Page 21 - World Journal of Laparoscopic Surgery

Appendicular Stump Closure by Polymer Clip vs Endoloop in Laparoscopic Appendectomy
Ultrasonography findings of three patients in endoloop group stay and postoperative complication rates were not statistically
showed minimal collection after 48 hours. In all other patients in significant.
endoloop group and polymer clip group, USG was normal. It was As the study conducted on a small number of patients so it
not statistically significant. Ultrasonography report was normal in needs further evaluation involving a large population. In the present
all patients after 1 month in follow-up in endoloop and polymer study, cases having intraoperative complicated appendix were not
clip group. included. So to use polymer clips in such situations requires further
study. The availability of polymer clip and its applicator is a major
dIscussIon limitation for this study. The availability of a 5 mm telescope is also
Laparoscopic appendectomy is expected to increase gradually and a limiting factor.
become the gold standard for the treatment of acute appendicitis conclusIon
because laparoscopic appendectomy has advantages similar to
laparoscopic cholecystectomy. This is a prospective study of 70 patients operated for laparoscopic
Despite differences in various laparoscopic techniques, appendectomy in the Department of General Surgery, Medical
the most important concern in laparoscopic appendectomy is College Baroda and Sir Sayajirao Gaekwad General Hospital in the
the safety of the method used for the closure of appendicular period from October 2016 to October 2017.
stump. Therefore, there have been many defined methods with Acute appendicitis is more common in men compared with
some superiority to others. Operative time, hospital stay, and women with a ratio of 1:1.7 (62.8% patients were male). The use of
postoperative complications are widely used parameters to polymer clip is well tolerated in appendicular stump closure. It is
compare the benefits of these methods. more feasible for surgeons to use polymer clip than endoloop to
In our conducted comparison regarding hospital stay, close appendicular stump as per the surgeon’s opinion taken after
postoperative complications, and ease of application for each surgery.
appendicular stump closure polymer clip and endoloop group. There are early discharge and less chance of postoperative
5
In a study by Polat and Kinaci in 2015 comparison done complications with the use of polymer clip in appendicular stump
regarding operating time, hospital stay, and postoperative closure compared with endoloop. Polymer clips can be used in place
complications in appendicular stump closure by endoloop of endoloop in the closure of appendicular stump with more ease
6
and polymer clip groups. In a study by Şimşek et al., in 2014, and it is beneficial to the patient.
comparison done regarding operating time, hospital stay, cost,

and postoperative complications in appendicular stump closure ethIcAl ApprovAl
by endoloop and polymer clip groups. The study was approved by the institutional ethics committee.
In our study, polymer clip was found to be a more feasible
technique to use for appendicular stump closure compared to references
endoloop as per surgeon’s opinion, and it is statistically significant
in our study (p value is 0.032). The opinion regarding the ease of 1. Tiwari MM, Reynoso JF, Tsang AW, et al. Comparison of outcomes
of laparoscopic appendectomy in management of uncomplicated
application in our study was given by operating surgeon, and he and complicated appendicitis. Ann Surg 2011;254(6):927–932. DOI:
was considered the time taken for stump closure, proper covering 10.1097/SLA.0b013e31822aa8ea.
of appendicular stump and intraoperative handling of endoloop 2. Strzalka M, Matyja M, Rembiasz K. Comparison of the results
or polymer clips for giving his opinion. of laparoscopic appendectomies with application of different
In our study, operating time was considered as the time techniques for closure of the appendicular stump. World J Emerg
taken from skeletenization of the appendix to the closure of the Surg 2016;11:4. DOI: 10.1186/s13017-015-0060-3.
appendicular stump. In a study by Polat and Kinaci and a study by 3. Delibegovic S, Matovic E. Hem-O-lok plastic clips in securing of
Şimşek, operating time was taken from the insertion of the first port the base of the appendix during laparoscopic appendectomy.
to the closure of appendicular stump. Surg Endosc 2009;23(12):2851-2854. DOI: 10.1007/s00464-009-
0493-4.
Hospital stay is directly associated with postoperative 4. Partecke LI, Kessler W, Patrzyk M, et al. Comparison among different
7
complications, therefore, we detected similar results in these closure during laparoscopic appendectomy. Surg Technol Int
two parameters. Hospital stay and postoperative complication 2011;21:85–91.
rates were low in polymer clip group, but it was not statistically 5. Polat Y, Kinaci E. Comparison of intra corporeal knot-tying suture
significant for both in our study (p value for hospital stay 0.144 and and hem-o-lok clip for closure of appendix stump in laparoscopic
postoperative complications 0.45). appendectomy: a retrospective study. Firat Tip Derg/Firat Med J
5
In a study by Polat and Kinaci in 2015, hospital stay and 2015;20(2):107–109.
postoperative complication rates were better in polymer clip group, 6. Şimşek O, Bilgin IA, Uludag S, et al. Comparison of endo-loop and
polymer locking clip in ligating appendiceal stump during laparoscopic
but it was not statistically significant. However, the p value was appendectomy. Eur J Endosc Laparosc Surg 2014;1(3):124–127.
close to 0.05 (0.061 for the hospital stay and 0.051 for postoperative 7. Fischer JE, Mcdermott WV, Holmes CR, et al. Fischer's mastery of
6
complications). In another study by Şimşek et al. in 2014, hospital surgery. 6th ed., Wolters Kluwer; 2012. pp. 280–282.

World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019) 67