Different Techniques used for Stump Closure in Laparoscopic Appendectomy

Background: The most prevalent surgical emergency for which patients present to the emergency room is acute appendicitis. Appendectomy is the surgical therapy for the problem, and it is one of the most common surgeries performed worldwide, with almost a quarter of all people (equally males and females) requiring one at some point in their lives. Methods that are used to close the stump in laparoscopic appendectomy include staplers, endo-loop, titanium clips, non-absorbable polymer clips (Hem-o-lock clips), hand-made loops, extracorporeal sliding knot, intra-corporeal ligation, ligature use or division with bipolar cautery.

Objective: To compare various methods of stumps closure in laparoscopic appendectomy.

Methods: This Double Blind – Randomized Quasi Experimental Trial was conducted upon a sample of 80 patients (selected using non-probability, consecutive sampling) in four groups (G1: Endoloop, G2: Intracorporeal Knotting with Vicryl Size 2/0, G3: Extracorporeal Knotting with Chromic Catalent no Zero, G4: Vicryl Intracorporeal Trans fixation of Stump with 2/0 vicryl) of 20 each. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, disease history, operative notes and post-operative follow-up. The data obtained was analyzed using SPSS 21.0 and MS. Excel.

Results: The mean age of the sample stood at 43.96 (SD ± 16.9) years, with the age ranging from 17 to 80 years. Study more females were presented in all four groups. They have shown insignificant statistical association with p-value of 0.983. Post-operative complication in every group was recorded as post-operative hemorrhage, knot slippage, abscess and surgical site infection. Overall in 9 (11.3%) of patients experienced different post-operative complications showed insignificant statistical association with the p-value of 0.945.

Conclusion: In current study we concluded that endoloop is the most efficient and less time consuming procedure used for the stump closure in the patient undergo laparoscopic appendectomy. Intra operative time taken is also less compared to other groups. Less number of intra-operative and post-operative complication were noted in the endoloop group. Hospital stay is also observed to be less in the endoloop group.