DOI: http://dx.doi.org/10.18203/2349-2902.isj20185007

Handmade endoloop knotting technique without knot pusher for appendicular stump closure in laparoscopic appendectomy: an experience

Akhilesh Kumar Yadav, Sankalp Dwivedi, Rahul Ranjan, Naveen Yadav

Abstract


Background: The objective of the study was to devise a handmade endoloop knotting technique without the use of knot pusher thereby reducing the overall cost of laparoscopic appendectomy.

Methods: This prospective study was conducted in MMIMSR Ambala from September 2016 to August 2018. All operations were performed by the same surgical team. Mesoappendix was coagulated with bipolar cautery and cut with scissors. Two handmade Meltzer loops were placed on base of appendix and tightened using conventional graspers.

Results: Around 50 patients were included in the study. The time spent for preparing and tying one loop was approximately 20-25 seconds. None of the patients had leakage from the appendicular stump. Only one polyglactin suture was used to make three loops. Knot pusher was not used in any of the patients.

Conclusions: Handmade endoloop used in this prospective study for securing appendicular stump using conventional laparoscopic graspers was found to be equally safe and can be easily mastered by any laparoscopic surgeon, which will reduce his dependency upon preformed endoloops making the procedure cost effective.


Keywords


laparoscopy, appendectomy, endoloop

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References


Richard F, William B. Long III. Surgical Knot Tying Manual (3rd edition). Norwalk: Covidien, 2008.

Ates M, Dirican A, Ince V, Ara C, Isik B, Yilmaz S. Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech. 2012; 22(3):226–31.

Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D. Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg. 2006; 93(11):1390–3.

Fallahzadeh H. Should a laparoscopic appendectomy be done? Am Surg. 1998;64:231-3.

McGrath B, Buckius MT, Grim R, Bell T, Ahuja V. Economics of appendicitis: cost trend analysis of laparoscopic versus open appendectomy from 1998 to 2008. J Surg Res. 2011;171:161-8.

Nguyen NT, Zainabadi K, Mavandadi S, Paya M, Stevens CM, Root J, et al. Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg. 2004;188:813-20.

Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endoscop. 2007;21;1764-7.

Rickert A, Bonninghoff R, Post S, Walz M, Runkel N, Kienle P. Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg. 2012;397(2):327-31.

Gullar U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, et al. Laparoscopic versus open appendectomy: outcomes comparison based on a large administrative database. Ann Surg. 2004;239:43-52.