Ates Mustafa, Dirican Abuzer, Ince Volkan, Ara Cengiz, Isik Burak, Yilmaz Sezai
Department of General Surgery, Inonu University Medical Faculty, Malatya, Turkey.
Surg Laparosc Endosc Percutan Tech. 2012 Jun;22(3):226-31. doi: 10.1097/SLE.0b013e31824f25cd.
Laparoscopic appendectomy is a well-described surgical technique. However, concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip, an endoloop, staples, or other techniques. Therefore, several modifications to the original technique with new materials have been introduced for appendiceal stump closure. The aim of this study was to compare intracorporeal (polyglactin) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy.
The study was carried out as a prospective randomized clinical trial between April 2010 and February 2011. Patients with a presentation of appendicitis were included into the study. Two groups were defined-patients with the titanium endoclip and patients with the knot-tying (polyglactin) suture. The results in terms of operating time, complication rates, and hospital stay were analyzed.
Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group (n=30) or the knot-tying (polyglactin) suture group (n=31). No statistically significant differences were detected between the groups in terms of the distribution of age, sex percentage, appendix localization, and histopathologic diagnosis (P>0.05). One patient required a second operation on postoperative day 10 because of intraperitoneal abscess. The mean operative time for the endoclip group (41.27 ± 12.2 min) was shorter than that for the knot-tying group (62.81 ± 15.4 min) (P=0.001). No statistically significant differences were detected between the groups in terms of hospital stay, follow-up time, and preoperative and postoperative complications (P>0.05).
In laparoscopic appendectomy, using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time. This also simplifies the procedure, so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure.
腹腔镜阑尾切除术是一种已被充分描述的外科技术。然而，对于阑尾残端的闭合是应使用夹子、内镜圈套器、吻合器还是其他技术，仍存在疑虑。因此，已引入了几种使用新材料对原始技术进行的改良方法用于阑尾残端闭合。本研究的目的是比较在腹腔镜阑尾切除术中使用体内（聚乙醇酸）打结缝合与钛制内镜夹进行阑尾残端闭合的效果。
本研究作为一项前瞻性随机临床试验于2010年4月至2011年2月进行。纳入有阑尾炎表现的患者。定义了两组——使用钛制内镜夹的患者和使用打结（聚乙醇酸）缝合的患者。分析了手术时间、并发症发生率和住院时间方面的结果。
61例行腹腔镜阑尾切除术的患者被纳入钛制内镜夹组（n = 30）或打结（聚乙醇酸）缝合组（n = 31）。两组在年龄分布、性别比例、阑尾位置和组织病理学诊断方面未检测到统计学显著差异（P>0.05）。1例患者在术后第10天因腹腔脓肿需要再次手术。内镜夹组的平均手术时间（41.27 ± 12.2分钟）短于打结组（62.81 ± 15.4分钟）（P = 0.001）。两组在住院时间、随访时间以及术前和术后并发症方面未检测到统计学显著差异（P>0.05）。
在腹腔镜阑尾切除术中，使用钛制内镜夹优化和控制阑尾残端闭合是安全的，且与较短的手术时间相关。这也简化了操作程序，因此它可以成为用于阑尾残端闭合的体内打结的一种有用替代方法。
