Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania.
Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania.
Medicina (Kaunas). 2023 Mar 9;59(3):533. doi: 10.3390/medicina59030533.
Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson's chi-squared test, Wilcoxon rank sum (Mann-Whitney U) test, and Fisher's exact test in R statistical software package version 4.2.1. 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (-value in comparison of groups' sex > 0.99, age -value 0.16), postoperative complications (-value > 0.99), histological findings (-value 0.27), or length of hospital stays (-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops-91.35 €, with PDS loops-96.51 €, and with a stapler-514.50 €. Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.
阑尾残端的闭合对于避免严重的术后并发症至关重要。有许多方法可供选择,但尚未确定最佳方法。本研究旨在评估使用自锁聚合物夹和内镜吻合夹闭合阑尾残端的效果。
对前瞻性维护的急性阑尾炎患者数据库进行了回顾性分析。记录了患者的人口统计学细节和手术特征,包括住院时间、术后并发症,以及阑尾残端闭合的费用。根据阑尾残端闭合方法将患者分为两组:使用自锁聚合物夹闭合的夹闭组和使用薇乔或可吸收缝线环闭合的环闭组。使用 R 统计软件包版本 4.2.1 中的 Pearson 卡方检验、Wilcoxon 秩和(Mann-Whitney U)检验和 Fisher 确切检验进行统计学分析。
2016 年 6 月至 2021 年 4 月期间,共有 515 例患者纳入本研究。两组患者在人口统计学方面(性别比较的卡方检验值>0.99,年龄的卡方检验值 0.16)、术后并发症(卡方检验值>0.99)、组织学发现(卡方检验值 0.27)或住院时间(卡方检验值 0.18)方面无显著差异。使用不同的阑尾残端闭合方法的手术费用有显著差异。在腹腔镜阑尾切除术中,使用自锁夹闭合一个阑尾残端的费用为 7.69 欧元,使用薇乔缝线环为 91.35 欧元,使用可吸收缝线环为 96.51 欧元,使用吻合器为 514.50 欧元。自锁聚合物夹可安全有效地闭合阑尾残端。夹闭组和环闭组患者的术后 30 天内时间或并发症发生率无显著差异。因此,在腹腔镜阑尾切除术后,这种方法可能是一种既能降低费用又能保持良好术后效果的技术。