Department of Colorectal Surgery, Clinic for Surgery, University Clinical Center, Tuzla, Bosnia and Herzegovina.
Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Surg Endosc. 2018 May;32(5):2295-2299. doi: 10.1007/s00464-017-5924-z. Epub 2017 Nov 2.
During laparoscopic appendectomy, the base of the appendix is usually secured by loop ligature or stapling device. Hem-o-lok and DS clips have been shown as alternative techniques. The aim of this study was to compare the clinical outcomes of various forms of securing the base of the appendix, in order to find the most suitable method.
The study included 120 patients with acute appendicitis randomly divided into four groups with 30 patients in each. In the first group, the base of the appendix was secured using an Endoloop, in the second group using a stapling device, in the third group using Hem-o-lok, and in the fourth group using a DS clip. The primary outcome was overall morbidity following securing the base of the appendix. Secondary outcomes were time of application and operative procedure, total length of stay, and surgical outcome.
No morbidity was recorded in any group. The time of application was significantly longer in the Endoloop group than in the Stapler (P < 0.0001), Hem-o-lok (P < 0.0001), and DS clips (P < 0.0001) groups. The time of application in the Stapler group was significantly shorter than in the Hem-o-lok (P < 0.0001) and the DS clips (P < 0.0001) groups. The time of the operative procedure was significantly longer in the Endoloop than in the Stapler group (P < 0.0001). The time of the operative procedure in the Stapler group was significantly shorter than in the DS clips group (P < 0.0001) but did not differ significantly from the Hem-o-lok group (P = 0.199). The time of the operative procedure in the Hem-o-lok group was significantly shorter than in the DS clips group (P = 0.044).
All forms of closure of the appendix base are acceptable, but Hem-o-lok and DS clips have the best potential for further development, and will probably become the method of choice in securing the base of the appendix.
在腹腔镜阑尾切除术时，阑尾根部通常采用套扎或吻合器进行结扎固定。Hem-o-lok 和 DS 夹已被证明是替代技术。本研究旨在比较不同固定阑尾根部方法的临床效果，以找到最适合的方法。
这项研究纳入了 120 例急性阑尾炎患者，随机分为四组，每组 30 例。在第一组中，使用 Endoloop 结扎阑尾根部，第二组使用吻合器，第三组使用 Hem-o-lok，第四组使用 DS 夹。主要结局是固定阑尾根部后的总并发症发生率。次要结局是应用时间和手术过程、总住院时间和手术结果。
任何一组均未发生并发症。Endoloop 组的应用时间明显长于吻合器（P<0.0001）、Hem-o-lok（P<0.0001）和 DS 夹（P<0.0001）组。吻合器组的应用时间明显短于 Hem-o-lok（P<0.0001）和 DS 夹（P<0.0001）组。手术时间 Endoloop 组明显长于吻合器组（P<0.0001）。吻合器组的手术时间明显短于 DS 夹组（P<0.0001），但与 Hem-o-lok 组无显著差异（P=0.199）。Hem-o-lok 组的手术时间明显短于 DS 夹组（P=0.044）。
所有固定阑尾根部的方法都是可以接受的，但 Hem-o-lok 和 DS 夹具有更好的发展潜力，可能成为固定阑尾根部的首选方法。
