Comparative Study Between Appendiceal Base Ligation with Hand-Made Endoloop Knot Pusher Versus Standard Endoloop in Laparoscopic Appendectomy

Abstract
Background: Using hand-made (endoloop and knot pusher) technique has the same reliability of the other methods in appendiceal base ligation in addition to the significant lower cost in comparison with standard endoloop.
Aim of Study: Is to compare between appendiceal base ligation with hand-made Endoloop knot pusher versus standard endoloop in laparoscopic appendectomy.
Patients and Methods: This prospective randomized comparative study was carried out in Gastrointestinal, Liver & Laparoscopic Surgery unit of Tanta University Hospitals from May 2017 till May 2018 on 40 patients with acute appendicitis divided into two equal groups; Group I: Were subjected to ligation of the base of the appendix with standard endoloop (commercial) in laparoscopic appendectomy (20 cases). Group II: Were subjected to ligation of the base of the appendix with hand-made endoloop knot pusher in laparoscopic appendectomy (20 cases).
Results: The mean age of group I was 29±5.10 years, compared to 29.33±5.39 in-group II, there were 12 males and 8 females in group I, while there were 10 males and 10 females in group II. Statistically significant difference was present in operative time between both groups; group I had operative time mean of 46.07±11.70 minutes compared to 54.73±11.33 minutes in-group II. A highly statistically significant difference in appendiceal base ligation cost between both groups; group I with Mean 69.10±10.41 USD compared to 7.75±1.77 USD in group II. Superficial wound infection developed in one patient in group I and two patients in group II, also each group had only one patient with postoperative ileus, only one patient in group II developed postoperative abscess in the RIF.
Conclusion: Using hand-made endoloop knot pusher technique and standard endoloop were proved safe, as both were not associated with major morbidity. Complications rate, hospital stay were average with other studies, Using hand-made endoloop knot pusher technique has significant lower cost in comparison with standard endoloop as it is reusable. However, hand-made endoloop knot pusher technique consuming a longer operative time.