Hand-Made Silk Loop Versus Hem-O-Lok Clip in Single Port Laparoscopic Appendectomy: A Randomized Controlled Trial
Keywords:
Acute appendicitis, Appendicular stump, Hand-made silk loop, Hem-o-lok, Single port laparoscopic appendectomyAbstract
Background: Instruments used for closing the appendicular stump contribute to the high cost of laparoscopic appendectomy. In the present study a hand-made Roeder loop made of 3-0 silk to be placed on the appendicular stump and tightened by a plastic tube was created to reduce operative costs.
Objective: The objective of the present study was to compare the operative time in single port laparoscopic appendectomy, when using hand-made silk loop and when using hem-o-lok clip, a commercial instrument, in the closure of the appendicular stump in patients diagnosed with acute appendicitis.
Methods: Patients who were diagnosed as having uncomplicated acute appendicitis at Hatyai Hospital in Songkhla, Thailand were enrolled from January 2018 to September 2019. The primary outcome was operative time. Patients were randomized to either the hand-made silk loop group or the hem-o-lok clip group. Data collected included age, gender, body mass index, operative time, pathological report, operative cost, pain score at 4, 8, 12, and 24 hours after operation, hospital stay, and 30-day postoperative complications.
Results: Thirty-eight patients were included in the study. There were no significant differences between the two groups in terms of age, gender, body mass index, and American Society of Anesthesiologists classification. The mean operative time ± SD was 41.4 ± 14.8 minutes in the hand-made silk loop group and 50.2 ± 19.8 minutes in the hem-o-lok clip group, which were not significantly different (p = 0.14). The cost of 3 hand-made silk loops used for each operation was 17 baht, and for the 3 hem-o-lok clips was 795 baht. The pain score at 4, 8, 12, and 24 hours, and hospital stay, were similar in both groups. No 30-day postoperative complication was observed in both groups.
Conclusion: The use of hand-made silk loop to close the appendicular stump in single port laparoscopic appendectomy resulted in a similar operative time as that with the use of hem-o-lok clip. Hand-made silk loop is safe, simple and effective for the closure of appendicular stump, and may help reduce operative cost.
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