Description

Appendectomy remains the gold standard treatment for acute appendicitis, one of the most common surgical emergencies worldwide. With the evolution of minimal access surgery, laparoscopic appendectomy has become the preferred approach due to its advantages of smaller incisions, reduced postoperative pain, faster recovery, and superior cosmetic results. Among various laparoscopic techniques, Mishra's Knot has emerged as a simple, safe, and cost-effective method for securing the appendicular base. Understanding Acute Appendicitis Acute appendicitis is an inflammation of the vermiform appendix, typically caused by luminal obstruction due to a fecolith, lymphoid hyperplasia, or rarely, tumors. Patients often present with: Pain starting around the umbilicus, later shifting to the right iliac fossa Nausea, vomiting, or anorexia Low-grade fever Tenderness at McBurney’s point Early surgical intervention prevents complications like perforation, abscess formation, and peritonitis. Laparoscopic Appendectomy Laparoscopic appendectomy involves three small incisions: A camera port at the umbilicus A working port in the suprapubic region Another working port in the left iliac fossa The appendix is identified, mesoappendix divided, and the base secured before removing the organ. Traditionally, endoloops, staplers, or clips have been used, but these methods can increase cost and require specialized devices. Mishra's Knot: A Cost-Effective Solution Mishra’s Knot, developed by Prof. Dr. R. K. Mishra at World Laparoscopy Hospital, is a secure extracorporeal knot widely used in laparoscopic surgery. It provides the strength of a surgeon’s knot with the reliability of a slip knot, making it an ideal option for appendicular base ligation. Key Features of Mishra’s Knot Secure and Reliable: Offers strong holding power, preventing slippage at the appendicular base. Cost-Effective: Eliminates the need for expensive staplers or endoloops. Simple Technique: Can be tied quickly by trained laparoscopic surgeons. Versatile Application: Apart from appendectomy, it is also useful in other laparoscopic procedures requiring intracorporeal or extracorporeal knotting. Technique of Appendectomy Using Mishra’s Knot The appendix is mobilized and the mesoappendix divided. An extracorporeal Mishra’s Knot is fashioned using absorbable suture material. The knot is introduced into the abdomen through a trocar. It is positioned at the base of the appendix and tightened securely. A second knot is often applied for additional safety. The appendix is transected distal to the knot and removed via an endobag or trocar. Advantages of Using Mishra’s Knot in Appendectomy Reduced operative cost compared to staplers or endoloops Easy to master during laparoscopic training programs Provides equally effective outcomes with low complication rates Especially beneficial in resource-limited settings where cost containment is important Conclusion Laparoscopic appendectomy using Mishra’s Knot combines modern minimally invasive surgical techniques with cost-effectiveness and safety. By replacing expensive disposable devices with a secure, reliable extracorporeal knot, this method ensures that laparoscopic appendectomy remains accessible and affordable without compromising patient outcomes.