Department of Surgery, Ameos Hospital, 17373, Ueckermünde, Germany.
Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald; Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
Langenbecks Arch Surg. 2019 Sep;404(6):711-716. doi: 10.1007/s00423-019-01814-w. Epub 2019 Aug 24.
The aim of this long-term study was the comparison of appendiceal stump closure with polymeric clips or staplers with respect to perioperative costs and surgical outcome under routine conditions in a university centre.
For this retrospective chart review, a total of 618 patients undergoing laparoscopic appendectomy for suspected acute appendicitis between 2010 and 2017 were reviewed: 410 patients in the stapler group and 208 patients in the clip group. The database contained demographic data, operation time, inflammation parameters, closure method of the stump, surgeon status, length of hospital stay, and complications as well as histology reports. The costs were also compared.
Clip application was more likely among younger patients (mean age 33.6 years vs. 41.7 years). Histopathological evidence for appendiceal pathology was found in 96.6% of patients in the clip group and 99.5% of patients in the stapler group. Laparoscopic appendectomy in the clip group was more frequently performed by resident physicians (69.2%) than in the stapler group (57.8%). The mean postoperative stay was 2.9 days in the clip group and 3.7 days in the stapler group. The use of the polymeric clip resulted in considerable cost savings (19.94€ vs. 348.70€).
The use of polymeric clips for appendiceal stump closure during appendectomy is safe and effective. The base of the appendix is amenable to clipping in 32% of appendectomies in adult patients. This study supports the use of polymeric clips over staplers to decrease cost and environmental impact.
本长期研究旨在比较在大学中心常规条件下，使用聚合夹或吻合器对阑尾残端进行闭合的围手术期成本和手术结果。
为了进行这项回顾性图表审查，我们回顾了 2010 年至 2017 年间因疑似急性阑尾炎而行腹腔镜阑尾切除术的 618 例患者：吻合器组 410 例，夹闭组 208 例。该数据库包含人口统计学数据、手术时间、炎症参数、残端闭合方法、外科医生身份、住院时间、并发症以及组织学报告。还比较了成本。
夹闭组中年轻患者（平均年龄 33.6 岁 vs. 41.7 岁）更有可能使用夹闭。夹闭组和吻合器组的组织病理学证据均显示 96.6%的患者存在阑尾病理。夹闭组中，由住院医师进行腹腔镜阑尾切除术的比例（69.2%）高于吻合器组（57.8%）。夹闭组的术后平均住院时间为 2.9 天，吻合器组为 3.7 天。使用聚合夹可显著节省成本（19.94 欧元 vs. 348.70 欧元）。
在阑尾切除术中使用聚合夹闭合阑尾残端是安全有效的。在成年患者中，32%的阑尾切除术可采用夹闭的方法。本研究支持使用聚合夹代替吻合器，以降低成本和减少环境影响。
