Our Summary

This research paper is about a study that compared the results of three different methods used to close the appendix stump during a laparoscopic appendectomy, which is a minimally invasive surgery to remove the appendix. The three methods compared were purse string invaginating sutures, intracorporeal knotting, and Hem-o-lock polymeric clips.

The study involved 882 patients who had this type of surgery between 2015 and 2017. Of these, 538 had their appendix stump closed using the purse string method, 229 had it closed using intracorporeal knotting, and 115 had it closed using Hem-o-lock clips.

The study found that there were similar rates of complications with all three methods. However, the average length of hospital stay was shorter for patients who had the purse string method, and these patients also had slightly lower scores on the American Society of Anesthesiologists (ASA) scale, which assesses a patient’s fitness for surgery.

However, the purse string method had a higher rate of wound infection for patients with uncomplicated appendicitis. There was no difference in infection rates among the three groups for patients with complicated appendicitis.

Based on these results, the researchers concluded that the purse string method did not lead to better outcomes after surgery, and their institution no longer recommends it as the first choice for closing the appendix stump during a laparoscopic appendectomy.

FAQs

  1. What are the three methods used to close the appendix stump during a laparoscopic appendectomy that were compared in the study?
  2. What were the findings of the research regarding the rate of complications and length of hospital stay for the different methods?
  3. Based on the study results, what method does the institution no longer recommend as the first choice for closing the appendix stump, and why?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic appendectomy is to ask about the method that will be used to close the appendix stump. Based on the research findings, it may be beneficial to inquire about alternatives to the purse string method, such as intracorporeal knotting or Hem-o-lock clips, in order to potentially reduce the risk of wound infection and improve overall outcomes. It is important to have an open discussion with your surgeon about the different closure techniques available and to make an informed decision together.

Suitable For

Patients who are typically recommended for laparoscopic appendectomy are those with acute appendicitis, which is inflammation of the appendix due to a blockage. Laparoscopic appendectomy is a minimally invasive procedure that is preferred over open surgery for most patients with uncomplicated appendicitis. Patients who are otherwise healthy and fit for surgery are good candidates for laparoscopic appendectomy.

In this particular study, the researchers did not specify the specific criteria for patient selection for laparoscopic appendectomy. However, based on the findings of the study, it is important to consider factors such as the type of appendicitis (complicated vs. uncomplicated), the patient’s overall health status, and the potential for postoperative complications when recommending a specific method for closing the appendix stump during the surgery.

Timeline

Before the laparoscopic appendectomy, the patient likely experiences symptoms such as abdominal pain, nausea, vomiting, and fever. The patient would undergo diagnostic tests such as imaging studies or blood tests to confirm appendicitis. Once a diagnosis is made, the patient would be scheduled for surgery.

During the laparoscopic appendectomy, the patient is placed under general anesthesia and small incisions are made in the abdomen for the insertion of a laparoscope and surgical instruments. The surgeon then removes the appendix and closes the stump to prevent infection. After the surgery, the patient may experience some pain and discomfort, but can typically return to normal activities within a few days.

In the post-operative period, the patient will be monitored for complications such as infection, bleeding, or bowel obstruction. The patient may be prescribed pain medication and antibiotics to aid in recovery. Follow-up appointments with the surgeon may be scheduled to ensure proper healing and to address any concerns. Overall, the laparoscopic appendectomy is a minimally invasive procedure with a relatively short recovery time compared to traditional open surgery.

What to Ask Your Doctor

Potential questions a patient may want to ask their doctor about laparoscopic appendectomy and the closure of the appendix stump include:

  1. What method do you typically use to close the appendix stump during a laparoscopic appendectomy?
  2. What are the potential complications associated with each closure method?
  3. How does the choice of closure method affect the length of hospital stay and recovery time?
  4. Are there any specific factors that would make one closure method more suitable for me than another?
  5. What is the rate of wound infection associated with each closure method, and how does it vary between uncomplicated and complicated appendicitis cases?
  6. Have you had experience with all three closure methods, and do you have a preference based on your own outcomes and experiences?
  7. Are there any long-term implications or risks associated with the closure method chosen for my surgery?
  8. Are there any alternative closure methods that could be considered for my surgery?
  9. How will the choice of closure method impact my overall recovery and future health?

Reference

Authors: Shadhu K, Ramlagun D, Wang Y, Ping X, Chen T, Zhu Y, Xu Z. Journal: Surg Endosc. 2020 Feb;34(2):779-786. doi: 10.1007/s00464-019-06828-5. Epub 2019 May 13. PMID: 31087172