Özgür Albuz, Hakan Buluş, Mustafa Doğan, Arzu Boztaş

Laparaskopik apendektomide apendisiyel güdüğün kapatılmasında linear endostapler kullanımı

Amaç : Akut apandisit şüphesi veya doğrulanmış hastalarda laparoskopik apandisit ameliyatı giderek artan bir tercihtir. Bu çalışmanın amacı stapler kullanımının appendiks güdüğünün kapatılmasındaki etkinliğini değerlendirmektir.Method: Akut apandisit tanısıyla Nisan 2016- Haziran 2016 tarihleri laparoskopik apandektomi uygulanan 24 hasta çalışmaya dahil edilmiştir. Çalışma retrospektif olarak planlanmıştır. Her bir konunun bilgilendirilmiş onayı ve Yerel Etik Komitesi onayı alındı. Bilgilendirilmiş onam formunu imzalayan hastalar çalışmaya dahil edildi. İmmün baskılama, diabetes mellitus, 18 yaş altı steroid ilaçları, plastrone apandisit tanısı alan, karın cerrahisi öyküsü olan ve makroskopik ve histopatolojik olarak kanıtlanmış negatif appendektomi yapılan hastalar hariç tutuldu. Hastanede kalış süresi, çalışma süresi, işe geri dönüş, geri dönüş oranı, güdük sızıntısı, yara enfeksiyon hızı ve maliyet açısından tıbbi kayıtlar retrospektif olarak tarandı. Sonuç: 16 erkek ve 8 kadın olan 24 hastaya laparoskopik apandektomi uygulandı. (ortalama yaş 33.1 – yaş ralığı 15-65 arasıdır) 24 hastada stapler kullanılarak laparoskopik appendektomi uygulamıştır. Ortalama hastane yatış süresi 2,8 gündür(2-6 gün aralığında). Sadece 1 hastada postoperatif yara yeri enfeksiyonu olmuştur(%4). Dönüşüm oranı %0 ‘dır. Appendiks güdüğünün açılması veya abse formasyonu vuku bulmamıştır(%4). Ameliyat süresi ortalama 13 (7-21) dakika, ilk oral gıdaya ve normal günlük aktiviteye başlama zamanı ise sırasıyla; 16 (12-26) saat, 3.8 (3-9) gün olarak bulunmuştur. Bunlara ek olarak mevcut maliyet 320 USD artırmıştır.

Anahtar Kelimeler:

Laparoskopik apendektomi, linear spapler, appendiks güdüğü, maliyet

Laparoscopic appendectomy using a linear endostapler to appendicular stump closure

Aim: Laparoscopic appendectomy is increasingly accepted as the operation of choice in patients with suspected or confirmed acute appendicitis. The aim of the current study was to evaluate the effectiveness of appendiceal stump closure using stapler.Methods: 24 patients with acute appendicitis who underwent laparoscopic appendectomy between April 2016 - June 2016 were included in the study. It was a retrospective reviewed. Informed consent of each subject and approval of the Local Ethics Committee was obtained. The patients who had signed the informed consent form were included in the study. Patients with immuno suppression, diabetes mellitus, using steroid medications, under the age of 18, over 65 were excluded. Additionally, cases diagnosed as plastrone appendicitis, who had history of abdominal surgery and negative appendectomy proven macroscopically and histopathologically were excluded.Medical records were screened retrospectively, in terms of hospitalization time, duration of operation, return to work, rate of return, stump leak, wound infection rate and cost.Results: Laparoscopic appendectomy was performed in 24 patients that is 16 males and 8 females .(mean age of 33.1 years; range of 16 to 65 years). Mean hospital stay was 2,8 days (range 2–6 days). Only one patient had post-operative wound infections (4% ). Conversion rate was 0%. No appendiceal stump leaks or intra-abdominal abscess occurred. Mean operative time was 13 (7-21) minute . In addition, time to the onset of oral feeding and normal daily activity were recorded and were 16 (12-26) hours, 3.8 (3-9) days respectively . Use of stapler for closure of the appendicular stump increased the current cost of 320$(total 940$).

Keywords:

Laparoscopic apendectomy, linear stapler, appendiceal stump, cost,

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