Comparison between the use of Titanium Clips and Monopolar Diathermy for Closure of the Mesoappendix in Laproscopic Appendectomy in terms of Operative Time and Cost

Shahzad Akhtar; Tariq Mukhtar  Farrani; Mukarram  Hussain; Muhammad  Yousaf; Ghazanfar  Jabbar; Talha  Makshoof

doi:10.51253/pafmj.v74i3.9852

Authors

Shahzad Akhtar Department of Surgery, Combined Military Hospital Nowshera/National University of Medical Sciences (NUMS) Pakistan
Tariq Mukhtar Farrani Department of Surgery, Combined Military Hospital Nowshera/National University of Medical Sciences (NUMS) Pakistan
Mukarram Hussain Department of Surgery, Combined Military Hospital /National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Yousaf Department of Surgery, Combined Military Hospital Panu Aqil/National University of Medical Sciences (NUMS) Pakistan
Ghazanfar Jabbar Department of Surgery, Combined Military Hospital Chhor/National University of Medical Sciences (NUMS) Pakistan
Talha Makshoof Department of Surgery, Pakistan Air Force Masroor Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i3.9852

Keywords:

Cost, Laparoscopic Appendectomy, Operative Time

Abstract

Objective: To compare the use of Titanium clips and Monopolar diathermy for laparoscopic appendectomy mesoappendix closure in terms of operative time and cost.

Study Design: Quasi-experiment study.

Place and Duration of Study: Department of Surgery, Combined Military Hospital, Nowshera Pakistan, from Jul 2021 to Jun 2022.

Methodology: A total of 70 patients who were diagnosed with acute appendicitis and were admitted for laparoscopic appendectomy were randomly divided into two groups via the lottery method. In Group-A, the closure of the mesoappendix was done using Titanium clips, and in Group-B, the ligation of the mesoappendix was done using Monopolar diathermy. Patient outcomes in terms of operative time and procedure cost were assessed.

Results: Out of 70 patients, 49(70.0%) were males and 21(30.0%) were females, aged 18 to 60 years, with a mean age of 37.57±7.71 years. The overall mean weight of the patients was 65.29±12.14 kg; height was 1.71±0.12 metres; and BMI was 24.96±5.23 kg/m2, respectively. Prolonged operative time was observed in 16(45.71%) patients in Group-A, compared to 7(20.0%) in Group-B (p-value 0.022). In Group-A, the total cost of the operation was Rs. 32,000, whereas in Group-B, it was Rs. 30,000 (p-value=0.001).

Conclusion: This study concluded that Monopolar diathermy for the closure of the mesoappendix is better in terms of operating time and cost as compared to the use of Titanium clips.

Downloads

Download data is not yet available.

References

Zewdu D, Wondwosen M, Tantu T, Tilahun T, Teshome T, Hamu A. Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study. Ann Med Surg 2022; 80: 104194.

https://doi.org/10.1016%2Fj.amsu.2022.104194

Pata F, Di Martino M, Podda M, Di Saverio S, Ielpo B, Pellino G; ACIE Appy Study Collaborative. Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study. World J Surg 2022; 46(9): 2021-2035. https://doi.org/10.1007/s00268-022-06649-z

Erratum in: World J Surg 2023; 47(1): 285.

Ferris M, Quan S, Kaplan B, Molodecky N, Ball C, Chernoff G, et al. The Global Incidence of Appendicitis: A Systematic Review of Population-based Studies. Ann Surg 2017; 266(2): 237-241.

https://doi.org/10.1097/SLA.0000000000002188

Danwang C, Bigna JJ, Tochie JN, Mbonda A, Mbanga CM, Nzalie RN, et al. Global incidence of surgical site infection after appendectomy: a systematic review and meta-analysis. BMJ Open 2020; 10(2): e034266. https://doi.org/10.1136/bmjopen-2019-034266

Kotaluoto S, Ukkonen M, Pauniaho SL, Helminen M, Sand J, Rantanen T. Mortality Related to Appendectomy; a Population Based Analysis over Two Decades in Finland. World J Surg 2017; 41(1): 64-69.

https://doi.org/10.1007/s00268-016-3688-6

Yeşiltaş M, Alemdar A. While the Laparoscopic Appendectomy Is the Gold Standard in the Treatment of Acute Appendicitis, What Should Be the Preference for Closure of the Appendix Stump? Duzce Med J 2022; 24(2): 147-151.

