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Erschienen in: Pediatric Surgery International 5/2010

01.05.2010 | Original Article

LigaSure™ compared with ligatures and endoclips in experimental appendectomy: how safe is it?

verfasst von: Levent Elemen, Yusufhan Yazir, Melih Tugay, Alper Akay, Seval Aydin, Karolin Yanar, Süreyya Ceylan

Erschienen in: Pediatric Surgery International | Ausgabe 5/2010

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Abstract

Purpose

The present study aims to compare strength, healing, and inflammation of appendiceal stumps closed by LigaSure Precise™ (Valleylab, Boulder, CO, USA) device, ligatures using polyglactin 910 (Vicryl, Ethicon, Edinburgh, UK) and endoclips (Ligaclip ERCA, Ethicon, OH, USA), and operation time (OT) in experimental appendectomy.

Methods

Forty-eight Sprague–Dawley rats were divided into two (Group A and B). Each group was further subdivided into three subgroups (AS, AC, AL, BS, BC, BL) containing eight rats. Appendectomy was performed and stump was closed by ligatures in S, by endoclips in C and by LigaSure™ in L subgroups. OT was recorded. In Group A, cecum bursting pressures (BP) were determined instantly after the operation. In Group B, BP, histological evaluations, and measurements of collagen contents estimated by the tissue hydroxyproline (HPL) level were made on the seventh postoperative day. Statistical analyses were performed with Kruskal–Wallis test and Mann–Whitney U test. P value was considered significant at less than 0.05.

Results

BPs of subgroups were comparable on postoperative immediate period and day 7. HPLs and OTs were significantly better in L subgroups. BL had the least inflammation.

