Soll Christopher, Wyss Paloma, Gelpke Hans, Raptis Dimitri Aristotle, Breitenstein Stefan
Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Department of Visceral and Transplantation Surgery, University Hospital Zürich, Zürich, Switzerland.
Langenbecks Arch Surg. 2016 Aug;401(5):661-6. doi: 10.1007/s00423-016-1459-3. Epub 2016 Jun 13.
Polymeric clips (hem-o-lok ligation system) are a novel alternative for securing the base of the appendix during laparoscopic appendectomy. There is a lack of systematic evaluation of polymeric clips to close the appendiceal stump with regard to postoperative intra-abdominal abscesses. The aim of this study was to compare the hem-o-lok ligation system with conventional devices.
The outcome of 813 consecutive patients, operated between 2009 and 2013 receiving laparoscopic appendectomy either with hem-o-look or endoloop for acute appendicitis, was analysed. The risk of postoperative intra-abdominal abscesses was investigated for two different techniques to close the appendiceal stump using univariate and multivariate analyses.
Hem-o-lok clips were used in 54 % (n = 435) and endoloop sutures were applied in 46 % (n = 378) of the patients. Based on the multivariate analysis, the postoperative lack of antibiotics as well as the application of endoloop was identified as an independent predictive factor for the development of postoperative intra-abdominal abscesses. Comparing the closure techniques, the odds ratio (OR) was 0.25 (95 % CI 0.09-0.69; p < 0.008).
Closure of the appendiceal stump using the non-absorbable hem-o-lok ligation system did result in a reduced rate of intra-abdominal surgical abscesses as compared to the application of endoloops.
聚合物夹（Hem-o-lok结扎系统）是腹腔镜阑尾切除术时固定阑尾根部的一种新型替代方法。关于术后腹腔内脓肿，目前缺乏对使用聚合物夹闭合阑尾残端的系统评估。本研究的目的是比较Hem-o-lok结扎系统与传统器械。
分析了2009年至2013年间连续813例行腹腔镜阑尾切除术的患者的手术结果，这些患者因急性阑尾炎接受了Hem-o-lok或Endoloop治疗。采用单因素和多因素分析研究了两种不同的阑尾残端闭合技术术后腹腔内脓肿的风险。
54%（n = 435）的患者使用了Hem-o-lok夹，46%（n = 378）的患者应用了Endoloop缝线。基于多因素分析，术后未使用抗生素以及应用Endoloop被确定为术后腹腔内脓肿发生的独立预测因素。比较闭合技术，优势比（OR）为0.25（95% CI 0.09 - 0.69；p < 0.008）。
与应用Endoloop相比，使用不可吸收的Hem-o-lok结扎系统闭合阑尾残端确实降低了腹腔内手术脓肿的发生率。
