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      Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis

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          Background and aim

          In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis.

          Patients and methods

          Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications.


          The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days.


          Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.

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          Most cited references 17

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          Endoscopic appendectomy.

           K. Semm (1983)
          These newly developed endoscopic methods in gynaecology for haemostasis during surgical pelviscopy (Endocoagulation Roeder-loop ligation, endoligature, endo-suture with intra- and extracorporeal knotting) make it possible to carry out appendectomy by endoscopy for any of the following indications: Postoperative adhesion of the appendix especially in "sterility" patients, elongated appendix extending into the small pelvis, endometriosis of the appendix, subacute and chronic appendicitis. The instrument-set employed in this method permits the performance of all the usual classical operative steps (purse-string suture, and Z-suture acc. to McBurney and Sprengel). The point for resection has to be sterilized over 20-30 sec. at 212 degrees F using the crocodile forceps (endocoagulation procedure) before division and extraction of the appendix is effected.
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            Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling?

            This metaanalysis aimed to compare endoscopic linear stapling and loop ligatures used to secure the base of the appendix. Randomized controlled trials on appendix stump closure during laparoscopic appendectomy were systematically searched and critically appraised. The results in terms of complication rates, operating time, and hospital stay were pooled by standard metaanalytic techniques. Data on 427 patients from four studies were included. The operative time was 9 min longer when loops were used (p = 0.04). Superficial wound infections (odds ratio [OR], 0.21; 95% confidence interval (CI), 0.06-0.71; p = 0.01) and postoperative ileus (OR, 0.36; 95% CI, 0.14-0.89; p = 0.03) were significantly less frequent when the appendix stump was secured with staples instead of loops. Of 10 intraoperative ruptures of the appendix, 7 occurred in loop-treated patients (p = 0.46). Hospital stay and frequency of postoperative intraabdominal abscess also were comparable in loop-treated and staple-treated patients. The clinical evidence on stump closure methods in laparoscopic appendectomy favors the routine use of endoscopic staplers.
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              SAGES guideline for laparoscopic appendectomy.


                Author and article information

                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                12 August 2015
                : 11
                : 1213-1216
                [1 ]Department of General Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
                [2 ]Department of General Surgery, Ataturk State Hospital, Antalya, Turkey
                [3 ]Department of Infectious Disease, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
                [4 ]Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
                Author notes
                Correspondence: Nurettin Ay, Diyarbakir Gazi Yasargil Egˇitim ve Araştırma Hastanesi, Organ Nakli klinigi, 3 Kat, Uckuyular, Yenişehir, 21010 Diyarbakir, Turkey, Tel +90 505 661 4260, Fax +90 412 258 0060, Email nurettinay77@ 123456hotmail.com
                © 2015 Ay et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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