Laparoscopic One-handed Knot Tying Technique of the Appendicular Stump

D Gomez, MD, F Arias, MD, G Herrera, MD, A Quintero, MD, N Cortes, MD, G Garcia, MD, L Rojas, MD, C Rodriguez, MD. Fundacion Hospital San Carlos.

Introduction: Laparoscopic appendectomy has gained acceptance over the past years. A critical step of this procedure is the closure of the appendicular stump which varies greatly and includes techniques such as mechanical suture, preformed knot and a polymeric clip. The objective is to describe the management of the appendicular stump by one-handed knot tying technique at a third-world country hospital.

Materials and Methods: 48 patients underwent laparoscopic appendectomy using one-handed knot tying technique for the appendicular stump at a public hospital in Colombia (February 2013 – September 2013). All procedures were carried out by one of the authors. Records were reviewed for demographic data, operative time, intraoperative findings, length of hospital stay and postoperative complications.

Results: All procedures were carried out successfully. The mean operative time was 62.6 minutes, with an average in hospital stay of 26.3 hours. There were no conversions. A total of 11 (22.9%) patients were left with a drain. Superficial surgical site infection occurred in 2 (4.1%) cases. We registered no major complications such as stump leak, bowel obstruction or re-intervention

Conclusions: Laparoscopic one-handed knot tying technique can be safely applied for the closure of the appendicular stump. Additionally it is a cost-effective method, which is particularly important in developing countries.


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