Laparoskopik Apendektomide Apendiks Güdüğünün Hemolok Klip İle Kapanması

Abstract

Laparoskopik apendektomide (LA) apendiks güdüğünü kapamak için birçok teknik kullanılmaktadır. Bu çalışma ile apendiks güdüğünün kapatılmasında Hemolok klip kullanımının güvenilirliğini ve kullanılabilirliğini araştırmayı amaçladık. Ocak 2015 ile Ekim 2018 tarihleri arasında Hemolok klipleri ile güdük kapatılması planlanan ve LA uygulanan 87 hasta üç ayrı cerrah tarafından opera edildi. Bunların arasında 9 (%10.3) hastaya hemolok klip uygulaması yapılamadı. Geriye kalan 78 hasta analizlere dahil edildi. Hastaların demografik verileri, ameliyat süreleri, hastanede kalış süreleri ve komplikasyonları irdelendi. Hemolok kullanılan 78 hastanın 39’u (%50) erkek 39’u (%50) kadındı. Yaş ortalaması 28,55 ± 10,61 (18-73) yıldı. Ortanca ameliyat süresi 51,3 (30-160) dakika idi. Hastaların 22 tanesinde (%28,2) komplike apandisit (perfore, nekroze gibi) hali mevcuttu. Hastalara ameliyat sonrası oral diet başlama zamanı 10.48 (4-36) saat idi ve hastanede yatış süresi ortanca 22,92 (6-72) saat idi. Hemolok kullanılan 4 hastada (%5,1) postoperatif komplikasyon gelişti. Bunların 2'si karın ağrısı, 1’i karın şişliği ve 1’i ise trokar yeri enfeksiyonuydu. Bunların hiç biri hemolok kullanımına bağlı değildi. Hastaların hiçbirinde tekrar ameliyata ihtiyaç duyulmadı. Hemolok kullanılamayan hastaların apendiks çapı hemolok kullanılan hastalardan anlamlı olarak daha kalındı (p = 0.003). LA yapılan olgularda apendiks güdüğünün hemolok ile kapatılması uygun, güvenli, hızlı ve kost-efektif bir tekniktir. Burada önemli olan, apendiks çapının 1 cm ve altında olmasının yanı sıra apendiks güdüğünün aşırı derecede ödemli ve nekroze olmamasıdır.

Keywords

• Akut apandisit
• laparoskopik apendektomi
• apendiks güdüğü
• hemolok klip

Appendiceal stump closure with hem-o-lok clips in laparoscopic appendectomy

Abstract

Various appendiceal stump closure techniques are used in laparoscopic appendectomy (LA). The purpose of this study was to investigate the safety and usefulness of the Hemolok clip for the closure of appendicular stumps in LA. From January 2015 to October 2018, a total of 87 consecutive patients underwent LA by three surgeons with planned use of Hemolok clips. In 9 (10.3%) patients, hemolok clips could not be used for the closure of the stump. The remaining 78 patients were included for analysis. The demographics, operation time, hospitalization time and complications were recorded. Of these 78 patients, 39 (50%) were male and 39 (50%) were female. The mean age was 28.55 ± 10.61 (18-73) years and median operation time was 51.3 (30-160) minutes. Twenty-two (28.2%) of the patients had complicated appendicitis (perforated, necrotic). The median time until oral diet allowance was 10.48 (4-36) hours after surgery and median hospitalization time was 22.92 (6-72) hours. Postoperative complications were seen in 4 (5.1%) patients; two had abdominal pain, one had abdominal distention and one had trocar site infection. None of the complications were associated with the use of hemolok clips. None of the patients required reoperation. The appendiceal diameter was found to be greater in patients without hemolok closure compared to patients with hemolok closure (p = 0.003). The closure of the appendix stump with hemolok in LA is an appropriate, safe, fast and cost-effective technique. It is important to note that the appendix stump should not be extremely edematous or necrotic in order to be able to apply hemolok clips. Ideally, the stump should have a diameter smaller than 1 cm.

Keywords

• Laparoscopic appendectomy
• appendiceal stump
• hem-o-lok clip
• Acute appendicitis

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