Abstract:
Background: Laparoscopic appendectomy is a well-described surgical
technique. However, concerns still exist regarding whether the
closure of the appendiceal stump should be done with a clip, an
endoloop, staples, or other techniques. Therefore, several modifications
to the original technique with new materials have been
introduced for appendiceal stump closure. The aim of this study
was to compare intracorporeal (polyglactin) knot-tying suture with
titanium endoclips in appendiceal stump closure during laparoscopic
appendectomy.
Methods: The study was carried out as a prospective randomized
clinical trial between April 2010 and February 2011. Patients with a
presentation of appendicitis were included into the study. Two
groups were defined—patients with the titanium endoclip and patients
with the knot-tying (polyglactin) suture. The results in terms
of operating time, complication rates, and hospital stay were analyzed.
Results: Sixty-one patients who underwent laparoscopic appendectomy
were enrolled in the titanium endoclip group (n= 30) or
the knot-tying (polyglactin) suture group (n= 31). No statistically
significant differences were detected between the groups in terms of
the distribution of age, sex percentage, appendix localization, and
histopathologic diagnosis (P> 0.05). One patient required a second
operation on postoperative day 10 because of intraperitoneal
abscess. The mean operative time for the endoclip group
(41.27± 12.2 min) was shorter than that for the knot-tying group
(62.81± 15.4 min) (P= 0.001). No statistically significant differences
were detected between the groups in terms of hospital stay,
follow-up time, and preoperative and postoperative complications
(P> 0.05).
Conclusions: In laparoscopic appendectomy, using a titanium endoclip
for optimizing and controlling the appendiceal stump closure
is safe and is associated with shorter operation time. This also
simplifies the procedure, so it can be a useful alternative to intracorporeal
knot-tying for appendiceal stump closure.
Key Words: laparoscopy, appendectomy, knot-tying, endoclip
