Apendiks Güdüğünün Kapatılmasında Kullanılan Hem-o-lok Klips ile İntrakorporal Sütürün Erken ve Geç Dönem Sonuçlarının Karşılaştırılması

Abstract

Giriş ve Amaç: Bu çalışmada apendiks güdüğü kapatılmasında kullanılan Hem-o-lok klips ile intrakorporal sütürün erken ve geç dönem sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntemler: Ocak 2019 ile Aralık 2020 tarihleri arasında üçüncü basamak bir sağlık kuruluşunda laparoskopik apendektomi yapılan hastalar geriye dönük olarak incelendi. Apendiks güdüğü Hem-o-lok kliplerle kapatılan hastalar Grup 1, intrakorporal sütürle kapatılan hastalar Grup 2 olarak adlandırıldı. Ameliyat sonrası ilk 30 gün içinde gelişen komplikasyonlar erken sonuçlar, 30 günden sonraki komplikasyonlar geç sonuç olarak kabul edildi. Gruplar arasındaki erken ve geç sonuç farklılıkları Mann Whitney U testi, bağımsız gruplarda t testi ve ki-kare testi kullanılarak değerlendirildi, p değeri <0,05 anlamlı kabul edildi. Bulgular: Çalışma kriterlerini karşılayan 147 hasta vardı ve hastaların 93'ü (%63,3) erkekti. Grup 1'de 120 (%81,6) hasta, Grup 2'de 27 (%18,4) hasta vardı. Preoperatif apendiks çapı (8,85mm- 14,48mm, p<0,001), operasyon süresi (65,87 - 110,15 dakika, p<0,001) ve ortanca hastanede kalış süresi (71,87'ye karşı 83,46, p=0,032) Grup 2'de daha yüksek iken, komplike olmayan akut apandisit oranı Grup 1'de daha yüksekti (%93,5'e karşı %50). Erken ve geç komplikasyonlar açısından iki grup arasında istatistiksel olarak anlamlı fark yoktu. Sonuç: Preoperatif apendiks çapının büyük olduğu durumlarda ve komplike apandisit olgularında daha çok tercih edilen intrakorporal sütür, ameliyat süresinin ve hastanede kalış süresinin uzaması dışında herhangi bir dezavantajı olmayıp, Hem-o-lok klips ile benzer erken ve geç komplikasyon oranlarına sahiptir. Bu nedenle, Hem-o-lok klipler gibi intrakorporal sütür son derece güvenilir ve kullanışlı bir yöntemdir.

Keywords

• Apandisit
• hem-o-Lok klips
• komplikasyon
• sütür ile bağlama

Comparison of Early and Late Results of Hem-o-lok Clip and Intracorporeal Knotting Used in Closure of Appendiceal Stump

Abstract

Introduction: In this study, it was aimed to compare the early and late results of Hem-o-lok clips and intracorporeal knotting used in appendiceal stump closure. Materials and Methods: Patients who underwent laparoscopic appendectomy in a tertiary healthcare institution between January 2019 and December 2020 were retrospectively analyzed. The patients whose appendix stump was closed with the Hem-o-Lok clips were named Group 1, and the patients whose appendix stump was closed with intracorporeal knotting were named Group 2. Complications that developed within the first 30 days after surgery were evaluated as early results, and complications after 30 days were considered as late results. Early and late result differences between the groups were evaluated using Mann Whitney U test, independent samples t test, and Chi-square test, assuming p value <0.05 significant. Results: There were 147 patients who met the study criteria, and 93 (63.3%) of the patients were male. There were 120 (81.6%) patients in Group 1, and there were 27 (18.4%) patients in Group 2. Preoperative appendix diameter (8.85mm vs. 14.48mm, p<0.001), operation time (65.87 vs. 110.15 minutes, p<0.001) and median length of hospital stay (71.87 vs. 83.46, p =0.032) While it was higher in Group 2, the rate of non-complicated acute appendicitis was higher in Group 1 (93.5% vs. 50%). There was no statistically significant difference between the two groups in terms of early and late complications. Conclusion:Intracorporeal knotting, which is more preferred in cases with large preoperative appendiceal diameter and in complicated acute appendicitis cases, has no disadvantages other than prolongation of operation time and hospital stay, and has similar early and late complication rates with Hem-o-lok clips closure. Therefore, intracorporeal knotting, like Hem-o-lok clips, is an extremely reliable and useful method.