Conclusion

Better healing, less inflammation, shorter OT, and equal strength achieved with LigaSure™ device comparing with polyglactin 910 ties and endoclips in experimental appendectomy is encouraging.
Literatur
1.
Zurück zum Zitat Dunn JCY (2006) Appendicitis. In: Grosfeld JL, O’ Neill JA, Fonkalsrud EW et al (eds) Pediatric Surgery, 6th edn. Mosby, Philadelphia, pp 1501–1513 Dunn JCY (2006) Appendicitis. In: Grosfeld JL, O’ Neill JA, Fonkalsrud EW et al (eds) Pediatric Surgery, 6th edn. Mosby, Philadelphia, pp 1501–1513
2.
Zurück zum Zitat Wehrman WE, Tangren CM, Inge TH (2007) Cost analysis of ligature versus stapling techniques of laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech A 17:371–374CrossRefPubMed Wehrman WE, Tangren CM, Inge TH (2007) Cost analysis of ligature versus stapling techniques of laparoscopic appendectomy in children. J Laparoendosc Adv Surg Tech A 17:371–374CrossRefPubMed
4.
Zurück zum Zitat Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11:59–62PubMed Hanssen A, Plotnikov S, Dubois R (2007) Laparoscopic appendectomy using a polymeric clip to close the appendicular stump. JSLS 11:59–62PubMed
5.
Zurück zum Zitat Sajid MS, Rimple J, Cheek E, Baig MK (2009) Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 19:11–15CrossRefPubMed Sajid MS, Rimple J, Cheek E, Baig MK (2009) Use of endo-GIA versus endo-loop for securing the appendicular stump in laparoscopic appendicectomy: a systematic review. Surg Laparosc Endosc Percutan Tech 19:11–15CrossRefPubMed
6.
Zurück zum Zitat Smulders JF, de Hingh IH, Stavast J, Jackimowicz JJ (2007) Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device. Surg Endosc 21:2105–2109 Smulders JF, de Hingh IH, Stavast J, Jackimowicz JJ (2007) Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device. Surg Endosc 21:2105–2109
7.
Zurück zum Zitat Shamiyeh A, Vattay P, Tulipan L, Schrenk P, Bogner S, Danis J, Wayand W (2004) Closure of the cystic duct during laparoscopic cholecystectomy with a new feedback-controlled bipolar sealing system in case of biliary obstruction–an experimental study in pigs. Hepatogastroenterology 51:931–933PubMed Shamiyeh A, Vattay P, Tulipan L, Schrenk P, Bogner S, Danis J, Wayand W (2004) Closure of the cystic duct during laparoscopic cholecystectomy with a new feedback-controlled bipolar sealing system in case of biliary obstruction–an experimental study in pigs. Hepatogastroenterology 51:931–933PubMed
8.
Zurück zum Zitat Matthews BD, Pratt BL, Backus CL, Kercher KW, Mostafa G, Lentzner A, Lipford EH, Sing RF, Heniford BT (2001) Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 67:901–906PubMed Matthews BD, Pratt BL, Backus CL, Kercher KW, Mostafa G, Lentzner A, Lipford EH, Sing RF, Heniford BT (2001) Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis. Am Surg 67:901–906PubMed
9.
Zurück zum Zitat Schulze S, Krisitiansen VB, Fischer Hansen B, Rosenberg J (2002) Sealing of cystic duct with bipolar electrocoagulation. Surg Endosc 16:342–344CrossRefPubMed Schulze S, Krisitiansen VB, Fischer Hansen B, Rosenberg J (2002) Sealing of cystic duct with bipolar electrocoagulation. Surg Endosc 16:342–344CrossRefPubMed
10.
Zurück zum Zitat Sorgato N, Bernante P, Pelizzo MR (2008) Application of the LigaSure tissue sealing system to intestinal resection. Experimental and clinical trial. Ann Ital Chir 79:383–388PubMed Sorgato N, Bernante P, Pelizzo MR (2008) Application of the LigaSure tissue sealing system to intestinal resection. Experimental and clinical trial. Ann Ital Chir 79:383–388PubMed
11.
Zurück zum Zitat Cihan A, Armutcu F, Ucan BH, Acun Z, Numanoglu VK, Gürel A, Ulukent SC (2003) Comparison of the measurement methods of bursting pressure of intestinal anastomoses. Hepatogastroenterology 50(Suppl 2):ccxxxii–ccxxxiv Cihan A, Armutcu F, Ucan BH, Acun Z, Numanoglu VK, Gürel A, Ulukent SC (2003) Comparison of the measurement methods of bursting pressure of intestinal anastomoses. Hepatogastroenterology 50(Suppl 2):ccxxxii–ccxxxiv
12.
13.
