COMPARATIVE ANALYSIS OF METHODS OF STUMP CLOSURE IN LAPAROSCOPIC APPENDECTOMY
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Keywords
Acute appendicitis, laparoscopic appendectomy, appendiceal stump, visual analogue scale, post operative complications
Abstract
BACKGROUND: Acute appendicitis is a frequent surgical emergency. The surgical treatment for this issue is an appendectomy, which is one of the most common surgeries done globally.
OBJECTIVE: To compare various methods of Appendiceal stumps closure in laparoscopic appendectomy.
METHODS: After getting ethical approval from ethical review board of Ziauddin university (REF #2021/01SCS) this comparative observational cross-sectional study was conducted. The data was collected from January 2021 to June 2021. Using the consecutive sampling technique, all patients diagnosed with acute appendicitis (Z) (Anerdala score) undergoing laparoscopic appendectomy in the surgery department of Ziauddin Hospital (North Campus) were taken into either group (G1, G2, G3, or G4). Groups G1 (Endoloop), G2 (Intracorporeal Knotting) Vicryl Size 2’0, G3 (Extracorporeal Knotting) Vicryl Size 2’0, and G4 (Intracorporeal Transfixation) with 2’0 vicryl were used for the closure procedures.
RESULTS: The mean age of the sample stood at 42.57±17.4 years, with the age ranging from 18 to 80 years. Females predominated among study groups. A large number of patients in Group14 18 (18%) and Group 15(12.5%) had the intra operative hemorrhage. Post-operative complications include hematoma, seroma formation, post-operative hemorrhage, knot slippage leading to bowel slippage and peritonitis, abscess formation and surgical site infection were observed at 1%, 2% and 3% equally among them. Time duration for the closure of appendiceal stump by in (1) Endoloop G2(intracorporeal knotting), G3(extracorporeal knotting) and G4 (intracorporeal Transfixation) were 44.7, 77, 78.4 & 12.8, 5.2 & 14.5 and 7.6 to 17.5 minutes respectively where mean hospital stay for G1, G2, G3 and G4 is 0.2, 0.25, 2.5±0.6, 0.6 and 3.5± 1.1 days respectively. Both G1 and G4 had highly significant statistical link with the groups with the p value of <0.001 and <0.001 respectively. On comparison of post-operative VAS pain score index with all the group we observed the highest pain felt group in group1 in 14 patients (13.79, 23.08%) and peak mild pain in group 1 while in group 2, 13 (16%), 16 (20%) in group 3 and 15 (18-8%) in group4 had mild pain VAS scores.
CONCLUSION: A wide array of closure methods may be utilized in laparoscopic appendectomy. Endoloop and Transfixation show superior outcomes in laparoscopic appendectomy. Among the studied techniques for closing the stump in laparoscopic appendectomy, the endoloop group had the fewest VAS scores, less time spent intraoperatively.
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Dr Shafaqat Azeemi
Senior Registrar, Department of General Surgery, Dr Ziauddin Hospital Karachi.
Dr Zahid Ali
Assistant Professor, Ziauddin University Hospital, Karachi.
Dr Naheed Akhtar
Assistant Professor, Department of Anatomy, Karachi Institute of Medical Sciences, CMH Malir Cantt, Karachi.
Dr Seema Salim
Senior RMO, Department of ICU/Wards (medicine, surgery, paeds), Midciti hospital, Karachi
Dr Umar Zeb
Post Graduate Trainee, Department of General Surgery, Dr Ziauddin Hospital Karachi
Dr Rihan Aslam Khan
Post Graduate Trainee, Department of General Surgery, Dr Ziauddin Hospital Karachi