Online ISSN: 2515-8260

Author : Amin, Mohammed Gamal Youssef ; Samir Ibrahim Mohammed; Islam Mohamed Ibrahim, Mohammad Farouk


Closure of Appendicular Stump in Laparoscopic Appendectomy by Ligation and Clipping Methods

Mohammed Gamal Youssef ; Samir Ibrahim Mohammed; Islam Mohamed Ibrahim, Mohammad Farouk Amin

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 466-476

Background: Laparoscopic appendectomy (LA) is now the standard of management
for cases of acute appendicitis. LA has the benefits of minimal access surgery.
There are many methods for securing the base of the appendix, some of which are
expensive others are not available or technically demanding. This study is aimed to
compare between ligation and clipping techniques regarding fesibility , safety ,
efficacy, operative time , postoperative outcome and complications. Patients and
methods: A randomized prospective clinical trial study included 90 patients with
acute appendicitis. The patients were randomly distributed into 2 main groups
(A&B): 54 patients we secured the base of the appendix by ligation methods (group
A) and in 36 patients by clip application (group B). All patients were subjected to
classic history taking and clinical examination. Radiological investigation:
ultrasonography was routinely done for all patients. CT with contrast was requested
when indicated in suspicion of complications. Surgical ligation or clipping were
performed. Results: There is statistically non-significant difference between
patients underwent different surgical techniques as regarding application of
peritoneal drainor conversion to open. Two patients within ligation group (A) had
been converted to open due to presence of friable base in one case and intraoperative
bleeding in other case while three patients within clipping group (B) had
been converted to open due to intestinal injury, friable base and intra-operative
bleeding .Two cases in clipping group (B) had been converted to ligation techniques
due to very wide base which can't be secured by clip application. Conclusion:
Ligation and clipping techniques were effective, safe ,feasible and same in
complications rate. Clip application is related to less operative time , easier
application and simpler for trainee than ligation techniques which require
more experiences.