Zurück zum Zitat Biert J, Seifert WF, Verhofstad AA, Wobbes T, de Man BM, Hoogenhout J, Hendriks T (1998) A semiquantitative histological analysis of repair of anastomoses in the rat colon after combined preoperative irradiation and local hyperthermia. Radiat Res 149:372–377CrossRefPubMed Biert J, Seifert WF, Verhofstad AA, Wobbes T, de Man BM, Hoogenhout J, Hendriks T (1998) A semiquantitative histological analysis of repair of anastomoses in the rat colon after combined preoperative irradiation and local hyperthermia. Radiat Res 149:372–377CrossRefPubMed
14.
Zurück zum Zitat Verhofstad MH, Lange WP, van der Laak JA, Verhofstad AA, Hendriks T (2001) Microscopic analysis of anastomotic healing in the intestine of normal and diabetic rats. Dis Colon Rectum 44:423–431CrossRefPubMed Verhofstad MH, Lange WP, van der Laak JA, Verhofstad AA, Hendriks T (2001) Microscopic analysis of anastomotic healing in the intestine of normal and diabetic rats. Dis Colon Rectum 44:423–431CrossRefPubMed
15.
Zurück zum Zitat Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16:34–40CrossRefPubMed Morrow SE, Newman KD (2007) Current management of appendicitis. Semin Pediatr Surg 16:34–40CrossRefPubMed
16.
Zurück zum Zitat Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A et al (2007) Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 31:750–755CrossRefPubMed Esposito C, Borzi P, Valla JS, Mekki M, Nouri A, Becmeur F, Allal H, Settimi A et al (2007) Laparoscopic versus open appendectomy in children: a retrospective comparative study of 2,332 cases. World J Surg 31:750–755CrossRefPubMed
17.
Zurück zum Zitat Aslan A, Karaveli C, Elpek O (2008) Laparoscopic appendectomy without clip or ligature. An experimental study. Surg Endosc 22:2084–2087CrossRefPubMed Aslan A, Karaveli C, Elpek O (2008) Laparoscopic appendectomy without clip or ligature. An experimental study. Surg Endosc 22:2084–2087CrossRefPubMed
18.
Zurück zum Zitat Little DC, Custer MD, May BH, Blalock SE, Cooney DR (2002) Laparoscopic appendectomy: an unnecessary and expensive procedure in children? J Pediatr Surg 37:310–317CrossRefPubMed Little DC, Custer MD, May BH, Blalock SE, Cooney DR (2002) Laparoscopic appendectomy: an unnecessary and expensive procedure in children? J Pediatr Surg 37:310–317CrossRefPubMed
19.
Zurück zum Zitat Yang HR, Wang YC, Chung PK, Jeng LB, Chen RJ (2005) Laparoscopic appendectomy using the LigaSure Vessel Sealing System. J Laparoendosc Adv Surg Tech A 15:353–356CrossRefPubMed Yang HR, Wang YC, Chung PK, Jeng LB, Chen RJ (2005) Laparoscopic appendectomy using the LigaSure Vessel Sealing System. J Laparoendosc Adv Surg Tech A 15:353–356CrossRefPubMed
20.
Zurück zum Zitat Olguner M, Akgür FM, Uçan B, Aktuğ T (1998) Laparoscopic appendectomy in children performed using single endoscopic GIA stapler for both mesoappendix and base of appendix. J Pediatr Surg 33:1347–1349CrossRefPubMed Olguner M, Akgür FM, Uçan B, Aktuğ T (1998) Laparoscopic appendectomy in children performed using single endoscopic GIA stapler for both mesoappendix and base of appendix. J Pediatr Surg 33:1347–1349CrossRefPubMed
21.
Zurück zum Zitat Kazemier G, in’t Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20:1473–1476CrossRefPubMed Kazemier G, in’t Hof KH, Saad S, Bonjer HJ, Sauerland S (2006) Securing the appendiceal stump in laparoscopic appendectomy: evidence for routine stapling? Surg Endosc 20:1473–1476CrossRefPubMed
22.
Zurück zum Zitat Khanna S, Khurana S, Vij S (2004) No clip, no ligature laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 14:201–203CrossRefPubMed Khanna S, Khurana S, Vij S (2004) No clip, no ligature laparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 14:201–203CrossRefPubMed
23.
Zurück zum Zitat Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393CrossRefPubMed Beldi G, Vorburger SA, Bruegger LE, Kocher T, Inderbitzin D, Candinas D (2006) Analysis of stapling versus endoloops in appendiceal stump closure. Br J Surg 93:1390–1393CrossRefPubMed
24.
Zurück zum Zitat Klima S (1998) Importance of appendix stump management in laparoscopic appendectomy. Zentralbl Chir 123:90–93PubMed Klima S (1998) Importance of appendix stump management in laparoscopic appendectomy. Zentralbl Chir 123:90–93PubMed
25.
Zurück zum Zitat Cristalli BG, Izard V, Jacob D, Levardon M (1991) Laparoscopic appendectomy using a clip applier. Surg Endosc 5:176–178CrossRefPubMed Cristalli BG, Izard V, Jacob D, Levardon M (1991) Laparoscopic appendectomy using a clip applier. Surg Endosc 5:176–178CrossRefPubMed
