Foula Mohammed S, Alsaleem Hassan, Eldamati Ahmed, Amer Naser M, Alsaffar Ali H, Alratrout Hefzi, Sharroufna Mohammed, Elsayed Waleed A, Zakaria Hazem
Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Drs. Foula, Alsaleem, Amer, Alratrout, Sharroufna, Elsayed, and Zakaria).
Department of Surgery, Alexandria University, Alexandria, Egypt. (Dr Eldamati).
JSLS. 2025 Jan-Mar;29(1). doi: 10.4293/JSLS.2024.00056. Epub 2025 Apr 3.
Acute appendicitis is the most frequent cause of emergency surgical procedures performed worldwide. Laparoscopic appendectomy (LA) has gained considerable popularity in the last decades. However, the ideal method for appendicular stump closure during LA is still debatable and depends on the surgeon's preference and intraoperative judgment. The endoloop ligatures (EL) is the most used method but its application is quite challenging. The efficacy of nonabsorbable polymeric clip (PC) has been proven and it was first described for appendicular stump closure in 2007.
A retrospective comparative cohort study was conducted including all consecutive patients who underwent LA from January 2017 to the end of 2023 in a tertiary university hospital. Data were retrieved from their electronic medical files. The patients were classified into 2 groups. The appendicular stump was closed using EL, in the first group, and using PC, in the second group. The calculated operative time started from the patient's entry to the operating theatre till transfer to the recovery room.
Out of 556 patients who underwent LA, 483 patients were included and classified into Group I (313 patients with EL), and Group II (170 patients with PC). Intraoperatively, complicated acute appendicitis was found in 27.8% and 36.5% and the median diameter of the appendix was reported 10 and 11.4 millimeters, respectively. The procedure was significantly shorter using PC (70 minutes vs 75 minutes, = .03) and the cost was lower using PC ($42.6 vs $95.8). Intra-abdominal collection was reported in 1.6% and 0.6%, localized abscess was reported in 1% and 0.6%, and the hospital readmission rate was 3.19% and 1.18%, respectively.
The use of nonabsorbable PCs is safe and feasible for appendicular stump closure during LA for acute appendicitis.
急性阑尾炎是全球范围内急诊外科手术最常见的病因。在过去几十年中，腹腔镜阑尾切除术（LA）已广受欢迎。然而，LA 期间阑尾残端闭合的理想方法仍存在争议，这取决于外科医生的偏好和术中判断。Endoloop 结扎术（EL）是最常用的方法，但其应用颇具挑战性。不可吸收聚合物夹（PC）的有效性已得到证实，并且在 2007 年首次被描述用于阑尾残端闭合。
进行了一项回顾性比较队列研究，纳入了 2017 年 1 月至 2023 年底在一家三级大学医院接受 LA 的所有连续患者。数据从他们的电子病历中获取。患者被分为两组。第一组使用 EL 闭合阑尾残端，第二组使用 PC 闭合阑尾残端。计算的手术时间从患者进入手术室开始，直至转移到恢复室。
在 556 例接受 LA 的患者中，483 例患者被纳入并分为第一组（313 例使用 EL）和第二组（170 例使用 PC）。术中发现复杂急性阑尾炎的比例分别为 27.8%和 36.5%，阑尾的中位直径分别报告为 10 毫米和 11.4 毫米。使用 PC 时手术时间明显更短（70 分钟对 75 分钟，P = 0.03），且使用 PC 的成本更低（42.6 美元对 95.8 美元）。腹腔内积液的报告发生率分别为 1.6%和 0.6%，局部脓肿的报告发生率分别为 1%和 0.6%，医院再入院率分别为 3.19%和 1.18%。
在 LA 治疗急性阑尾炎期间，使用不可吸收的 PC 进行阑尾残端闭合是安全可行的。
