COMPARISON OF NON-INVAGINATION VERSUS INVAGINATION OF APPENDIX STUMP FOLLOWING APPENDECTOMY

Main Article Content

Pooja Kumari
Aisha Shaikh
Ibrahim Asghar
Sughran Khatoon
Muhammad Muqeem
Saira Fatima

Keywords

Efficacy, Invagination, Appendix Stump, Appendectomy, Wound Infection

Abstract

Objective: To compare the efficacy of non-invagination versus invagination of appendix stump following appendectomy in terms of wound infection.


Study Design: Comparative Study.


Setting: Department of Surgery Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan.


Duration: Six months after the approval of synopsis from September 2020 to March 2021.


Materials and Methods: All patients who fulfilled the inclusion criteria and visited to SMBBMU, Larkana were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. The patients were randomly divided into two groups using computer-generated sequential number placed in sealed envelopes and opened only before the commencement of the study. In Group A after ligation and trans fixation, invagination of stump was done, while in group B only simple ligation and trans fixation of appendicular stump was done. Post-operative fever, vomiting if any and wound infection was noted. All the collected data were entered into the proforma attached at the end and used electronically for research purpose.


Results: Mean ±SD of age in group A was 29.3±6.3 and group B was 28.4±5.8 years. In group wise distribution of gender, 50 (57.4%) male and 37 (42.6%) females were enrolled in group A while 55 (63.2%) male and 32 (36.8%) females were included in group B. In comparison of efficacy, non-invagination was found to be effective in 05 (5.7%) while invagination was found to be effective in 14 (16.1%) patients after appendectomy and P value found to be significant i.e. (P=0.029).


Conclusion: It is to be concluded that significant difference was noted between non-invagination versus invagination in term of efficacy.

