Köhler Franziska, Reese Lena, Kastner Carolin, Hendricks Anne, Müller Sophie, Lock Johan F, Germer Christoph-Thomas, Wiegering Armin
Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany.
Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany.
Front Surg. 2022 Jun 8;9:919744. doi: 10.3389/fsurg.2022.919744. eCollection 2022.
Surgical site infections (SSIs) are one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have been published on the effect of open versus conventional laparoscopic appendectomy (CLA) reporting faster postoperative recovery and less postoperative pain for CLA. A development from CLA has been the single-port appendectomy (SPA), associated with a better cosmesis but seemingly having a higher risk of wound infections. The aim of this systematic literature review and meta-analysis is to investigate whether reduced port or SPA alters the ratio of SSIs.
Pubmed, Embase, and Cochrane databases were screened for suitable articles. All articles published between January 1, 2002, and March 23, 2022, were included. Articles regarding children below the age of 18 were excluded as well as manuscripts that investigated solemnly open appendectomies. Articles were screened for inclusion criteria by two independent authors. Incidence of SSI was the primary outcome. Duration of operation and length of hospital stay were defined as secondary outcomes.
A total of 25 studies were found through a database search describing 5484 patients. A total of 2749 patients received SPA and 2735 received CLA. There was no statistical difference in the rate of SSI ( = 0.98). A total of 22 studies including 4699 patients reported the duration of operation (2223 SPA and 2476 CLA). There was a significantly shorter operation time seen in CLA. The length of hospital stay was reported in 23 studies (4735 patients: 2235 SPA and 2500 CLA). A shorter hospital stay was seen in the SPA group ( < 0.00001). Separately performed analysis of randomized controlled trials could not confirm this effect ( = 0.29).
SPA is an equally safe procedure considering SSI compared to CLA and does not lead to an increased risk of SSI. A longer operation time for SPA and a minor difference in the length of stay does lead to the use of SPA in selected patients only.
手术部位感染（SSIs）是阑尾切除术后最常见的术后并发症之一，会导致再次手术、住院时间延长以及使用抗生素。关于开放手术与传统腹腔镜阑尾切除术（CLA）的效果，已有大量研究和荟萃分析发表，结果表明CLA术后恢复更快，术后疼痛更轻。CLA的一项发展成果是单孔阑尾切除术（SPA），其美容效果更好，但伤口感染风险似乎更高。本系统文献综述和荟萃分析的目的是研究减少切口数量或采用SPA是否会改变SSIs的发生率。
在Pubmed、Embase和Cochrane数据库中筛选合适的文章。纳入2002年1月1日至2022年3月23日期间发表的所有文章。排除关于18岁以下儿童的文章以及仅研究开放阑尾切除术的手稿。由两名独立作者根据纳入标准筛选文章。SSI的发生率是主要结局。手术时间和住院时间定义为次要结局。
通过数据库搜索共找到25项研究，涉及5484例患者。共有2749例患者接受了SPA，2735例接受了CLA。SSI发生率无统计学差异（=0.98）。共有22项研究（4699例患者）报告了手术时间（2223例接受SPA，2476例接受CLA）。CLA的手术时间明显更短。23项研究（4735例患者：2235例接受SPA，2500例接受CLA）报告了住院时间。SPA组的住院时间更短（<0.00001）。对随机对照试验单独进行的分析无法证实这种效果（=0.29）。
与CLA相比，考虑到SSI，SPA是一种同样安全的手术方法，不会导致SSI风险增加。SPA手术时间较长，住院时间略有差异，这使得SPA仅在特定患者中使用。
