Med J Bakirkoy. 2020; 16(4): 336-342 | DOI: 10.5222/BMJ.2020.59254

Comparison of Stump Burying using Laparoscopic and Open Methods in Complicated Acute Appendicitis

Sina Ferahman, Turgut Donmez, Serhan Yilmaz, Sezer Akbulut, Ahmet Surek, Hamit Ahmet Kabuli, Mehmet Karabulut
Bakýrkoy Dr.Sadi Konuk Training and Research Hospital, Department of General Surgery, Istanbul, Turkey

Objective: The choice of laparoscopic technique in the treatment of complicated acute appendicitis (CAA) harbours debatable
evidence because of higher rates of surgical complications such as postoperative intraabdominal abscess (POIIA). The aim of this
study is to compare postoperative results of appendiceal stump (AS) ligation and its burial into the cecum using laparoscopic or
open surgical techniques in patients with CAA.
Method: This is a single-center and retrospective analysis of patients with CAA operated between May 2018 and April 2020. AS
was intracorporeally knotted with silk and buried in the cecum with a purse-string suture (PSS). The patients were divided into
open appendectomy (OA) and laparoscopic appendectomy (LA) groups. Data concerning demographic characteristics,
intraoperative variables, hospital stay, surgical complications, morbidities, and postoperative findings were compared.
Results: A total of 66 patients including 36 patients (54.54%) underwent LA and 30 patients had OA were enrolled in the study.
Partial resection of cecum was performed in one patient in the OA group and two patients in the LA group with the help of a
stapler due to cecal floor necrosis. The operative time and duration of hospital stay were significantly shorter in the LA group
compared to the OA group. Surgical site infection and POIAA were significantlymore frequent in the OA group (p<0.001).
Conclusion: In acute complicated appendicitis, laparoscopic method can be applied as an effective method by closing the
appendiceal stump and burying into the cecum with a purse-string suture.

Keywords: complicated acute appendicitis, open appendectomy, laparoscopic appendectomy, purse string suture

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Komplike Akut Apandisitte Laparoskopik ve Açýk Yöntemle Güdük Gömmenin Karþýlaþtýrmasý

Sina Ferahman, Turgut Donmez, Serhan Yilmaz, Sezer Akbulut, Ahmet Surek, Hamit Ahmet Kabuli, Mehmet Karabulut
Bakýrkoy Dr.Sadi Konuk Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi, Ýstanbul, Türkiye

Amaç: Ameliyat sonrasý intraabdominal apse (POIIA) gibi daha yüksek cerrahi komplikasyonlar nedeniyle komplike akut apandisiti
(CAA) olan hastalarda laparoskopik yaklaþýmýn kullanýmýna iliþkin tartýþmalý kanýtlar vardýr. Bu çalýþmanýn amacý, CAA'lý hastalarda
laparoskopik veya açýk cerrahi teknik kullanýlarak apendiks güdüðünün ligasyonu ve çekuma gömülme yönteminin postoperatif
sonuçlarýný karþýlaþtýrmaktýr.
Yöntem: 2Mayýs 2018'den Nisan 2020'ye kadar ameliyat edilen CAA hastalarýnýn klinik kayýtlarýnýn tek merkezli retrospektif bir
analizidir. Apendiks güdük intrakorporeal olarak ipekle düðümlendi ve kese aðzý sütürü (PSS) ile çekuma gömüldü. Hastalar açýk
apendektomi (OA) ve laparoskopik apendektomi (LA) olarak iki gruba ayrýldý. Demografik veriler, intraoperatif deðiþkenler, hastanede
kalýþ süreleri, cerrahi komplikasyonlar, morbidite ve ameliyat sonrasý bulgular karþýlaþtýrýldý.
Bulgular: Çalýþmaya 36 LA (% 54,54) ve 30 OA olmak üzere toplam 66 hasta dahil edildi. Çekum taban nekrozu nedeniyle OA grubunda
1, LA grubunda 2 hastaya stapler yardýmý ile parsiyel çekum rezeksiyonu yapýldý. LA grubunda ameliyat süresi ve hastanede
kalýþ süresi OA grubuna göre anlamlý olarak daha kýsaydý. Cerrahi alan enfeksiyonu ve POIAA OA grubunda LA grubuna göre
anlamlý derecede yüksekti (p <0.001).
Sonuç: Akut komplike apandisitte laparoskopi, apendiks güdüðünün kapatýlmasý ve çekumun kese aðzý sütürü ile gömülmesiyle
güvenli ve etkili bir yöntem olarak uygulanabilir.

Anahtar Kelimeler: komplike akut apandisit, açýk apendektomi, laparoskopik apendektomi, gömme, kese aðzý sütürü

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