Komplike Olmayan Akut Apandisitte Uygulanan Laparoskopik Apendektomilerde Güdük Kapatma Yöntemlerinin Karşılaştırılması: Retrospektif Bir Kohort Çalışması

Year 2021, Volume: 74 Issue: 2, 176 - 182, 31.08.2021

Elvan Onur Kırımker

Abstract

Amaç: Daha kısa hastanede kalış süresi ve daha erken çalışmaya dönüş süresi sunan laparoskopik apendektomi, daha az postoperatif ağrı ve daha iyi kozmesis ile dünya çapında kabul gördü ve ilk laparoskopik apendektomi bildiriminden on yıllar sonra kılavuzlarda standart tedavi olarak yerini aldı. Bu çalışmada güdük kapatma yöntemleri ile postoperatif enfeksiyon komplikasyonları arasındaki ilişki incelenmiştir.

Gereç ve Yöntem: Komplike olmayan akut apandisit nedeniyle 10 yıllık bir süre içinde bir üniversite hastanesinde gerçekleştirilen laparoskopik apendektomi olguları retrospektif olarak incelendi. Stapler, polimer klips ve intrakorporeal düğüm dahil olmak üzere üç güdük kapatma yöntemi karşılaştırıldı.

Bulgular: Nihai analize toplam 391 olgu dahil edildi. Stapler, polimerik klips ve intrakorporeal düğüm sırasıyla 191 (%48,8), 52 (%13,3) ve 148 (%37,9) hastada güdük kapatılması için kullanıldı. Apendiks çapı stapler grubunda daha büyük, intrakorporeal düğüm grubunda daha küçük bulundu. Diğer preoperatif özellikler gruplar arasında benzerdi. İki intraabdominal apse dahil olmak üzere 9 (%2,3) cerrahi alan enfeksiyonu görüldü. Dokuz cerrahi alan enfeksiyonundan 8’i görece risk oranı 8.699 bulunan stapler grubunda gözlendi. Cerrahi alan enfeksiyonu olan olgularda postoperatif lökosit azalması daha az sıklıkta, lökosit azalması ise kantitatif olarak daha az bulundu veya hiç olmadı.

Sonuç: Polimerik klipsler ve intrakorporeal düğümler, komplike olmayan akut apandisit olgularında zımba kullanımına tercih edilmesini önerdiğimiz güdük kapatma yöntemleridir. Peroperatif lökosit sayısının seyri, postoperatif cerrahi alan enfeksiyonlarını öngörmede değerli olabilir.

Anahtar Kelimeler: Apandisit, Apendektomi, Laparoskopik Cerrahi

Keywords

Apandisit , Apendektomi , Laparoskopik Cerrahi

Ethical Statement

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Supporting Institution

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Project Number

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Thanks

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Comparison of Stump Closure Methods in Laparoscopic Appendectomies Performed for Uncomplicated Acute Appendicitis: A Retrospective Cohort Study

Abstract

Objectives: Laparoscopic appendectomy offering shorter hospital stay and time to work, less postoperative pain and better cosmesis gained worldwide acceptance and took its place as the standard treatment in the guidelines decades after the first report of laparoscopic appendectomy. In the present study, relationship between stump closure methods and postoperative infectious complications were analyzed.

Materials and Methods: Laparoscopic appendectomy cases performed for non-complicated acute appendicitis at a university hospital in a ten-year period were analyzed retrospectively. Three stump closure methods including stapler, polymer clip and intracorporeal knot were compared.

Results: Totally 391 cases were included in the final analysis. Stapler, polymeric clip and intracorporeal knot were used for closure of the stump in 191 (48.8%), 52 (13.3%) and 148 (37.9%) patients, respectively. Appendix diameter was found larger in the stapler group and smaller in the intracorporeal knot group. Other preoperative characteristics were similar among the groups. Nine (2.3%) surgical site infections including 2 intraabdominal abscesses were observed. Eight of 9 surgical site infections were observed in the stapler group with odds ratio of 8,699. Postoperative leucocyte decrease was found to be less frequent and leucocyte decrease was quantitatively less or absent in cases with surgical site infections.

Conclusion: Polymeric clips and intracorporeal knots are the stump closure methods we recommend being preferred over stapler use in cases of uncomplicated acute appendicitis. The course of the peroperative leukocyte count may be valuable in predicting postoperative surgical site infections.

Key Words: Appendicitis, Appendectomy, Laparoscopic Surgery

Keywords

Appendicitis , Appendectomy , Laparoscopic Surgery

Ethical Statement

Ethics Committee Approval: The study was approved by the Ethics Committee of the Ankara University School of Medicine (approval number: I11-710-20). Informed Consent: Informed consent was obtained from all participants in the study. Peer-reviewed: Externally peer-reviewed. Financial Disclosure: The author declared that this study received no financial support

Supporting Institution

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Project Number

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Thanks

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