Abstract
Background
Appendiceal stump closure is a crucial step in laparoscopic appendectomy (LA). This study aims to evaluate the LigaSureTM Vessel Sealing System in laparoscopic appendectomy (LA) for sealing the base of the appendix in children.
Materials and methods
A prospective review of the author's clinical experience with appendiceal stump closure with the LigaSureTM (Medtronic Inc., Minneapolis, MN) in LA under 18 years old was performed from May 2021 to June 2022. Demographic information, surgical findings, oral feeding times, pathology results, hospital stay, and postoperative complications were evaluated retrospectively.
Results
In 31 patients, LA was performed using only LigaSureTM, and the appendix stump was sealed and cut by this device. Out of 31 patients (19 boys and 12 girls), no complications occured in 30 patients. The mean age of the patients and standard deviation (SD) were 12.64 ± 3.12 years. The mean postoperative hospital stay was 1.2 ± 0.4 days (1–2 days), except for two patients with postoperative abscess and fever.
Conclusion
This study demonstrated the efficacy of LA using LigaSureTM system, from the separation of the mesoappendix to stump closure.
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References
Minneci PC, Sulkowski JP, Nacion KM et al (2014) Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children. J Am Coll Surg 219:272–279. https://doi.org/10.1016/J.JAMCOLLSURG.2014.02.031
Mak GZ, Loeff DS (2016) Paradigm shifts in the treatment of appendicitis. Pediatr Ann 45:e235–e240. https://doi.org/10.3928/00904481-20160525-01
Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64. https://doi.org/10.1055/S-2007-1021466
Pogorelić Z, Domjanović J, Jukić M, Poklepović PT (2020) Acute appendicitis in children younger than five years of age: diagnostic challenge for pediatric surgeons. Surg Infect (Larchmt) 21:239–245. https://doi.org/10.1089/SUR.2019.175
Yau KK, Siu WT, Tang CN, Yang GPC, Li MKW (2007) Laparoscopic versus open appendectomy for complicated appendicitis. J Am Coll Surg 205:60–65. https://doi.org/10.1016/J.JAMCOLLSURG.2007.03.017
Lintula H, Kokki H, Vanamo K, Antila P, Eskelinen M (2002) Laparoscopy in children with complicated appendicitis. J Pediatr Surg 37:1317–1320. https://doi.org/10.1053/jpsu.2002.34998
Wei B, Qi CL, Chen TF et al (2011) Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis. Surg Endosc 25:1199–1208. https://doi.org/10.1007/S00464-010-1344-Z/FIGURES/5
Kapischke M, Pries A, Caliebe A (2013) Short term and long term results after open vs. laparoscopic appendectomy in childhood and adolescence: a subgroup analysis. BMC Pediatr 13:154. https://doi.org/10.1186/1471-2431-13-154
Wehrman WE, Tangren CM, Inge TH (2007) Cost analysis of ligature versus stapling techniques of laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech 17:371–374. https://doi.org/10.1089/LAP.2006.9996
Croce E, Olmi S (2000) Intracorporeal knot-tying and suturing techniques in laparoscopic surgery: technical details. JSLS 4:17–22
Pogorelić Z, Kostovski B, Jerončić A et al (2017) A comparison of endoloop ligatures and nonabsorbable polymeric clips for the closure of the appendicular stump during laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech A 27:645–650. https://doi.org/10.1089/lap.2016.0433
Pan H, Leung KKC, Ng EKW (2020) Tissue fusion technology versus suture and staple in porcine bowel anastomosis: an in vivo study. Brazilian J Med Biol Res 53:e9305. https://doi.org/10.1590/1414-431X20209305
Harrell AG, Kercher KW, Heniford BT (2004) Energy sources in laparoscopy. Semin Laparosc Surg 11:201–209. https://doi.org/10.1177/107155170401100310
Macario A, Dexter F, Sypal J, Cosgriff N, Heniford TB (2008) Operative time and other outcomes of the electrothermal bipolar vessel sealing system (LigaSure) versus other methods for surgical hemostasis: a meta-analysis. Surg Innov 15:284–291. https://doi.org/10.1177/1553350608324933
Khanna S, Khurana S, Vij S (2004) No clip, no ligature laparoscopic appendectomy. Surg Laparosc Endosc Percutaneous Tech 14:201–203. https://doi.org/10.1097/01.SLE.0000136657.27798.B8
Elemen L, Yazir Y, Akay A, Boyacioǧlu Z, Ceyran B, Ceylan S (2011) Comparison of bipolar electrosurgical devices with ligatures and endoclips in the rat appendicitis model. J Pediatr Surg 46:1923–1929. https://doi.org/10.1016/J.JPEDSURG.2011.04.062
Qaiser D, Srivastava A, Ranjan P, Kataria K (2017) Physics for surgeons part 3: why cyst is spherical in shape? Indian J Surg 79:143–147. https://doi.org/10.1007/s12262-016-1586-7
Smulders JF, De Hingh IHJT, Stavast J, Jackimowicz JJ (2007) Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device. Surg Endosc 21:2105–2109. https://doi.org/10.1007/S00464-007-9330-9
Gupta V, Chauhan SPS, Gupta M, Verma R, Singh SP, Panday A (2022) Efficacy and Safety of LigaSure in Laparoscopic Sutureless Appendectomy. Cureus 14:e24764. https://doi.org/10.7759/cureus.24764
Hamdy AA, Ayoup MFL, Elsayed AAI (2018) Loop knots versus harmonic scalpel in laparoscopic appendectomy. Egypt J Hosp Med 72:4109–4112. https://doi.org/10.21608/EJHM.2018.9125
Gupta V, Singh SP, Singh SP, Bansal M, Pandey A (2020) Sutureless appendectomy by using harmonic scalpel: is it possible? J Laparoendosc Adv Surg Tech A 30:429–432. https://doi.org/10.1089/LAP.2019.0782
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Study protocol was approved by the University Clinical Research Ethics Committee (2011-KAEK-27/2021-E.2100058095).
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Kurtuluş, Ş. Appendiceal stump closure using LigaSureTM alone in laparoscopic appendectomy in children: ıs it safe and feasible?. J Ped Endosc Surg 5, 67–71 (2023). https://doi.org/10.1007/s42804-023-00167-y
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DOI: https://doi.org/10.1007/s42804-023-00167-y