Johans as knot pusher

Published Date: 19th July 2016

Publication Authors: Kaul A

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Background

The base of appendix can be secured by stapling or with endoloops. The authors have reported the use of Johan forceps as endoloop pushers for laparoscopic appendicectomy.

Objectives

A feasibility study of safety and cost effectiveness of using Johan forceps as endoloop pushers for laparoscopic appendicectomy.

Material and Methods

A prospectively collected data of all patients who underwent laparoscopic appendicectomy by this technique at two separate institutions was reviewed. Three standard extra-corporeal endoloops utilising one vicryl tie were deployed using Johan forceps. Demographics, operative findings, post-op stay, post-op complications as were as readmissions were recorded & analysed.

Result

Total number of patients was 69. There were 46 (66.6%) males while rest were female with an age of *24 (14-77). Inflamed appendix (including perforation, localised abscess) was noted in 81% of cases, while 19% had grossly normal appendix. There were no intra-operative complications. The post-op stay was *2(1-4) days. Complications include 4 (5.8%) wound infections which were managed conservatively. 7(%) patients were re-admitted due to pain. The cost of one vicryl tie was 0.5 Vs 49.80 (for 3 standard endoloops available in the market). The cost analysis showed Johan assisted appendicectomy to be 99 times cheaper than the standard marketed endoloops.

Conclusion

Our early experience confirms that use of Johan forceps as endoloop knot pushers is a feasible and safe technique with promising results. It is a cheap and safe alternative to the standard endoloops available in the market.

*Median

Siddique, K; Khan, K; Kaul, A; Shiwani, MH. (2014).  Use of johans as knot pusher for lap appendicectomy-safety & feasibility . European Surgical Research. 52 (3-4), 139-140.

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