Mathur Apoorva, Yadav Gulab Dhar, Verma Shraddha, Shukla Priyesh
Department of General Surgery, Ganesh Shankar Vidhyarthi Memorial Medical College, Kanpur, IND.
Cureus. 2025 Jul 22;17(7):e88560. doi: 10.7759/cureus.88560. eCollection 2025 Jul.
Background and objective Appendicitis is a common cause of acute abdominal pain and a frequent indication for emergency abdominal surgery. Laparoscopic appendectomy has become the preferred surgical treatment due to its many advantages over open appendectomy, including reduced morbidity, shorter hospital stay, and faster recovery. A critical step in laparoscopic appendectomy is the secure closure of the appendix stump to prevent postoperative complications. While laparoscopic appendectomy is widely practiced, there is no consensus on the optimal method for appendix stump closure. This prospective study aimed to compare the harmonic scalpel (HS) with suture ligation (SL) for appendix base closure in terms of operative time, surgical site infection (SSI), postoperative pain, postoperative ileus, and hospital stay. Methods This prospective randomized controlled trial was conducted at the Department of General Surgery, GSVM Medical College, Kanpur, involving 60 patients with appendicitis undergoing laparoscopic appendectomy. The data entry was performed using Microsoft Excel. The final statistical analysis was carried out using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY). Continuous variables were presented as mean ± standard deviation (SD) or median with interquartile range (IQR), depending on data distribution. Categorical variables were expressed as frequencies and percentages. A p-value <0.05 was considered statistically significant. Results A total of 60 patients were randomized into two groups (30 each): HS and SL. The most affected age group was 18-42 years, with a male-to-female ratio of 1.2:1. The mean operative time was significantly shorter in the HS group (28.4 ± 6.2 minutes) compared to the SL group (43.3 ± 7.1 minutes, p<0.05). Postoperative pain scores were lower in the HS group at six, 24, and 48 hours (p<0.05). SSI (6.6% vs. 13.3%), postoperative ileus (6.6% vs. 13.3%), and readmission rates (3.3% vs. 10%) were all lower in the HS group. Hospital stay was also reduced (2.8 ± 1.2 vs. 3.5 ± 1.4 days, p<0.05), and patients returned to normal activities earlier. Conclusions This study demonstrates HS is a safe and effective alternative to suture ligation, offering improved surgical outcomes and faster recovery for appendiceal stump closure during laparoscopic appendectomy. HS significantly reduces operative time, postoperative pain, complication rates, hospital stay, and readmissions, while enhancing recovery and overall patient outcomes.
背景与目的 阑尾炎是急性腹痛的常见病因，也是急诊腹部手术的常见指征。与开腹阑尾切除术相比，腹腔镜阑尾切除术具有诸多优势，如发病率降低、住院时间缩短和恢复更快等，已成为首选的手术治疗方式。腹腔镜阑尾切除术中的一个关键步骤是安全闭合阑尾残端以预防术后并发症。虽然腹腔镜阑尾切除术已广泛应用，但对于阑尾残端闭合的最佳方法尚无共识。本前瞻性研究旨在比较超声刀（HS）与缝合结扎（SL）在阑尾根部闭合方面的手术时间、手术部位感染（SSI）、术后疼痛、术后肠梗阻及住院时间。
方法 本前瞻性随机对照试验在坎普尔GSVM医学院普通外科进行，纳入60例行腹腔镜阑尾切除术的阑尾炎患者。数据录入使用Microsoft Excel。最终统计分析使用SPSS Statistics 25.0版（IBM公司，纽约州阿蒙克）。连续变量根据数据分布以均值±标准差（SD）或中位数及四分位数间距（IQR）表示。分类变量以频率和百分比表示。p值<0.05被认为具有统计学意义。
结果 总共60例患者被随机分为两组（每组30例）：HS组和SL组。受影响最大的年龄组为18 - 42岁，男女比例为1.2:1。HS组的平均手术时间（28.4±6.2分钟）明显短于SL组（43.3±7.1分钟，p<0.05）。HS组在术后6小时、24小时和48小时的疼痛评分较低（p<0.05）。HS组的SSI（6.6%对13.3%）、术后肠梗阻（6.6%对13.3%）和再入院率（3.3%对10%）均较低。住院时间也缩短了（2.8±1.2天对3.5±1.4天，p<0.05），患者更早恢复正常活动。
结论 本研究表明，超声刀是缝合结扎的一种安全有效的替代方法，在腹腔镜阑尾切除术中用于阑尾残端闭合可提供更好的手术效果和更快的恢复。超声刀显著缩短手术时间、减轻术后疼痛、降低并发症发生率、缩短住院时间和再入院率，同时促进恢复并改善患者总体预后。
