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Surg Endosc. 2020 Feb;34(2):779-786. doi: 10.1007/s00464-019-06828-5. Epub 2019 May 13.

Re-evaluation of purse string suture in laparoscopic appendectomy.

Shadhu K1,2, Ramlagun D1,2, Wang Y1,2, Ping X3,4, Chen T1,5, Zhu Y6,7, Xu Z1,2.

Author information

1
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China.
2
Division of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China.
3
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China. pingxiaochun@jsph.org.cn.
4
Division of Gastric Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China. pingxiaochun@jsph.org.cn.
5
Division of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China.
6
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China. yanhui1002@hotmail.com.
7
Division of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University & Jiangsu Province Hospital, Guangzhou Road, 300, Gulou District, Nanjing, 210029, Jiangsu, People's Republic of China. yanhui1002@hotmail.com.

Abstract

PURPOSE:

The aim of this study was to compare the outcomes of laparoscopic appendectomy (LA) using purse string invaginating sutures (PS) with those using intracorporeal knotting (IK) or Hem-o-lock polymeric clips (HL).

METHODS:

A total of 882 patients who underwent laparoscopic appendectomy from January 2015 to December 2017 were studied retrospectively. Of these, 538 patients used PS, 229 patients used IK and 115 patients used HL to close the appendiceal stump. Their demographic characteristics, intraoperative findings and postoperative complications were analysed retrospectively.

RESULTS:

There were similar percentages of complicated cases in all the groups (21.7% in PS vs. 21.4% in IK vs. 24.3% in HL, p = 0.803). The mean length of hospital stay was shorter in PS group when compared to IK or HL group (3.72 + 2.35 in PS vs. 4.41 + 2.40 in IK, 4.43 + 2.66 in HL, p < 0.05) as well as lower ASA scores (1.7 + 0.6 in PS vs. 1.8 + 0.6 in IK vs. 1.7 + 0.6 in HL, p < 0.05). The overall complication rates for the PS, the HL and the IK groups were 12.1, 8.7 and 9.2%, respectively. The rate of wound infection was higher in PS group for uncomplicated appendicitis (5.0% in PS vs. 2.8% in IK and 1.1% in HL, p = 0.129). Furthermore, there were no differences in the rate of intra-abdominal infection among the groups in both uncomplicated and complicated cases.

CONCLUSIONS:

Based on our results, purse string suture failed to demonstrate better postoperative outcome in laparoscopic appendectomy and is no longer recommended by our institution as initial approach.

KEYWORDS:

Acute appendicitis; Hem-o-lock polymeric clips; Intracorporeal knotting; Laparoscopic appendectomy; Purse string invaginating sutures

PMID:
31087172
DOI:
10.1007/s00464-019-06828-5

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