Endoloop versus intracorporeal knotting: Comparison of two appendiceal ligation methods during laparoscopic appendectomy

INTRODUCTION: The laparoscopic approach to appendectomy surgery led to various appendiceal ligation methods; however, the ideal technique for appendiceal stump closure has yet to be determined. This study is a comparison of intracorporeal knotting (IK) and Endoloop (Ethicon, Inc., Somerville, NJ, USA) (EL) techniques for appendiceal stump closure during laparoscopic appendectomy (LA) surgery.
METHODS: All of the LAs included in the study were performed by only 2 surgeons between June 2013 and June 2018 and the results were retrieved retrospectively. The patients were divided into an IK group and an EL group. Early postoperative complications (<30 days) were evaluated. All of the LAs were performed using 3 trocars. In the IK group, the appendiceal base was ligated with a manually constructed single intracorporeal knot. In the EL group, the appendiceal base was ligated with a single Endoloop tie (Vicryl ligature; Ethicon, Inc., Somerville, NJ, USA). A LigaSure device (Medtronic, Inc., Minneapolis, MN, USA) was utilized in both techniques for transection of the appendix. The specimen was extracted through the umbilical port within an Endobag (Medtronic, Inc., Minneapolis, MN, USA). A normal diet was administered within 6 hours postoperatively and the patients were discharged the day after the operation.

RESULTS: The IK group consisted of 54 patients and the EL group comprised 75 patients. The groups were similar regarding gender, age, body mass index, and American Society of Anesthesiologists score. Although the operation time tended to be longer in the IK group, the difference was not statistically significant (48.46±23.85 vs. 45.36±22.28 minutes; p=0.459). In the EL group, the drain was retained in 1 patient for 2 weeks due to liver cirrhosis and 1 patient had an intraabdominal abscess. The latter patient was treated with percutaneous drainage and antibiotherapy.
DISCUSSION AND CONCLUSION: The IK technique and the EL technique had similar results. Due to its lower cost and wider availability, IK might be suggested over the EL technique. Eliminating the dependence on commercial products and providing the means for the development of advanced laparoscopic skills are additional benefits of the IK technique.