1. A COMPARATIVE STUDY TO ASSESS THE
OUTCOMES OF LAPAROSCOPIC
APPENDICECTOMY WITH SINGLE ENDOLOOP
AND DOUBLE ENDOLOOP KNOT AT THE BASE OF
APPENDIX IN GIMS
PRESENTER: DR RAKSHITH M S
SECOND YEAR POST GRADUATE
GIMS GADAG
MODERATOR: DR RAJASHEKHAR T PATIL
ASSOSCIATE PROFESSOR
GIMS GADAG
2. INTRODUCTION
• Laparoscopic appendicectomy , currently laparoscopic appendicectomy is considered
as standard approach.
• Appendicular stump closure is the most critical event in Laparoscopic
appendicectomy . The ideal method for appendix stump closure should be safe,
accessible, technically simple to use and cost effective.
• Due to the rarity of the published articles regarding the treatment of the appendix
stump using endoloops, we performed a prospective randomized trial to evaluate the
number of loops needed for Laparoscopic appendicectomy .
3. • Several techniques for securing the appendiceal base have been
described, including single and double ligatures. However, there is no
consensus on which technique is superior in terms of postoperative
complications, operation duration, and cost.
• This study aims to compare the outcome of laparoscopic appendectomy
with single and double endoloop knotting at the base of appendix.
4. OBJECTIVES
To compare the outcome of Laparoscopic Appendicectomy with single
and double endoloop knotting at the base of appendix in terms of
operation duration, post-op complications, hospital stay.
5. MATERIALS AND METHODS
• Cross sectional observational study compiling information of patients with Acute
appendicitis who presented in Department of General Surgery, GIMS from January
2023 to March 2023.
• 15 patients underwent Laparoscopic Appendicectomy with single endoloop knotting
at the base of appendix (group A) and double endoloop knotting at the base of
appendix(group B) each.
• Patients were followed up
6. • Patient’s age, sex, radiologic examinations, appendix base diameter,
operation duration, hospital stay, perioperative complications, will be
analysed from the prospectively collected database.
• Statistical tests employed were chi-square test and independent-t test.
7. • Inclusion criteria:
1. Patients aged 18-60 years who present with acute appendicitis.
2. Medical fitness for general anesthesia and laparoscopic
appendectomy.
• Exclusion criteria:
Patients with complicated appendicitis( perforated appendicitis,
appendicular abscess, gangrenous appendix) will be excluded.
8. RESULTS
• A comparison of patient age, and duration of operation and hospital stay
between the two groups found that the duration of operation was longer
in Group II (61.2±18.8 min) compared to Group I (54.9±16.1 min)
(p=0.001), but there was no statistically significant difference concerning
patient age and length of hospital stay (p>0.05).
• The incidence of wound infections or complications requiring
rehospitalization or re-operation were compared. There were no
statistically significant difference in the rate of wound infection between
the two groups(p>0.05), however there were no rehospitalization or re-
operation required in both the groups.
12. 2.6
2.65
2.7
2.75
2.8
2.85
2.9
Group A Group B
Mean hospital stay
• Mean hospital stay in
group A is 2.85±2.02 days
while in group B is
2.69±1.84, but there was
no statistically significant
difference(p>0.05).
13. • None of the patients in group A but 1
patient in group B had superficial
wound infection, for which pus c/s sent
and antibiotics were prescribed
accordingly.
0
0.2
0.4
0.6
0.8
1
1.2
Group A Group B
Superficial wound infection
14. DISCUSSION
• After mobilization of the appendix, the division of the base can be done
using a stapler, simple coagulation, or endoloops. The use of a stapler is
safe and quick, but the costs are much higher than the use of a endoloop.
• Simple coagulation of the appendix stump after cutting the base with
scissors can be insufficient and is generally not recommended. Necrosis
due to coagulation and inflammation will lead to a higher rate of
postoperative leakage and abscess formation.
15. • Our data show that laparoscopic appendectomy can be safely
performed using one proximal endoloop.
• There were no statistical differences between the two groups in terms
of complications.
16. CONCLUSION
• Endoloop use is as safe as other methods in laparoscopic
appendectomy.
• Using a double endoloop does not decrease the rate of post-
operative complications; however, it increases the duration of
the operation.
• Therefore, we have concluded that using a single endoloop in a
laparoscopic appendectomy may be more appropriate.
17. REFERENCES
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prospective, randomized clinical trial. Surg Endosc. 2004;18(5):749-750.
4. Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during
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5. Rakić M, Jukić M, Pogorelić Z, Mrklić I, Kliček R, Družijanić N, et al. Analysis of endoloops and
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6. Nadeem M, Khan SM, Ali S, Shafiq M, Elahi MW, Abdullah F, et al. Comparison of extra-corporeal
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