Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
Division of Pediatric Surgery, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
Surg Endosc. 2018 Aug;32(8):3570-3575. doi: 10.1007/s00464-018-6081-8. Epub 2018 Feb 5.
There is a limited and conflicting evidence about the most appropriate method for appendiceal stump closure during laparoscopic appendectomy (LA). We aimed to compare endoloop (EL) versus endostapler (ES) for stump closure during LA for complicated perforated appendicitis in children.
We retrospectively reviewed the records of 708 patients (463 boys and 245 girls with an average age of 9.8 years) who underwent LA for complicated appendicitis in 5 international centers of Pediatric Surgery over a 5-years period (January 2011-December 2016). The appendix was perforated with localized peritonitis in 470 cases and diffuse peritonitis in 238 patients. EL was used in 374 cases (G1), whereas ES was adopted in 334 cases (G2).
No intra-operative complication occurred in both groups but 5 conversions to open surgery were reported in G1 (1.3%) and 4 in G2 (1.1%) (OR 1.1; 95% CI 0.30-4.19). Use of EL was significantly associated with higher incidence of intra-abdominal abscess (OR 1.36; 95% CI 0.84-2.18), postoperative ileus (OR 3.61; 95% CI 0.76-17.11), and re-operations/readmissions (OR 6.46; 95% CI 1.46-28.62) compared to ES. The average cost of supplies for LA was significantly higher in G2 (€ 915.60) compared to G1 (€ 578.36) (p = 0.0001). The average cost of re-operations/readmissions was significantly higher in G1 (€ 4.091,39) compared to G2 (€ 2.127,88) (p = 0.0001) (OR 1.72; 95% CI 1.47-2.01).
Our study is the first in the pediatric population to demonstrate that the method used for appendiceal stump closure may influence the outcome of LA in complicated appendicitis. Although ES is more expensive compared to EL, our results demonstrated that appendix stump closure should be performed using ES rather than EL in complicated perforated appendicitis since its use was associated with a lower incidence of postoperative intra-abdominal abscess and postoperative ileus and lower re-operations and readmissions rates and costs.
腹腔镜阑尾切除术（LA）中阑尾残端的闭合方法最合适的方法存在有限且相互矛盾的证据。我们旨在比较腔内环（EL）与吻合器（ES）在儿童复杂性穿孔性阑尾炎 LA 中的残端闭合效果。
我们回顾性分析了 5 家国际小儿外科中心在 5 年期间（2011 年 1 月至 2016 年 12 月）接受 LA 治疗的 708 例（463 名男孩和 245 名女孩，平均年龄 9.8 岁）复杂性阑尾炎患者的记录。阑尾穿孔伴局限性腹膜炎 470 例，弥漫性腹膜炎 238 例。EL 用于 374 例（G1 组），ES 用于 334 例（G2 组）。
两组均无术中并发症，但 G1 组有 5 例（1.3%）转为开腹手术，G2 组有 4 例（1.1%）（OR 1.1；95%CI 0.30-4.19）。与 ES 相比，EL 的使用与更高的腹腔脓肿发生率（OR 1.36；95%CI 0.84-2.18）、术后肠梗阻（OR 3.61；95%CI 0.76-17.11）和再次手术/再入院（OR 6.46；95%CI 1.46-28.62）显著相关。与 G1 组（€578.36）相比，G2 组（€915.60）LA 的耗材平均费用显著更高（p=0.0001）。与 G2 组（€2.127.88）相比，G1 组（€4.091.39）的再次手术/再入院平均费用显著更高（p=0.0001）（OR 1.72；95%CI 1.47-2.01）。
我们的研究是首个在儿科人群中证明阑尾残端闭合方法可能影响复杂阑尾炎 LA 结局的研究。尽管 ES 比 EL 更昂贵，但我们的结果表明，在复杂穿孔性阑尾炎中，应使用 ES 而不是 EL 进行阑尾残端闭合，因为它与术后腹腔脓肿和术后肠梗阻的发生率较低、再次手术和再入院率和费用较低相关。
