Assessment of the haematological profile after appendectomy using linear titanium stapler clips: An experimental study in rats (original) (raw)
Related papers
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2011
Background and Objectives: The standard technique for securing the base of the appendix during laparoscopic appendectomy is by absorbable endoloop ligature, although clinical reports favor the use of the stapler. Nonabsorbable Hem-o-lok clips have been shown to be an alternative technique to this. However, it is currently not clear whether nonabsorbable clips have any effects on the intestine or promote infection in the surgical area. Materials and Methods: Sixty Wistar albino rats were randomized into 3 treatment groups: group I (nϭ20) the base of the appendix was secured by endoloop 2-0 ligature; group II (nϭ20) dissection of the appendix was performed by a 45-mm thick stapler; and group III (nϭ20) the base of the appendix was secured by a Hem-o-lok plastic clip. The animals were sacrificed on the 14th and 28th days after surgery. The secured stump was used for histopathological examination. Results: There were no significant differences in histopathological changes observed on the 14th postoperative day between the groups. On the 28th postoperative day, it was proved that mild and moderate inflammation is more frequent in the endoloop and Hem-o-lok groups than in the stapler group. Reaction to a foreign body is more frequent in the endoloop than in stapler and Hem-o-lok groups. Conclusion: The mildest postoperative inflammatory changes were seen in the stapler group, followed by the Hem-o-lok group. However, because of the price of the plastic clip and the simplicity of its application, its use is still favored during laparoscopic appendectomy.
Kafkas Universitesi Veteriner Fakultesi Dergisi, 2021
The aim of the study was to determine possible adverse effects on haematological parameters of the rats, using different surgical techniques, i.e. titanium double shanked ligation (DS) clips and endoloop polyglactin 910 suture material in laparoscopic appendectomy. The use of DS clips and other similar methods is not widely represented in veterinary surgery, as is the case in humans. Fifty rats were randomized into three groups: group 1 in which the appendiceal base was closed with a endoloop polyglactin 910 ligatures, 20 rats, group 2 in which the appendectomy was closed with DS titanium clips, 20 rats. Group 3 was the control, in which the animals were not subjected to the surgical procedure, 10 rats. Blood was drawn from the caudal vein of ten animals from each experimental group, 7 and 28 days post-surgery. Thrombocytopenia was found in the DS clips group, and hypochromia with hypochromic erythrocytes, as well as neutrophilia and lymphopenia in both experimental groups. From a haematological standpoint, DS clips are more applicable for potential patients than endoloop polyglactin 910 ligatures.
LigaSure™ compared with ligatures and endoclips in experimental appendectomy: how safe is it?
Pediatric Surgery International, 2010
Purpose The present study aims to compare strength, healing, and inflammation of appendiceal stumps closed by LigaSure Precise TM (Valleylab, Boulder, CO, USA) device, ligatures using polyglactin 910 (Vicryl, Ethicon, Edinburgh, UK) and endoclips (Ligaclip ERCA, Ethicon, OH, USA), and operation time (OT) in experimental appendectomy. Methods Forty-eight Sprague-Dawley rats were divided into two (Group A and B). Each group was further subdivided into three subgroups (AS, AC, AL, BS, BC, BL) containing eight rats. Appendectomy was performed and stump was closed by ligatures in S, by endoclips in C and by LigaSure TM in L subgroups. OT was recorded. In Group A, cecum bursting pressures (BP) were determined instantly after the operation. In Group B, BP, histological evaluations, and measurements of collagen contents estimated by the tissue hydroxyproline (HPL) level were made on the seventh postoperative day. Statistical analyses were performed with Kruskal-Wallis test and Mann-Whitney U test. P value was considered significant at less than 0.05. Results BPs of subgroups were comparable on postoperative immediate period and day 7. HPLs and OTs were significantly better in L subgroups. BL had the least inflammation. Conclusion Better healing, less inflammation, shorter OT, and equal strength achieved with LigaSure TM device comparing with polyglactin 910 ties and endoclips in experimental appendectomy is encouraging.
Journal of Minimally Invasive Surgical Sciences, 2017
Background: Laparoscopic appendectomy (LA) has become the standard choice for acute appendicitis. Several techniques to close the appendiceal stump were investigated, and use of polymeric clips, are shown safe and cost effective. Objectives: Evaluation of the efficacy and safety of appendiceal stump closure with polymeric clips in LA. Methods: This is a retrospective cohort study included 35 patients who underwent LA, between April 2013 and August 2016 in Rasoole-Akram university hospital. appendiceal stumps ligation were performed by polymeric clips. One month follow up after surgery was performed for all patients. Demographic information of patinets, surgery, complications, readmission and pathological reports, were collected from medical records and data base. Results: Thirty-five patients were included in this retrospective study. Nineteen patients were male and 16 patients were female (54.3% vs 45.7%). The mean age was 28.49 ± 9.56 years, mean operative time was 59.6 ± 11.8 minutes and mean hospitalization was 2.54 ± 0.7 days. There was no intraoperative complication and intraabdominal abscess formation. Also no readmission and no perioperative death were recorded in documents. In pathologic reports, there were 15 (42.8%) suppurative and one gangrenous (2.8%) appendicitis. Conclusions: Application of polymeric clips for stump ligation is safe, cost effective and time saving, and could be used as favorable technique in LA.