26.
Zurück zum Zitat Antal A, Pósa I, Kovács Z, Nagy G (2007) Simplified economical laparoscopic appendectomy. Magy Seb 60:87–89PubMed Antal A, Pósa I, Kovács Z, Nagy G (2007) Simplified economical laparoscopic appendectomy. Magy Seb 60:87–89PubMed
27.
Zurück zum Zitat Ballantyne GH (1983) Intestinal suturing. Review of the experimental foundations for traditional doctrines. Dis Colon Rectum 26:836–843CrossRefPubMed Ballantyne GH (1983) Intestinal suturing. Review of the experimental foundations for traditional doctrines. Dis Colon Rectum 26:836–843CrossRefPubMed
28.
Zurück zum Zitat Shomaf M (2003) Histopathology of human intestinal anastomosis. East Mediterr Health J 9:413–421PubMed Shomaf M (2003) Histopathology of human intestinal anastomosis. East Mediterr Health J 9:413–421PubMed
29.
Zurück zum Zitat Knighton DR, Hunt TK, Thakral KK, Goodson WH 3rd (1982) Role of platelets and fibrin in the healing sequence: an in vivo study of angiogenesis and collagen synthesis. Ann Surg 196:379–388CrossRefPubMed Knighton DR, Hunt TK, Thakral KK, Goodson WH 3rd (1982) Role of platelets and fibrin in the healing sequence: an in vivo study of angiogenesis and collagen synthesis. Ann Surg 196:379–388CrossRefPubMed
30.
Zurück zum Zitat Thornton FJ, Barbul A (1997) Healing in the gastrointestinal tract. Surg Clin North Am 77:549–573CrossRefPubMed Thornton FJ, Barbul A (1997) Healing in the gastrointestinal tract. Surg Clin North Am 77:549–573CrossRefPubMed
31.
Zurück zum Zitat Elemen L, Sarimurat N, Ayik B, Aydin S, Uzun H (2009) Is the use of cyanoacrylate in intestinal anastomosis a good and reliable alternative. J Pediatr Surg 44:581–586CrossRefPubMed Elemen L, Sarimurat N, Ayik B, Aydin S, Uzun H (2009) Is the use of cyanoacrylate in intestinal anastomosis a good and reliable alternative. J Pediatr Surg 44:581–586CrossRefPubMed
32.
Zurück zum Zitat Del Rio JV, Beck DE, Opelka FG (1996) Chronic perioperative steroids and colonic anastomotic healing in rats. J Surg Res 66:138–142CrossRefPubMed Del Rio JV, Beck DE, Opelka FG (1996) Chronic perioperative steroids and colonic anastomotic healing in rats. J Surg Res 66:138–142CrossRefPubMed
33.
Zurück zum Zitat Wise L, McAlister W, Stein T, Schuck P (1975) Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet 141:190–194PubMed Wise L, McAlister W, Stein T, Schuck P (1975) Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet 141:190–194PubMed
34.
Zurück zum Zitat Menteş O, Zeybek N, Oysul A, Onder SC, Tufan T (2008) Stump appendicitis, rare complication after appendectomy: report of a case. Ulus Travma Acil Cerrahi Derg 14:330–332PubMed Menteş O, Zeybek N, Oysul A, Onder SC, Tufan T (2008) Stump appendicitis, rare complication after appendectomy: report of a case. Ulus Travma Acil Cerrahi Derg 14:330–332PubMed
35.
Zurück zum Zitat Al-Dabbagh AK, Thomas NB, Haboubi N (2009) Stump appendicitis. A diagnostic dilemma. Tech Coloproctol 13:73–74CrossRefPubMed Al-Dabbagh AK, Thomas NB, Haboubi N (2009) Stump appendicitis. A diagnostic dilemma. Tech Coloproctol 13:73–74CrossRefPubMed
36.
Zurück zum Zitat Wiersma F, Srámek A, Holscher HC (2005) US features of the normal appendix and surrounding area in children. Radiology 235:1018–1022CrossRefPubMed Wiersma F, Srámek A, Holscher HC (2005) US features of the normal appendix and surrounding area in children. Radiology 235:1018–1022CrossRefPubMed
37.
Zurück zum Zitat Je BK, Kim SB, Lee SH, Lee KY, Cha SH (2009) Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children. World J Gastroenterol 15:2900–2903CrossRefPubMed Je BK, Kim SB, Lee SH, Lee KY, Cha SH (2009) Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children. World J Gastroenterol 15:2900–2903CrossRefPubMed
Metadaten
Titel
LigaSure™ compared with ligatures and endoclips in experimental appendectomy: how safe is it?
verfasst von
Levent Elemen
Yusufhan Yazir
Melih Tugay
Alper Akay
Seval Aydin
Karolin Yanar
Süreyya Ceylan
Publikationsdatum
01.05.2010
Verlag
Springer-Verlag
Erschienen in
Pediatric Surgery International / Ausgabe 5/2010
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-010-2557-x

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