Technical Modifications of Appendicular Stump Closure During Laparoscopic Appendectomy

NCT ID: NCT03750032

Last Updated: 2020-10-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-06-01

Study Completion Date

2019-06-01

Brief Summary

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Laparoscopic appendectomy (L-APPE) presents a golden standard in the treatment of acute appendicitis nowadays. However, there are ongoing controversies regarding the ideal technique of appendicular stump closure during L-APPE in the published literature. Several technical modifications of appendicular stump closure are available at the present - closure using endoloop, endostapler or Hem-o-lock clips. The aim of the proposed project (CAS study) is to compare medical and economic outcomes of patients undergoing L-APPE with different methods of appendicular stump closure (endostapler, endoloop and Hem-o-lock clips).

Detailed Description

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Acute appendicitis presents one of the most common surgical illnesses which affect approximately 7% of the western population. In the Czech Republic, 11664 patients were hospitalized and operated for the diagnosis of acute appendicitis (K35-K38) during 2016. It might seem that the procedure of appendectomy will be guided by a clear algorithm for its frequency, but it is not so. Because of acute appendicitis, appendectomy may be performed via laparotomy or laparoscopy (minimally invasive surgery). During laparoscopic appendectomy (L-APPE), there are no clear recommendations regarding trocar placement, methods of dividing appendicular mesenteriolum, methods of appendicular stump closure or appendicular stump sinking.

The proposed clinical study is focused on the issue of the appendicular base interruption during L-APPE. At the present, there are several technical modifications of appendicular stump closure - by means of endoloop (the suture loop from absorbable fiber), endostapler or using Hem-o-lock clips. The performed literature search revealed that evidence-based medicine data regarding the optimal way of appendicular stump closure are insufficient. That is why the investigators have decided to conduct a prospective randomized single-center clinical study aimed to compare different technical modifications of appendicular stump closure during L-APPE. Within a study period, all patients undergoing L-APPE at the University Hospital Ostrava will be randomized to one of the technical modifications of appendicular stump closure.

The aim of the project (CAS study) is to compare medical and economic outcomes of patients undergoing L-APPE with different methods of appendicular stump closure (endostapler, endoloop and Hem-o-lock clips). The operative time, intraoperative and postoperative complications will be the primary outcome measures of the study, economic outcomes will be the secondary outcome measures.

Conditions

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Acute Appendicitis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The patients will be randomized into three groups of various appendicular stump closure.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

No masking will be used in the study.

Study Groups

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Stapler appendectomy

A total of 40 study subjects undergoing appendectomy will be randomized into the group with appendicular stump closure using a stapler.

Group Type EXPERIMENTAL

Stapler appendectomy

Intervention Type PROCEDURE

The patients randomised for this intervention will undergo stapler appendectomy.

Endoloop

A total of 40 study subjects undergoing appendectomy will be randomized into the group with appendicular stump closure using endoloop.

Group Type EXPERIMENTAL

Endoloop

Intervention Type PROCEDURE

The patients randomised for this intervention will undergo appendicular stump closure using Endoloop.

Hem-O-Lock

A total of 40 study subjects undergoing appendectomy will be randomized into the group with appendicular stump closure using Hem-O-Lock.

Group Type EXPERIMENTAL

Hem-O-Lock

Intervention Type PROCEDURE

The patients randomised for this intervention will undergo appendicular stump closure using Hem-O-Lock.

Interventions

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Stapler appendectomy

The patients randomised for this intervention will undergo stapler appendectomy.

Intervention Type PROCEDURE

Endoloop

The patients randomised for this intervention will undergo appendicular stump closure using Endoloop.

Intervention Type PROCEDURE

Hem-O-Lock

The patients randomised for this intervention will undergo appendicular stump closure using Hem-O-Lock.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* age ≥18 years
* acute appendicitis
* laparoscopic approach
* signed informed content

Exclusion Criteria

\- necrosis or advanced inflammatory changes in the area of appendicular stump
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital Ostrava

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter Ihnát, Ass.Prof.,MD,PhD,MBA

Role: PRINCIPAL_INVESTIGATOR

University Hospital Ostrava

Locations

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University Hospital Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

Countries

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Czechia

References

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Mayir B, Bilecik T, Ensari CO, Oruc MT. Laparoscopic appendectomy with hand-made loop. Wideochir Inne Tech Maloinwazyjne. 2014 Jun;9(2):152-6. doi: 10.5114/wiitm.2014.41624. Epub 2014 Mar 24.

Reference Type BACKGROUND
PMID: 25097680 (View on PubMed)

Matyja M, Strzalka M, Rembiasz K. Laparosocopic Appendectomy, Cost-Effectiveness of Three Different Techniques Used to Close the Appendix Stump. Pol Przegl Chir. 2015 Dec;87(12):634-7. doi: 10.1515/pjs-2016-0015.

Reference Type BACKGROUND
PMID: 26963058 (View on PubMed)

Mayir B, Ensari CO, Bilecik T, Aslaner A, Oruc MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg. 2015 Aug 18;31(4):229-31. doi: 10.5152/UCD.2015.2768. eCollection 2015.

Reference Type BACKGROUND
PMID: 26668532 (View on PubMed)

Yildiz I, Koca S. Is There An Ideal Stump Closure Technique In Laparoscopic Appendectomy? Surg Technol Int. 2016 Apr;28:117-20.

Reference Type BACKGROUND
PMID: 27121413 (View on PubMed)

Delibegovic S, Mehmedovic Z. Erratum to: The Influence of the Appendiceal Base Diameter on Appendix Stump Closure in Laparoscopic Appendectomy. World J Surg. 2016 Nov;40(11):2832. doi: 10.1007/s00268-016-3709-5. No abstract available.

Reference Type BACKGROUND
PMID: 27627887 (View on PubMed)

Ihnat P, Tesar M, Tulinsky L, Ihnat Rudinska L, Okantey O, Durdik S. A randomized clinical trial of technical modifications of appendix stump closure during laparoscopic appendectomy for uncomplicated acute appendicitis. BMC Surg. 2021 May 31;21(1):272. doi: 10.1186/s12893-021-01279-z.

Reference Type DERIVED
PMID: 34059039 (View on PubMed)

Other Identifiers

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FNO-CHIR-CAS

Identifier Type: -

Identifier Source: org_study_id

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