Keywords

• Appendicitis
• Hem-o-lok clip
• complication
• intracorporeal knotting

References

1. Bayrak, S, Tatar, C, ve ark., Evaluation of the predictive power of laboratory markers in the diagnosis of acute appendicitis in the elderly, Northern Clinics of Istanbul, 2019, 6(3), 293-301.
2. Antoniou, S.A, Mavridis, D, ve ark., Optimal stump management in laparoscopic appendectomy: A network meta-analysis by the Minimally Invasive Surgery Synthesis of Interventions and Outcomes Network, Surgery, 2017, 162(5), 994-1005.
3. Masoomi, H, Mills, S, et al., Does laparoscopic appendectomy impart an advantage over open appendectomy in elderly patients? World Journal of Surgery, 2012, 36(7), 1534-9.
4. Gomes, C.A, Junior, C.S, ve ark., Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World Journal of Emergency Surgery, 2013, 8(1), 1-5.
5. Alis, H, Gonenc, M, ve ark., Metal endoclips for the closure of the appendiceal stump in laparoscopic appendectomy, Techniques in Coloproctology, 2012, 16(2), 139-41.
6. Reinke, C.E, Tabone, L.E, ve ark., Safety and efficacy of polymeric clips for appendiceal stump closure, Journal of the Society of Laparoendoscopic Surgeons, 2016,20(3), e2016.00045.
7. Ates, M, Dirican, A, ve ark., Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study, Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(3), 226-31.
8. Strzałka, M, Matyja, M, ve ark., Comparison of the results of laparoscopic appendectomies with application of different techniques for closure of the appendicular stump, World Journal of Emergency Surgery, 2016, 11(1), 1-6.

9. Kiudelis, M, Ignatavicius, P, ve ark., Analysis of intracorporeal knotting with invaginating suture versus endoloops in appendiceal stump closure, Videosurgery and Other Miniinvasive Techniques, 2013, 8(1), 69-73.
10. Soll, C, Wyss, P, et al., Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses, Langenbeck's Archives of Surgery, 2016, 401(5), 661-6.
11. Wilson, M, Maniam, P, ve ark., Polymeric clips are a quicker and cheaper alternative to endoscopic ligatures for securing the appendiceal stump during laparoscopic appendicectomy, The Annals of The Royal College of Surgeons of England, 2018, 100(6), 454-8.
12. Rickert, A, Krüger, C.M, ve ark., The TICAP-Study (titanium clips for appendicular stump closure): A prospective multicentre observational study on appendicular stump closure with an innovative titanium clip, BMC Surgery, 2015, 15(1), 1-9.
13. Bozkurt, M, Unsal, M, ve ark., Is laparoscopic appendectomy going to be standard procedure for acute appendicitis; a 5-year single center experience with 1,788 patients, European Journal of Trauma and Emergency Surgery, 2015, 41(1), 87-9.
14. Shadhu, K, Ramlagun, D, ve ark., Re-evaluation of purse string suture in laparoscopic appendectomy, Surgical Endoscopy, 2020, 34(2), 779-86.
15. Gonenc, M, Gemici, E, ve ark., Intracorporeal knotting versus metal endoclip application for the closure of the appendiceal stump during laparoscopic appendectomy in uncomplicated appendicitis, Journal of Laparoendoscopic & Advanced Surgical Techniques, 2012, 22(3), 231-5.