Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure

• DOI: 10.1097/sle.0b013e31824f25cd
• Publication Date: 2012-06-08T21:05:52Z
• Authors: Mustafa Ates; Abuzer Dirican; Volkan Ince; Cengiz Ara; Burak Isik; Sezai Yilmaz
• Keywords: Adult; Male; Titanium; Sutures; Suture Techniques; Length of Stay; Appendicitis; Surgical Instruments; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Appendectomy; Humans; Female; Laparoscopy; Prospective Studies; Polyglactin 910

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.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.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).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.