A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis
Abstract Background Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. Methods This was a p...
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BMC
2021-05-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-021-01279-z |
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| author | Peter Ihnát Milan Tesař Lubomír Tulinský Lucia Ihnát Rudinská Okaikor Okantey Štefan Durdík |
| author_facet | Peter Ihnát Milan Tesař Lubomír Tulinský Lucia Ihnát Rudinská Okaikor Okantey Štefan Durdík |
| author_sort | Peter Ihnát |
| collection | DOAJ |
| description | Abstract Background Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. Methods This was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler). Results In total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was—104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072). Conclusions The present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 ( http://www.clinicaltrials.gov ). |
| first_indexed | 2024-12-17T00:26:47Z |
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| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-17T00:26:47Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-c57864e750fc4f03829a2d8504f3b1e42022-12-21T22:10:27ZengBMCBMC Surgery1471-24822021-05-012111810.1186/s12893-021-01279-zA randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitisPeter Ihnát0Milan Tesař1Lubomír Tulinský2Lucia Ihnát Rudinská3Okaikor Okantey4Štefan Durdík5Department of Surgery, University Hospital OstravaDepartment of Surgery, University Hospital OstravaDepartment of Surgery, University Hospital OstravaDepartment of Forensic Medicine, University Hospital OstravaDepartment of Cardiovascular Surgery, University Hospital OstravaDepartment of Oncosurgery, Faculty of Medicine, Commenius University BratislavaAbstract Background Closure of the appendix stump presents the most critical part of laparoscopic appendectomy. The aim of the present study was to compare the medical outcomes and cost analysis of laparoscopic appendectomy with respect to the different methods of stump closure. Methods This was a prospective randomized clinical trial conducted in a single institution (University Hospital Ostrava) within a 2-year study period. All included patients were randomized into one of three trial arms (endoloop, hem-o-lok clips or endostapler). Results In total, 180 patients (60 patients in each arm) were enrolled into the study. The mean length of hospital stay (3.6 ± 1.7 days) was comparable in all study arms. The shortest operative time was noted in the hem-o-lok subgroup of patients (37.9 ± 12.5 min). Superficial surgical site infection was detected in 4.4% of study patients; deep surgical site infection was noted in 1.7% of the patients. The frequency of surgical site infections was comparable in all study arms (p = 0.7173). The mean direct costs of laparoscopic appendectomy were significantly the lowest in the hem-o-lok subgroup of patients. Laparoscopic appendectomy is not a profit-making procedure in our institution (mean profit of made from the study patients was—104.3 ± 579.2 Euro). Closure of the appendix stump by means of endostapler presents the most expensive and the highest loss-incurring technique (p = 0.0072). Conclusions The present study indicates that all technical modifications of appendix stump closure are comparable with regards to postoperative complications. The stapler technique is significantly the most expensive. We concluded that hem-o-lok clips have the potential for becoming the preferred method of securing the appendix base during laparoscopic appendectomy. Trial registration NCT03750032 ( http://www.clinicaltrials.gov ).https://doi.org/10.1186/s12893-021-01279-zAppendicitisLaparoscopic appendectomyAppendix stump closurePostoperative complicationsCost-effectiveness |
| spellingShingle | Peter Ihnát Milan Tesař Lubomír Tulinský Lucia Ihnát Rudinská Okaikor Okantey Štefan Durdík A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis BMC Surgery Appendicitis Laparoscopic appendectomy Appendix stump closure Postoperative complications Cost-effectiveness |
| title | A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| title_full | A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| title_fullStr | A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| title_full_unstemmed | A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| title_short | A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| title_sort | randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis |
| topic | Appendicitis Laparoscopic appendectomy Appendix stump closure Postoperative complications Cost-effectiveness |
| url | https://doi.org/10.1186/s12893-021-01279-z |
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