COMPARISSION OF EFFICACY BETWEEN NON ABSORBABLE POLYMER CLIPS AND ENDOLOOP LIGATION FOR APPENDICULAR STUMP CLOSURE DURING LAPAROSCOPIC APPENDICECTOMY

Abstract

BACKGROUND: Inflammation of vermiform appendix is the hallmark of appendicitis, which usually manifests acutely within 24 hours. It is among the most dangerous surgical conditions that needs to be treated right away. Two commonly used approaches of appendectomy are laparoscopic approach and open approach. The laparoscopic method is the method of choice for appendectomy procedures. The crucial manoeuvre is to ligate the appendix's base because improper closure could result in problems. In this study, we examine the relative effectiveness of endoloop ligation and a non absorbable polymer clip in closing stump of appendix during laparoscopic appendicectomy. METHODOLOGY : A prospective comparative randomised control trial , where the patients admitted in RL Jalappa Hospital for laparoscopic appendicectomy was included. The period of study was from September 2022 to April 2024. The subjects were divided into two groups, where non absorbable polymer clips were used in the group A and endoloop ligature were used in the group B. The outcomes like, cost effectiveness were noted and the patients were regularly followed up for any post op complications like intra abdominal abcess , post operative pain and Surgical site infection.Time taken to apply non absorbable polymer clips / endoloop ligatures were noted and questionnaire was given to the surgeons performing the surgery to know how convineient each technique was. xvii RESULTS : The surgeons were asked to score the ease of each technique from 1--3 , 1 being hard , 2 being moderately hard and 5 being very easy.The average score for applying non absorbable polymer clip was , and the average score for applying endoloop ligature was . The P value for this comparison was , indicating there is no much significant difference in ease of technique. The second entity of comparison between these 2 techniques was time taken to apply non absorbable polymer clip and endoloop ligature. Applying an endoloop ligature took an average of 5.16 minutes, while applying a non--absorbable polymer clip took 4.63 minutes.The average time taken to apply each approach varied significantly, as indicated by the P value of less than 0.05 for this comparison. The cost--effectiveness served as the third comparison entity. Two non--absorbing polymer clips were utilized in group A to ligate the closure of the appendicular stump. Each clip costed about 700 rupees, summing up 1400 rupees for each patient. In group B, 2 knots were made using polyglactin ( vicryl 2--0 rb ) ,each costing 800 rupees , summing up 1600 rupees per patient . The P value was zero, indicating that there is no discernible difference in the average cost between both the groups because the cost remained the same for every patient in each group.The 4th entity for the comparison was post operative complications. The patients were kept under observation for intra--abdominal abscesses, surgical site infections, fecal fistula, wound dehiscence and post--operative discomfort. The post operative pain was assessed using the VAS score.The average post operative pain score in group A where non absorbable polymer clips were used was 2 , and the average post operative pain score in group B , where endoloop ligature were used was 3 . The average pain score after surgery did not differ significantly, as indicated by the P value of 1 for the comparison mentioned above. Three of the thirty--three patients in group A, where non--absorbable polymer clips were used, experienced surgical site infections, and five of the thirty--three patients in group B, where endoloop ligatures were utilized, experienced the same outcome. xviii Wound dehiscence was noted in one case where endoloop ligature was used and no cases of wound dehiscence was observed in non absorbable polymer clips group. There were no incidences of fecal fistula in both the groups. There was no significant difference in post operative hospital stay also. CONCLUSION: The amount of time required to apply the non--absorbable polymer clip was significantly less than that required to apply the endoloop ligature, which contributed to a shorter intraoperative stay.Use of non--absorbable polymer clips can be considered inlaparoscopic appendicectomy , to effectively reduce the intra operative time period.