Hand Assisted versus Intracorporeal Ligation of Appendicular Base During Laparoscopic Appendicectomy

Abstract

Background: Laparoscopic appendicectomy is one of the most common operations in surgical practice. It can be performed by open and laparoscopic methods. Laparoscopic appendicectomy have the advantage of less pain time and early return to work. The current work aimed to evaluate the safety, and effectiveness of intracorneal ligation versus extraction of the appendicular base during laparoscopic appendectomy.

Patients and methods: This clinical trial involved 40 patients with acute appendicitis. They were selected from the surgery department, Al-Azhar Faculty of Medicine, Damietta, Egypt.  They were scheduled for laparoscopic appendectomy and randomized to one of two groups; the first (A) for intracorporeal ligation of the based and the second (B) for hand assisted ligation of the stump. The collected data included operative time, postoperative outcome (duration of stay, back to usual oral feeding and postoperative complications (e.g., wound infection or leakage)).    

Results: Male patients were slightly predominating in both groups. The hand assisted ligation of appendicular stump had significantly shorter operative time (34.4±3.05 vs 42.95±8.21 minutes respectively).  However, there was no significant differences in both groups regarding post operative complication, except significant increase of port-site infection in hand assisted than the intracorporeal group (45.0% vs 10.0%) which was mild and treated conservatively. No leakage was reported in both groups.

Conclusion: Hand assisted ligation of appendicular base during laparoscopic appendicectomy is safe and effective method with shorter operative time. It encourages the surgeon to do more complex procedures