Rozhl Chir. 2020 Winter;99(12):534-538.
Appendiceal transection is the most critical part of laparoscopic appendectomy (LAPPE). The aim of our study was to evaluate post-operative and economic outcomes of laparoscopic appendectomy with different technical modifications of transection of the appendix.
This was a prospective, randomized, unicenter clinical study comparing different techniques of appendiceal transection in patients with acute appendicitis during the study period (18 months). The patients were randomized to one of three arms - endoloop, hem-o-lok clips and the stapler.
In total, 120 patients were enrolled in the study. The shortest operative time was noted in the hem-o-lok arm (37.3 minutes); mean length of hospital stay (3.7 days) was comparable in all study arms. Postoperative morbidity was 6.6%; all recorded complications were SSIs (Surgical Site Infections). The number of postoperative complications was comparable in all study arms. Mean direct costs of laparoscopic appendectomy were lowest in the hem-o-lok arm. According to our findings, LAPPE is not a profit making surgery irrespective of the type of appendiceal transection (mean profit in the study patients was CZK -4019).
The rate of postoperative complications was similar for all the technical modifications of appendiceal stump closure. As indicated by the study outcomes, hem-o-lok clips have the potential of becoming the method of choice in securing the appendix base during LAPPE.
阑尾横断是腹腔镜阑尾切除术（LAPPE）最关键的部分。我们的研究目的是评估不同阑尾横断技术的腹腔镜阑尾切除术后和经济结果。
这是一项前瞻性、随机、单中心的临床研究，比较了急性阑尾炎患者在研究期间（18 个月）不同阑尾横断技术。患者随机分为肠套环、Hem-o-lok 夹和吻合器三组。
共有 120 例患者入组研究。Hem-o-lok 组的手术时间最短（37.3 分钟）；所有研究组的平均住院时间（3.7 天）相似。术后发病率为 6.6%；所有记录的并发症均为 SSIs（手术部位感染）。所有研究组的术后并发症数量相当。腹腔镜阑尾切除术的直接费用以 Hem-o-lok 组最低。根据我们的发现，无论阑尾横断的类型如何，LAPPE 都不是一项盈利手术（研究患者的平均利润为 CZK -4019）。
所有阑尾残端闭合技术的改良在术后并发症发生率方面相似。研究结果表明，Hem-o-lok 夹在 LAPPE 时固定阑尾根部有成为首选方法的潜力。
