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Role of Laparoscopic Appendectomy Radix Ligation Techniques on the Formation of Inner Abdomen Abscess
Ömer Avlanmış1, Rıza Gürhan Işıl2, Adnan Nadir Hacim1
1Department of General Surgery, Camlica Erdem Hospital, Istanbul, Turkey.
Objectives:
Our aim was to study whether laparoscopic appendectomy radix ligation techniques were eutrophic in the development of intra-abdominal abscess.
Methods:
Between September 2009 and April 2017, all emergency cases admitted to our surgery polyclinic were reviewed, and the results of the patients who underwent laparoscopic appendectomy were collected. Appendectomy radix ligation techniques were reviewed from surgical notes on discharge reports. Postoperative controls were also reviewed, and any cases with abscess formation were reported.
Results:
A total of 350 patients were included in the study. Of these cases, 207 were males, and 143 were females. The mean age of the patients was 26.89±4.9 years. One hundred eighty-nine cases were found to have two endoloops placed on top of each other, whereas 161 cases had a 2 mm distance left in between the two endoloops and tied. None of the 189 cases who had endoloops placed on top of each other developed abscess formation. However, of the 161 cases who had endoloops with a 2 mm distance in between, 8 reported with abscess formation in the inner abdomen. Of these eight cases, seven had percutaneous abscess drainage by an interventional radiologist, whereas one was treated with relaparoscopy.
Conclusion:
In the present study, patients who had endoloops placed on top of each other developed no abscess formation, whereas in the literature's gold standard procedure, those with a 2 mm distance left between two endoloops developed an inner abdominal abscess formation in 8 (4.9%) of the patients. We believe that this 2 mm dead space distance left between the two endoloops contributes to the formation of the abscess.
Insights
Placing endoloops directly on top of each other during laparoscopic appendectomy significantly reduced intra-abdominal abscess formation compared to the standard 2 mm gap technique. This finding suggests a safer ligation method for appendectomy radix.
Area of Science:
- Surgical Innovation
- Gastrointestinal Surgery
- Minimally Invasive Procedures
Background:
- Intra-abdominal abscesses are a potential complication following appendectomy.
- Laparoscopic appendectomy is a common surgical procedure.
- Radix ligation techniques aim to prevent complications like abscess formation.
Purpose of the Study:
- To evaluate the efficacy of different laparoscopic appendectomy radix ligation techniques in preventing intra-abdominal abscesses.
- To compare the incidence of abscess formation between two distinct endoloop placement methods.
Main Methods:
- Retrospective review of 350 emergency laparoscopic appendectomy cases (September 2009 - April 2017).
- Analysis of appendectomy radix ligation techniques based on surgical notes.
- Comparison of abscess formation rates between endoloops placed directly atop each other versus those with a 2 mm separation.
Main Results:
- No abscesses occurred in 189 patients with directly superimposed endoloops.
- Eight of 161 patients (4.9%) with a 2 mm endoloop gap developed intra-abdominal abscesses.
- Abscesses in the 2 mm gap group required percutaneous drainage (7 cases) or relaparoscopy (1 case).
Conclusions:
- Directly superimposed endoloops for appendectomy radix ligation appear to be a safer technique, significantly reducing intra-abdominal abscess formation.
- The 2 mm 'dead space' created by the standard technique may contribute to abscess development.
- This study suggests a modification to the standard ligation technique to improve patient outcomes.
