate the technical stump by viewing the appendicular base and its diameter (by
feasibility and eventual advantages of this way of securing the endoloop or by polymer clip).
base of the appendix. All laparoscopic appendectomy was done by a consultant

MAterIAls And Methods surgeon of different units of Surgery Department of SSG Hospital,
Vadodara. Patients scheduled for laparoscopic appendectomy were
This is a prospective study of 70 cases of laparoscopic appendectomy administered antibiotics intravenously in the form of single-dose
operated in the Department of General Surgery, SSG Hospital, ceftriaxone just before the start of the surgery.

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