Department of Surgery, DRK Kliniken Berlin Köpenick, Klinik für Chirurgie, Salvador Allende Straße 2-8, 12559, Berlin, Germany.
Surg Endosc. 2011 Jan;25(1):124-9. doi: 10.1007/s00464-010-1144-5. Epub 2010 Jun 15.
An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. The effectiveness of various appendiceal stump closure methods, for instance, staplers or endoloops, was evaluated. Many analyses show that the use of a stapler for transection and closure of the appendiceal stump lowers the risk of this infection but a statistically significant risk of postoperative intra-abdominal abscess or wound infection was not considered in any randomized study. The aim of this study was to evaluate the complications after using endoloops in a high-volume center.
The data of 1,790 patients who underwent laparoscopic appendectomy between January 1998 and December 2006 and a single center was prospectively acquired. The standard procedure used was an appendiceal stump closure using endoloops and a selective use of staplers. The outcome criteria for inclusion in the study were intra-abdominal abscess formations, other specific intraoperative and postoperative complications, and the different costs of the operation.
Laparoscopic appendectomy was performed in 1,790 (80.8%) patients and open appendectomy in 425 (19.2%) patients. Conversion to open surgery occurred in 74 (4.13%) patients. Laparoscopic appendectomy with stump closure using endoloops was performed in 1,670 (97.3%) patients and stump closure using a stapler in 46 (2.7%) patients. Among 851 patients with acute appendicitis, 284 patients with perforated appendicitis, and 535 patients with other or no pathology, the rate of intra-abdominal abscess after using an endoloop or a stapler was not significantly different (1.5 vs. 0%, p = 0.587; 3.5 vs. 4.2%, p = 0.870; 0.7% vs. 0, p = 0.881, respectively). There were no significant differences between the endoloop group and the stapler group with respect to the other specific intraoperative and postoperative complications.
This study shows the safety of the endoloop for clinical daily routine. A selective procedure for stump closure has been established. Appendiceal stump closure using an endoloop is an easy, safe, and cost-effective procedure.
阑尾残端闭合不充分会导致腹腔内手术部位感染。各种阑尾残端闭合方法的效果，例如吻合器或内镜圈，已经得到了评估。许多分析表明，使用吻合器横断和闭合阑尾残端可以降低这种感染的风险，但在任何随机研究中都没有考虑到术后腹腔脓肿或伤口感染的统计学显著风险。本研究旨在评估在高容量中心使用内镜圈后的并发症。
1998 年 1 月至 2006 年 12 月期间，前瞻性地获取了 1790 例接受腹腔镜阑尾切除术的患者的数据，且均来自单一中心。标准手术过程是使用内镜圈闭合阑尾残端，并选择性使用吻合器。纳入研究的结果标准为腹腔脓肿形成、其他特定的术中及术后并发症，以及手术的不同费用。
腹腔镜阑尾切除术在 1790 例（80.8%）患者中进行，开腹阑尾切除术在 425 例（19.2%）患者中进行。有 74 例（4.13%）患者中转开腹。1670 例（97.3%）患者使用内镜圈闭合阑尾残端，46 例（2.7%）患者使用吻合器闭合阑尾残端。在 851 例急性阑尾炎患者、284 例穿孔性阑尾炎患者和 535 例其他或无病变患者中，使用内镜圈或吻合器后的腹腔脓肿发生率无显著差异（1.5%与 0%，p=0.587；3.5%与 4.2%，p=0.870；0.7%与 0，p=0.881）。内镜圈组与吻合器组在其他特定的术中及术后并发症方面也没有显著差异。
本研究表明内镜圈在临床日常工作中的安全性。已经建立了选择性的残端闭合程序。使用内镜圈闭合阑尾残端是一种简单、安全且具有成本效益的方法。