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References

1. Suvera MS, Kharadi AH, Asari US, Damor PB, Shah MT, Patel MB. Open appendicectomy stump: invaginate or not to invaginate. Int J Res Med Sci. 2013;1(3):248-51.
2. Qazi SR, Darokar AV, Bijwe VN, Mulmule RM, Bele KK. A comparative study of simple ligation and simple ligation with invagination of appendicular stump. Int J Res Med Sci. 2016;4(5):1485-9.
3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.
4. Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of metaanalyses of randomised controlled trials. BMC Gastroenterol. 2015;15(1):48.
5. Drake FT, Mottey NE, Farrokhi ET, Florence MG, Johnson MG, Mock C, et al. Time to appendectomy and risk of perforation in acute appendicitis. JAMA Surg. 2014;149(8): 837-44.
6. Ramachandra J, Sudhir M, Sathyanarayana BA. Evaluation of modified Alvarado score in preoperative diagnosis of acute appendicitis. J Evol Med Dent Sci. 2013;2(46):9019-30.
7. Hiramatsu K, Toda S, Tate T, Fukui Y, Tomizawa K, Hanaoka Y, et al. Can laparoscopic appendectomy be safely performed by surgical residents without prior experience of open appendectomy? Asian J Surg. 2018;41(3):270-3.
8. Blake L, Som R. Best evidence topic: What is the best management of the appendix-stump in acute appendicitis: Simple ligation or stump invagination? Int J Surg. 2015;24: 20-3.
9. Qian D, He Z, Hua J, Song Z. Stump invagination versus simple ligation in open appendicectomy: a systematic review and meta-Analysis. Int Surg. 2015;100(7-8):1199206.
10. Rbihat HS, Mestareehy KM. Al lababdeh MS, Jalabneh TM, Aljboor ME, Uraiqat AA. Laparoscopic versus open appendectomy retrospective study. Int J Adv Med. 2017;4(3): 620-2.
11. Gravante G, Yahia S, Sorge R, Mathew G, Kelkar A. Back to basics: a meta-analysis of stump management during open appendicectomy for uncomplicated acute appendicitis. World J Surg Proced. 2013;3(3):47-53.
12. Shi Y, Tang D, Tang X, Wang D. Simple ligation versus stump invagination for the appendix stump: a systematic review and meta-analysis. Int J Clin Exp Med. 2018;11(11): 11372-82.
13. Afridi NG, Iqbal Z, Nazeem S, Ahmad S. Simple ligation versus invagination of stump in open appendicectomy. J Med Sci. 2014;22(2):93-5.
14. Chalya PL, Mchembe M. Is invagination of appendicular stump in appendicectomy necessary? a prospective randomized clinical study. East Central Afr J Surg. 2012;17(1): 85-9.
15. Ellis BW. Acute appendicitis in Brian W Ellis and Simon Paterson-Brown, Hamilton Bailey’s Emergency Surgery 13th edition, Hodder Arnold: 399-410.
16. Boswell CB. Diseases of appendix. In. Doherty GM, Meko JB, Olson JA, Peplinski GR, Worrall NK eds. The Washington Manual of Surgery. 1999;2:228-35.
17. Sabiston Textbook of Surgery 18th edition, The Biological Basis Of Modern Surgical Practice, Section X Abdomen , Chapter 49 The appendix.
18. Addis DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendicectomy in United States. Am J Epid 1990;132:910-25.
19. Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, et al. Incidence of acute non-perforated and perforated appendicitis: age specific and sex-specific analysis. World Surg 1997;21:313-7.
20. Schwartz principle of surgery, 8th edition, F Charles Brunicardi 29:The Appendix.
21. Scott-Conner CE, Hall TJ, Anglin BL, Muakkassa FF. Laparoscopic appendectomy. Ann Surg. 1992;215(6):660.
22. Fischer JE, Bland KI, Callery MP, editors. Mastery of surgery. Lippincott Williams & Wilkins; 2006.
23. Bailey and Love’s Short practice of surgery, 25th edition, Norman S. Williams, Christopher J. K. Bulstrode and P. Roman O’connell 67: the Vermiform Appendix 1204-18.
24. Chaudhary IA, Samiullah, Mallhi AA, Afridi Z, Bano A. Is it necessary to invaginate the stump after appendicectomy? Pak J Med Sci J 2005;21(1):35-8.
25. Mahzar R, Leem AM, Sarfraz A, Riaz U. Appendicectomy; non-invagination vs. invagination of appendicular stump. Ann King Edward Med Coll 2006;12(1):58-60.
26. Lavonius MI, Liesjarvi S, Niskanen RO, Ristkari SK, Korkala O, Mokka RE. Simple ligation vs stump inversion in appendicectomy. Ann Chir Gynaecol. 1996;85(3):222-4.
27. Jacobs PP, Koeyers GF, Buryninckx CM. Simple ligation superior to inversion of the appendiceal stump; a prospective randomized study. Ned Tijdschr Geneeskd. 1992;136 (21):1020-3.
28. Engstrom L, Fenyo G. Appendicectomy: assessment of stump invagination versus simple ligation: a prospective randomized trial. Br J Surg 1985;72(12):971-2.
29. Ellis BW. Acute appendicitis, in Ellis BW, Brown SP (edit) Hamilton Bailey’s Emergency Surgery 12th edition Butterworth-Heinemann Ltd Oxford,1995:411-23.
30. Watter DAK, Walker MA, Abernethy BC. The appendix stump: should it be invaginated? Ann Roy Coll Surg Engl 1984;66:92-6.
31. Osime U, Ofili OP, Duze A. A prospective randomized comparison of simple ligation and stump invagination during appendicectomy in Africans. J Pak Med Assoc 1988;38(5):134-6.
32. Dass HP, Wilson SJ, Khan S, Parlade S, Uy A. Appendicectomy stump: ‘to bury or not to bury’. Trop Doct. 1989;19(3):108-9.
33. Chaudhary IA, Samiullah, Mallhi AA, Afridi Z, Bano A. Is it necessary to invaginate the stump after appendicectomy? Pak J Med Sci J 2005; 21 (1):35-8.
34. Naeem S, Khalid I. Appendicectomy: non-invagination vs. invagination of appendicular stump. Professional 2004;11(2):117-20.
35. Minhas Q, Siddique K, Mirza S, Malik A. Post-operative complications of stump ligation alone versus stump ligation with invagination in appendicectomy. Int J Surg. 2010;22(2).
36. Johnson EK, Arcila ME, Steele SR. Appendiceal inversion: a diagnostic and therapeutic dilemma. JSLS. 2009;13:92-5.
37. Rashid ZA, Tariq M. Appendicectomy; assessment of caecal invagination of appendicular stump. Professional Med J. 2011;18(1):102-5.
38. Aldeen B, Mujamaee AK. Non burial of the appendix stump during appendectomy a safe procedure. 2010;6(3).
39. Khan S. Assessment of stump invagination versus simple ligation in open appendicectomy. J Instit Med Nepal. 2010;32(1):7-10.
40. Haider J, Zaheer F, Khan TM. Tube cecostomy in appendicular mass or abscess: a review of 21 cases. Pak J Surg. 2008;24(4):240-2.
41. Khan JS, Farooq U, Hassan H. Appendicectomy. Prof Med J. 2012;19(01):001-5.