Division of General Surgery, Virgen del Rocío University Hospital, Av Manuel Siurot S/N, 41013, Seville, Spain.
Langenbecks Arch Surg. 2021 Aug;406(5):1581-1589. doi: 10.1007/s00423-020-02050-3. Epub 2021 Jan 7.
There is still controversy regarding the ideal technique to close the appendicular stump in laparoscopic appendectomy (LA). The objective of this study was to determine the safety and efficiency of the use of an endoloop (EL) and endostapler (ES) in complicated and uncomplicated acute appendicitis.
Retrospective cohort study of patients undergoing LA from February 2013 to December 2019. Acute uncomplicated and complicated appendicitis were analysed separately, establishing two groups according to the stump closure technique: EL or ES. Seven hundred-nine patients were included (535 uncomplicated and 174 complicated). In uncomplicated appendicitis, an EL was used in 447 of the patients (83.55%) and an ES was used in 88 patients (16.45%). In complicated appendicitis, an EL was used in 85 patients (48.85%) and an ES was used in 89 patients (51.15%). An analysis of effectiveness and a cost analysis of each technique were performed.
In uncomplicated appendicitis, we found no differences with respect to global complications, although there were significant differences in the total mean hospital stay (EL group 1.55 (SD 1.48) days; ES group 2.21 (SD 1.69) days; p = 0.046). This meant a savings of 514.12€ per patient using the EL p < 0.001). In complicated appendicitis, the reoperations classified as Clavien-Dindo IIIB in the EL group (6.4%) were greater than in the ES group (0%) (p = 0.012), although the rate of postoperative abscesses (p = 0.788) and the mean volume of abscesses (p = 0.891) were similar.
The systematic use of an EL could reduce costs in uncomplicated appendicitis, while in complicated cases, both options are valid. Prospective studies with a greater number of patients are needed to observe differences in postoperative complications.
在腹腔镜阑尾切除术（LA）中，阑尾残端的理想闭合技术仍存在争议。本研究的目的是确定在单纯性和复杂性急性阑尾炎中使用肠线环（EL）和吻合器（ES）的安全性和有效性。
这是一项回顾性队列研究，纳入了 2013 年 2 月至 2019 年 12 月期间行 LA 的患者。分别分析单纯性和复杂性急性阑尾炎，根据残端闭合技术将患者分为两组：EL 或 ES。共纳入 709 例患者（单纯性阑尾炎 535 例，复杂性阑尾炎 174 例）。在单纯性阑尾炎中，447 例患者使用 EL（83.55%），88 例患者使用 ES（16.45%）。在复杂性阑尾炎中，85 例患者使用 EL（48.85%），89 例患者使用 ES（51.15%）。对每种技术的有效性进行分析，并进行成本分析。
在单纯性阑尾炎中，我们发现两种技术在整体并发症方面没有差异，但总平均住院时间有显著差异（EL 组 1.55（SD 1.48）天；ES 组 2.21（SD 1.69）天；p = 0.046）。这意味着使用 EL 可使每位患者节省 514.12 欧元（p < 0.001）。在复杂性阑尾炎中，EL 组（6.4%）Clavien-Dindo 分级为 IIIB 的再次手术比例高于 ES 组（0%）（p = 0.012），但术后脓肿发生率（p = 0.788）和脓肿平均体积（p = 0.891）相似。
在单纯性阑尾炎中，系统使用 EL 可降低成本，而在复杂性阑尾炎中，两种方法均有效。需要进行前瞻性研究，纳入更多患者，观察术后并发症的差异。