Annals of the Royal College of Surgeons of England, 2018
INTRODUCTION The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of pol-ymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. MATERIALS AND METHODS Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendi-cectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. RESULTS A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postop-erative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. DISCUSSION Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.
The effect of stump ligation techniques on operative time in laparoscopic appendectomy
Archives of Medical Science - Civilization Diseases
Introduction: We aimed to evaluate the effect of stump ligation techniques on operative time in laparoscopic appendectomy. Material and methods: The patients who underwent laparoscopic appendectomy in our General Surgery Clinic between January 2016 and August 2018 were retrospectively reviewed. The effects of stump ligation techniques used in the operations on operative times were evaluated. Results: Sixty consecutive patients were screened and 3 groups, 20 patients in each group, were formed based on stump ligation techniques. Extracorporeal knotting-loop ligation was used in Group 1; intracorporeal knotting was used in the Group 2; hem-o-lok clip was used in Group 3.There was no statistically significant difference between the groups in terms of gender distribution and mean age. However, there was a significant difference between the hem-o-lok clip group (Group III) and the intracorporeal knot group (Group II) in terms of operative time. Group III had a shorter operative time. The Group III patients had the shortest operative time, while the Group II patients had the longest operative time (p < 0.05). Conclusions: We can speculate that hem-o-lok clip among the stump ligation techniques reduces the cost, is a safe method and shortens the operative time. However, prospective randomized studies with a large sample size comparing different techniques are needed to determine the ideal treatment procedure. At the same time, stapler use may be considered in cases where the base of the appendix is too inflamed or necrosed. It is known that the use of a stapler and endoloop is more expensive than all other techniques. However, the most important issue for the surgeon is patient safety; therefore the most appropriate technique should be preferred.
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2013
Background and Objectives: The common technique used in securing the base of the appendix is Endoloop ligature (Ethicon, Somerville, NJ, USA). Vicryl (polyglactin 910) (Ethicon) and polydioxanone (PDS) (Ethicon) Endoloop ligatures can be used. There are potential benefits of the use of PDS Plus (Ethicon) Endoloop ligature. However, the use of different materials may vary in terms of inflammation, foreign-body reaction, rate of infection in the surgical area, or rate of adhesion formation. An ideal suture would induce minimal inflammatory response and adhesion formation. Methods: Ninety rats were randomized into 3 groups: group I, in which appendectomy was performed with Vicryl ligature; group II, in which appendectomy was performed with PDS ligature; and group III, in which appendectomy was performed with PDS Plus ligature. The animals were killed on the seventh, 28th, and 60th days after surgery. The secured stump was used for histopathologic and immunohistochemistry analysis, as well as evaluation of the formation of adhesions. Results: Mild and moderate inflammation was more frequent in the PDS and PDS Plus groups than in the Vicryl group on the seventh postoperative day. There were no significant differences in the degree of inflammation on the 28th and 60th postoperative days. The lowest degree of postoperative adhesions was observed in the PDS group. Conclusion: Milder postoperative inflammatory changes and a lower degree of postoperative adhesions were seen in the PDS ligature group, suggesting that this could be the standard Endoloop used to secure the base of the appendix.
Laparoscopic appendectomy using a polymeric clip to close the appendicular stump
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler. This was a prospective study in 2 stages. In phase 1, 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups. In 14 patients, the appendicular base was occluded by using an endoscopic linear cutting stapler. In the remaining 14, the appendicular base was ligated by using nonabsorbable polymeric clips (Hem-o-lock). We compared the surgical time, hospital stay, hospital costs, and complications. In phase 2, 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the app...
Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump
Langenbeck's Archives of Surgery, 2010
Background The aim of this study was to evaluate the feasibility, morbidity, and cost-effectiveness of the closure of the appendicular stump with a single non-absorbable polymeric clip compared with the closure of the appendicular stump with a stapler. Methods From January 2009 to December 2009, 82 patients, 31 males and 51 females (mean age of 35.4 years; range of 17 to 79 years), were included in this prospective, non-randomized trial. In 56 patients, the appendicular stump was closed by staplers, and in 26 patients, a single Hem-o-lok MLX polymeric clip was applied. The data collected included age, sex, time of surgery, costs, time of hospitalization, day-time of surgery, complications, and preoperative white blood count (WBC) and c-reactive protein (CRP). Results There were no differences between the two groups regarding age, sex, WBC, CRP, and time of hospitalization. Time of surgery was longer in the clip group due to the introductory phase. Morbidity did not differ significantly and was highly acceptable in both groups. The costs of one set of Hem-o-lock clips were negligible compared to staplers (19.94 € versus 356.43 €).