The use of the extracorporeally prepared hand-made endo-loop technique in laparoscopic appendectomy

BACKGROUND: Acute appendicitis is the leading emergency condition among surgical abdominal diseases. The treatment of choice for appendicitis is open or laparoscopic appendectomy. There are different methods for appendiceal stump closure. Laparoscopic ap-pendectomy became more applicable with hand-made endo-loop applications to close the appendiceal stump, especially in state hospi-tals where the resources were limited. This article aims to evaluate the outcomes of patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop.
METHODS: Fifty patients undergoing laparoscopic appendectomy with the appendiceal stump closure using a hand-made endo-loop in the General Surgery Department of our hospital between June 2014 and December 2018 were evaluated. The ages, genders, length of stay in the hospital, complications, and histopathological investigation results of the patients were gathered retrospectively. Lapa-roscopic appendectomy was performed with three ports. The appendiceal stump was closed using two hand-made endo-loops. The loop was made with a modification of Roeder’s loop whose safety was proven in the literature. The first port was introduced to the abdomen with the open method. SPSS 26.0 statistical program was used for statistical analysis.
RESULTS: Thirty-one (62%) of patients were males and 19 (38%) of them were females. The mean age was 32.2±11.9 years. The age ranged between 19 and 74 years. The median length of stay in the hospital of the patients was 1.12±0.47 days. One of the patients was 21 weeks pregnant. A surgical site infection occurred in one patient during the post-operative period. Recovery was obtained with antibiotherapy. No leakage through the base of the appendix or cecal fistula was determined in none of the patients.
CONCLUSION: One of the most important parameters in the cost of laparoscopic appendectomy is the closure technique of the stump. The cost comes into question much more especially in state hospitals where the resources are limited. Appendiceal stump closure using a hand-made endo-loop is an easy, safe, and cost-effective method.

Laparoskopik apendektomide ekstrakorporeal hazýrlanan el yardýmlý loop kullanýlmasý

AMAÇ: Akut apandisit, cerrahi akut karýn olgularýnda ilk sýrada yer almaktadýr. Tedavisi açýk veya laparoskopik appendektomidir. Apendiks güdüðünü kapatmak için farklý yöntemler mevcuttur. Özellikle imkanlarýn daha kýsýtlý olduðu devlet hastanelerinde güdüðü kapatmak için el yardýmlý loop uygulamasý ile laparoskopik apendektomi daha yapýlabilir hale gelmiþtir. Bu yazýda, apendiks güdüðünün el yapýmý loop ile kapatýldýðý laparoskopik appendektomi uygulanan olgularýn sonuçlarýnýn deðerlendirilmesi amaçlandý.
GEREÇ VE YÖNTEM: Hastanemiz genel cerrahi kliniði’nde Haziran 2014-Aralýk 2018 tarihleri arasýnda apendiks güdüðünün el yapýmý loop ile kapatýldýðý laparoskopik appendektomi uygulanan 50 olgu deðerlendirildi. Hastalarýn yaþý, cinsiyeti, yatýþ süresi, komplikasyonlar ve histopatolojik inceleme sonuçlarý retrospektif olarak toplandý. Laparoskopik appendektomi üç port ile yapýldý. Apendiks güdüðü iki adet el yardýmý ile yapýlan loop kullanýlarak kapatýldý. Loop literatürde güvenilirliði kanýtlanmýþ olan Roeder’s loop’ un modifiye edilmesi ile yapýldý. Tüm olgularda ilk port batýna açýk yöntemle girildi. Ýstatistiksel deðerlendirme için SPSS 26,0 istatistik programý kullanýldý.
BULGULAR: Hastalarýn 31’i (%62) erkek, 19’u (%38) kadýn idi. Ortalama yaþ 32.2±11.9 olup yaþ aralýðý 19-74 idi. Hastalarýn ortalama yatýþ süresi 1.12±0.47 gündü. Olgulardan biri 21 haftalýk gebe idi. Ameliyat sonrasý dönemde bir hastada cerrahi alan enfeksiyonu meydana geldi. Antibiyoterapi ile düzelme saðlandý. Hiçbir olguda appendiks güdüðünden kaçak veya çekal fistül saptanmadý.
TARTIÞMA: Laparoskopik appendektominin maliyetinde en önemli parametrelerden biri güdüðün kapatýlma tekniðidir. Özellikle kýsýtlý imkanlara sahip devlet hastanelerinde maliyet daha fazla önem kazanmaktadýr. El yapýmý loop ile apendiks güdüðünün kapatýlmasý kolay, güvenli ve ucuz bir yöntemdir.