Makaram N, Knight S R, Ibrahim A, Patil P, Wilson M S J
Department of General Surgery, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
Usher Institute, University of Edinburgh, Edinburgh, EH16 4XU, UK.
Ann Med Surg (Lond). 2020 Aug 4;57:228-235. doi: 10.1016/j.amsu.2020.07.058. eCollection 2020 Sep.
Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure.
A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies.
From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure.
阑尾残端闭合是腹腔镜阑尾切除术中的关键步骤。阑尾残端处理不当可能导致严重的发病情况。已经描述了几种残端闭合方法，然而高级别证据有限。我们进行了一项系统评价，评估阑尾残端闭合方法的临床结果和证据质量。
使用Medline、Embase、Cochrane数据库和谷歌学术进行系统文献检索，以识别从开始到2019年10月比较腹腔镜急性阑尾炎阑尾切除术中阑尾残端闭合方法的研究。从所有纳入研究中整理出关于手术持续时间、围手术期并发症、住院时间和费用的数据。
从160项已识别的研究中，19项符合纳入标准。Endoloops和Endoclips以较低成本提供等效的临床结果，而使用Endoclip闭合时手术持续时间最短。Endostapler装置的围手术期并发症发生率最低（3.56%），然而其成本限制了其在许多医疗环境中的常规使用。所有残端闭合方法的术后并发症发生率和住院时间相似。结论：虽然腹腔镜阑尾切除术中残端闭合方法没有显著差异，但使用Endoclips闭合手术持续时间最短。在比较残端闭合方法时，需要对成本数据进行稳健和标准化的报告，同时在得出关于最佳残端闭合方法的确切结论之前，需要多中心随机对照试验形式的更高级别证据。