Samuels E, Shakirat OO. History of Minimal Access Surgery (MAS). In Gynaecological Endoscopic Surgery: Basic Concepts. Cham: Springer International Publishing, 2022.

Milev I, Stefanovska VV, Mitevski A, Karagjozov P, Mihailov M. The predictive role of selective laboratory parameters for the occurance of “unwanted events” in adults with laparoscopic appendectomy. J Morphol Sci 2022; 5(1): 64-74.

https://doi.org/10.55302/JMS2251064m

Lloyd AJ, Abd Elwahab SM, Boland MR, Elfadul A, Hill ADK, Power C. Acute complicated appendicitis caused by an ingested toothpick - A case report. Int J Surg Case Rep 2022; 92: 106872. https://doi.org/10.1016/j.ijscr.2022.106872

Duza G, Davrieux CF, Palermo M, Khiangte E, Azfar M, Rizvi SA, et al. Conventional Laparoscopic Appendectomy Versus Single-Port Laparoscopic Appendectomy, a Multicenter Randomized Control Trial: A Feasible and Safe Alternative to Standard Laparoscopy. J Laparoendosc Adv Surg Tech A 2019; 29(12): 1577-1584. https://doi.org/10.1089/lap.2019.0460

Gomes CA, Junior CS, de Peixoto RO, Netto JM, Gomes CC, Gomes FC. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World J Emerg Surg 2013; 8(1): 35. https://doi.org/10.1186/1749-7922-8-35

Makaram N, Knight SR, Ibrahim A, Patil P, Wilson MSJ. Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature. Ann Med Surg 2020; 57: 228-235. https://doi.org/10.1016/j.amsu.2020.07.058

Al-Temimi MH, Berglin MA, Kim EG, Tessier DJ, Johna SD. Endostapler versus Hem-O-Lok clip to secure the appendiceal stump and mesoappendix during laparoscopic appendectomy. Am J Surg. 2017; 214(6): 1143-1148.

https://doi.org/10.1016/j.amjsurg.2017.08.031

Rickert A, Bönninghoff R, Post S, Walz M, Runkel N, Kienle P. Appendix stump closure with titanium clips in laparoscopic appendectomy. Langenbecks Arch Surg 2012; 397(2): 327-331. https://doi.org/10.1007/s00423-011-0869-5

Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg 2015; 31(4): 229-231.

https://doi.org/10.5152/UCD.2015.2768

Akıncı O, Abdulrahman SMFA, Güngör Ö. Mini-incision open appendectomy versus laparoscopic appendectomy: An experience in a rural hospital. Ulus Travma Acil Cerrahi Derg 2021; 27(3): 310-314.

https://doi.org/10.14744/tjtes.2020.83023

Reinke CE, Tabone LE, Fong P, Yoo JS, Park CW. Safety and Efficacy of Polymeric Clips for Appendiceal Stump Closure. JSLS 2016; 20(3): e2016.00045.

https://doi.org/10.4293/JSLS.2016.00045

Durán Muñoz-Cruzado V, Anguiano-Diaz G, Tallón Aguilar L, Tinoco González J, Sánchez Arteaga A, Aparicio Sánchez D, et al. Is the use of endoloops safe and efficient for the closure of the appendicular stump in complicated and uncomplicated acute appendicitis? Langenbeck Arch Sur 2021; 406(5): 1581-1589.

Al-Shalah MA. Comparative study of laparoscopic appendectomies with application of different techniques for closure of the appendicular mesoappendix and stump. J Uni Babylon Pure Appl Sci 2018; 26(3): 196-206.

Khalid S, Nawaz T, Anwar MI. Laparoscopic Appendicectomy: Comparison of Monopolar Cautery and Harmonic Scalpel in Ligation of Mesoappendix. J Rawalpindi Med Coll 2018: 337-341.