The Usage of Intracorporeal Knotting Instead of Endoloops during Laparoscopic Appendectomy

Author(s): Mahmoud Sallam, Jimmy Mena

Laparoscopic appendectomy is currently a widely used surgical treatment for acute appendicitis. Compared to open access, laparoscopy offers several advantages, such as less postoperative pain, shorter hospital stay, faster recovery and lower incidence of wound infection. Although laparoscopy is associated with prolonged surgical and high operative costs, it is more effective and cost-effective than open surgery for uncomplicated appendicitis in experienced hands. However, it remains the first choice for surgical treatment and is indicated specifically for obese patients, the elderly, and patients with underlying medical conditions. Due to the range of techniques available, appendicular stump closure has been the subject of several studies: endo-loop ligatures (pre-defined suture loops (including endo-loops) and intracorporeal tie stitches). There are two important factors to decide which approach to take: patient safety and financial costs. The first component includes prolonged anaesthetic effects due to longer operating times, repeated closures and damage for improper closure (eg, loop failure), extended hospital stay, and cost reduction.