Swank Hilko A, van Rossem Charles C, van Geloven A A W, in't Hof Klaas H, Kazemier Geert, Meijerink W J H J, Lange Johan F, Bemelman Willem A
Department of Surgery, Academic Medical Center, G4-146.1, 22660, 1100 DD, Amsterdam, The Netherlands,
Surg Endosc. 2014 Feb;28(2):576-83. doi: 10.1007/s00464-013-3207-x. Epub 2013 Sep 19.
Laparoscopic appendectomy is the treatment of choice for appendicitis provided sufficient laparoscopic expertise is available. The endostapler possibly provides an easier and safer closure of the appendiceal stump, but at greater expense. This study aimed to compare two strategies for closure of the appendiceal stump in a large retrospective cohort of patients.
This study reviewed patients who underwent laparoscopic appendectomy for acute appendicitis in three academic hospitals and two regional hospitals in The Netherlands during the period 1 January 2007 to 30 June 2011. The endostapler was routinely used in two hospitals and selectively used in the remaining three hospitals. Both strategies were compared for complications according to the Clavien-Dindo classification.
A total of 1,036 patients were analyzed according to the strategy followed. The 571 patients in the first group were routinely treated with the endostapler. For the 465 patients in the second group, the intentional method of stump closure was with endoloops. The endostapler was used when indicated for 69 of these patients. The patient characteristics did not differ between the two groups. The groups also did not differ significantly in number of intra- and postoperative complications. In both groups, 4.3 % of the patients had complications classified as grade 3 or higher. There were no significant differences in the prevalence of intraabdominal abscesses (3.2 % vs. 4.3) or wound infections (0.4 and 1.5 %). In a multivariate analysis, the chosen strategy for stump closure was not a significant predictor for postoperative complications.
Routine use of the endostapler showed no clinical advantages over the use of endoloops with selective endostapler closure. The latter strategy is preferable because it is more cost effective.
如果有足够的腹腔镜技术，腹腔镜阑尾切除术是阑尾炎的首选治疗方法。吻合器可能会使阑尾残端的闭合更容易、更安全，但成本更高。本研究旨在比较一大批回顾性队列患者中两种阑尾残端闭合策略。
本研究回顾了2007年1月1日至2011年6月30日期间在荷兰三家学术医院和两家地区医院接受腹腔镜阑尾切除术治疗急性阑尾炎的患者。在两家医院常规使用吻合器，在其余三家医院选择性使用。根据Clavien-Dindo分类法比较两种策略的并发症情况。
根据所采用的策略对总共1036例患者进行了分析。第一组的571例患者常规使用吻合器治疗。第二组的465例患者，阑尾残端的闭合方法是使用圈套器。其中69例患者在有指征时使用了吻合器。两组患者的特征无差异。两组在术中及术后并发症数量上也无显著差异。两组中，4.3%的患者出现3级或更高等级的并发症。腹腔内脓肿（3.2%对4.3%）或伤口感染（0.4%和1.5%）的发生率无显著差异。在多变量分析中，所选的阑尾残端闭合策略不是术后并发症的显著预测因素。
与选择性使用吻合器闭合并使用圈套器相比，常规使用吻合器没有显示出临床优势。后一种策略更可取因为它更具成本效益。
