Laparoscopic appendiceal stump closure using titanium endoclips is a useful alternative to knotting the stump with polyglactin sutures, according to a new study.

Researchers at Inonu University (Malatya, Turkey) conducted a prospective randomized study involving 61 patients who underwent laparoscopic appendectomy between April 2010 and February 2011. The patients were randomized to a titanium endoclip group (30 patients) or to a knot-tying (polyglactin suture) group (31 patients). No significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis. The main outcome measures were operating time, complication rates, and hospital stay.

The results showed that the mean operative time for the endoclip group (41 minutes) was shorter than that for the knot-tying group (63 minutes). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications, but one patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The study was published in the June 2012 issue of Surgical Laparoscopy Endoscopy & Percutaneous Techniques.

“In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time,” concluded lead author Mustafa Ateş, MD, and colleagues of the department of general surgery. “This also simplifies the procedure.”

Laparoscopic knots are a modification of knots used by Seamen, Fishermen, or Weavers. In much of the literature on laparoscopic surgery, the learning curve for performing the technique is described as steep, since visualization is different, the instruments are different, and the tactile aspects are very different. As a result, the titanium clip has become the most widely used tissue approximation technique used by the general laparoscopic surgeon.



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