Page 20 - World Journal of Laparoscopic Surgery

Appendicular Stump Closure by Polymer Clip vs Endoloop in Laparoscopic Appendectomy
then sutures were removed on the seventh postoperative day in two cases due to improper closure of appendicular stump. These
the follow-up. extra used polymer clips and endoloops were counted as wasted
Patients had come for follow-up in the outpatient department polymer clip or endoloop.
after 1 week, 2 weeks, and 1 month of surgery. Ultrasonography was In the surgery of 21 patients, time taken for appendicular
done 1 month after surgery in all cases. In follow-up, the patient stump closure was between 10 minutes and 15 minutes and for 14
was clinically examined for complications, such as wound discharge, patients, it was between 15 minutes and 20 minutes in polymer clip
swelling over the local site, tenderness on the abdomen, and fever. group. In the surgery of 12 patients, the time taken for appendicular
stump closure was between 10 minutes and 15 minutes, and for 23
Statistical Analysis patients it was between 15 minutes and 20 minutes in endoloop
Data analysis was performed using MedCalc version 17.9.5 software. group. Surgeon had given opinion regarding the ease of application
Categorical variables were analyzed with the Chi-squared test as excellent in 21 patients of polymer clip group and 12 patients
and continuous variables were analyzed with “t” test. Values were of endoloop group.
reported as mean ± standard deviation or median (extremes) or The surgeon had given opinion regarding the ease of
percentages as and when required. p value of less than 0.05 was application as good in 14 patients of polymer clip group and
considered significant. 23 patients of endoloop group (Table 2). None of the operating
surgeons given a poor opinion for endoloop group or polymer
results clip group. This measurement (ease of application) is statistically
A total of 70 patients with laparoscopic appendectomy were significant in our study (p value is 0.032, Table 2).
included in this study. Adequacy of randomization was evident Three patients were discharged on the fifth postoperative day
from the similarity in patient characteristics in both the groups in the polymer clip group, and 32 patients were discharged on
(Table 1). No protocol violations were recorded during the study. the third postoperative day. Three patients were discharged on
One extra endoloop was used in four cases due to improper the fifth postoperative day, two patients were discharged on the
closure of appendicular stump. One extra polymer clip was used in seventh postoperative day, and 30 patients were discharged on
the third postoperative day in endoloop group (Table 3). It is not
statistically significant in our study (p value 0.144, Table 3).
In three cases of endoloop group, there was a serous discharge
present from the wound after the first dressing. The daily dressing
was done with proper asepsis in all three cases. Culture and
sensitivity for wound discharge sent and according to per the
sensitivity antibiotics were started. The total count was sent but
3
in all three cases it was below 11,000 mm . In this study, patients
having wound discharge and fever in polymer clips and endoloop
groups were compared, and it was not statistically significant
(p value 0.45, Table 4).

Table 2: Ease of application in polymer group and endoloop group
Ease of Polymer group Endoloop group
application (number of patients) (number of patients) p value
Poor 0 0 –
Good 14 23 0.032
Fig. 3: Endoloop Excellent 21 12 0.032

Table 1: Comparison of present study, study done by Polat and Kinaci Table 3: Correlation of present study, study done by Polat and Kinaci
and study done by Osman for sex-wise distribution of patients and study done by Şimşek for hospital stay
Polymer clip group Endoloop group Polymer clip Endoloop group
Different studies Male Female Male Female Total Different studies group (in days) (in days) p value
In present study 20 15 24 11 70 In present study 3.1 ± 0.56 3.4 ± 1.06 0.144
Polat and Kinaci 23 25 20 24 92 Polat and Kinaci 1.1 ± 0.6 1.4 ± 0.9 0.061
Şimşek 18 12 16 14 60 Şimşek 2.2 ± 1.3 1.97 ± 1.4 >0.05
Table 4: Correlation of present study, study done by Polat and Kinaci and study done by Şimşek for postoperative complications
Polymer clip group Endoloop group
Wound infection Wound infection
(number of Fever (number of (number of Fever (number of
Different studies patients) patients) Total patients patients) patients) Total patients p value
In present study 0 3 35 3 2 35 0.45
Polat and Kinaci 1 1 48 4 6 44 0.051
Şimşek 0 0 30 0 0 30 >0.05

66 World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019)