Kryspin Mitura, Wyrzykowsk Dorota
General Surgery Department, Siedlce Hospital, Siedlce, Poland.
JSLS. 2018 Oct-Dec;22(4). doi: 10.4293/JSLS.2018.00062.
Although laparoscopic appendectomy (LA) has been used for 35 years, the open approach (OA) is preferred worldwide. Widespread access to instrumentation in a number of centers has reduced economic and logistical obstacles. The aim of this work is to compare the results for patients with suspected appendicitis treated using an OA versus patients treated using LA.
A retrospective study of all patients (N = 290) who underwent operation due to suspected appendicitis in the General Surgery Department from 2014 to 2017 was conducted. LA was performed in 91 patients, and OA was performed in 199 patients.
Average surgery duration was 67.8 minutes in the LA group and 62.9 minutes in the OA group ( =.082). It was necessary to perform 3 conversions (3.3%) from LA to OA. Wound infections occurred in 2.2% of patients in the LA group and in 12.6% of patients in the OA group ( = .007). A reduced duration of hospitalization was noted in the LA group (3.3 days) compared with the OA group (4.7 days) ( < .001).
The duration of LA is not considerably longer than that of OA. LA in patients with suspected appendicitis reduces the number of operation site infections compared with OA. LA with single endoloop stump closure is a safe method and may be recommended for wider applications.
尽管腹腔镜阑尾切除术(LA)已应用35年,但在全球范围内开放手术入路(OA)仍更受青睐。多个中心广泛配备手术器械减少了经济和后勤方面的障碍。本研究的目的是比较疑似阑尾炎患者采用OA治疗与采用LA治疗的结果。
对2014年至2017年在普通外科因疑似阑尾炎接受手术的所有患者(N = 290)进行回顾性研究。91例患者接受LA,199例患者接受OA。
LA组平均手术时间为67.8分钟,OA组为62.9分钟(P = 0.082)。有3例(3.3%)患者需由LA转为OA。LA组2.2%的患者发生伤口感染,OA组为12.6%(P = 0.007)。与OA组(4.7天)相比,LA组住院时间缩短(3.3天)(P < 0.001)。
LA的手术时间不比OA显著长。与OA相比,疑似阑尾炎患者采用LA可减少手术部位感染的数量。单端环结扎残端闭合的LA是一种安全的方法,可推荐更广泛应用。