Çocuklarda laparoskopik appendektomide iki farklı sütür materyali ile appendiks güdüğünün kapatılması

Amaç: İki farklı dikiş materyali kullanılarak apendiks güdüğünün kapatılması sonuçlarının literatür verileri ile karşılaştırılması. Gereç ve yöntem: Bu çalışmada laparoskopik apendektomi uygulanan 36 çocuk vakasını retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: Vicryl sütür grubu ve ipek sütür grubu. Laboratuvar sonuçları, tanı algoritmaları, cerrahi teknikler ve komplikasyonlar araştırıldı. Bulgular: Olguların 16'sı (%44) erkek, 20'si (%56) kızdı. Tüm hastaların ortalama hastaneye başvuru süresi 2.22±1,6 gün (1-7 gün) idi. Ortalama WBC ve CRP seviyeleri vicryl grubunda 14.67±5.8x109/L, 139.3±120 mg/L ve ipek grubunda 15,36±6,4x109/L ve 86±80 mg/L idi. Vicryl grubunda 9, silk grubunda 6 hastada ince barsak obstrüksiyonu görüldü. Olguların 31'ine ultrasonografi yapıldı, 21'ine (%67) apendiks görüldü. 25 olguya intravenöz kontrastlı BT uygulandı. Laparoskopik eksplorasyonda 20 vaka komplike olarak sınıflandırıldı - 17'si perforasyon ve 3'ü gangrenöz. Tüm olgular geniş spektrumlu antibiyotiklerle tedavi edildi. Ortalama takip süresi 43 aydı (10-117 ay); hiçbir hastada intraoperatif komplikasyon görülmedi ve sadece iki hastada postoperatif dönemde minör komplikasyon gelişti. Sonuç: Her koşulda ve apendiksin çapından bağımsız olarak apendiks güdüğü hem ipek hem de vikril sütür materyali ile güvenli bir şekilde kapatılabilir.

Anahtar Kelimeler:

Laparoskopik apendektomi, çocuk, güdük kapatılması, komplikasyonlar

Closure of the appendix stump with two different suture materials in laparoscopic appendectomy in children

Purpose: To evaluate the outcomes of the closure of the appendix base using two different suture materials that we used in our clinic with those published in the literature. Materials and methods: The study retrospectively reviews 36 cases of children who underwent laparoscopic appendectomies. The patients were divided into two groups: the Vicryl suture group and the silk suture group. Laboratory results, diagnostic algorithms, surgical techniques, and complications were investigated. Results: Sixteen (44%) of the cases were male, and twenty (56%) were female. All patients' mean hospital admission time was 2.22±1.6 days (range: 1-7 days). The mean WBC and CRP levels were 14.67±5.8x109/L, 139.3±120 mg/L in the vicryl group and 15.36±6.4x109/L and 86±80 mg/L in the silk group. Small bowel obstruction was observed in nine patients in the vicryl group and six patients in the silk group. Ultrasonography was performed in 31 of the cases, the appendix was visualized in 21 cases (67%).Intravenous contrast-enhanced CT imaging was applied in 25 cases. At laparoscopic exploration, 20 cases were classified as complicated—17 due to perforation, and 3 due to gangrene. All cases were treated with broad-spectrum antibiotics. The mean follow-up period was 43 months (range: 10-117 months); none of the patients experienced intraoperative complications, and only two patients had minor complications in the postoperative period. Conclusion: In all circumstances and regardless of the appendix's diameter, the appendix stump can be securely closed with both silk and vicryl suture material.

Keywords:

Laparoscopic appendectomy, child, stump closure, complications,

PDF

___

1. Akhtar Danesh GG, Doumouras AG, Flageole H, Hong D. Geographic and socioeconomic predictors of perforated appendicitis: a national Canadian cohort study. J Pediatr Surg 2019;54:1804-1808. https://doi.org/10.1016/j.jpedsurg.2018.10.065
2. Hue CS, Kim JS, Kim KH, Nam SH, Kim KW. The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy. J Korean Surg Soc 2013;84:27-32. https://doi.org/10.4174/jkss.2013.84.1.27
3. Mayir B, Bilecik T, Ensari C, Oruc M. Laparoscopic appendectomy with hand-made loop. Videosurgery and Other Miniinvasive Techniques. 2014;9:152-156. https://doi.org/10.5114/wiitm.2014.41624
4. Colak E, Kement M, Ozlem N, et al. A comparison of nonabsorbable polymeric clips and endoloop ligatures for the closure of the appendicular stump in laparoscopic appendectomy: a prospective, randomized study. Surg Laparosc Endosc Percutan Tech 2013;23:255-258. https://doi.org/10.1097/SLE.0b013e31828b8382
5. Gemici E, Dönmez T, Sürek A, et al. Comparison of three techniques for appendiceal stump closure during laparoscopy. J Surg Med 2020;4:618-622. https://doi.org/10.28982/josam.781614
6. Ates M, Dirican A, Ince V, Ara C, Isik B, Yilmaz S. Comparison of intracorporeal knot-tying suture (polyglactin) and titanium endoclips in laparoscopic appendiceal stump closure: a prospective randomized study. Surg Laparosc Endosc Percutan Tech 2012;22:226-231. https://doi.org/10.1097/SLE.0b013e31824f25cd
7. Agalar C, Derici S, Çevlik AD, et al. Do the stump knotting technique and specimen retrieval method effect morbidity in laparoscopic appendectomy? Ulus Travma Acil Cerrahi Derg 2019;25:34-38. https://doi.org/10.5505/tjtes.2018.90382
8. Gupta V, Chauhan SPS, Gupta M, Verma R, Singh SP, Panday A. Efficacy and safety of ligasure in laparoscopic sutureless appendectomy. Cureus 2022;14:e24764. https://doi.org/10.7759/cureus.24764
9. Semm K. Endoscopic appendectomy. Endoscopy 1983;15:59-64. https://doi.org/10.1055/s-2007-1021466
10. Kliuchanok K, Keßler W, Partecke I, et al. A comparison of non-absorbable polymeric clips and staplers for laparoscopic appendiceal stump closure: analysis of 618 adult patients. Langenbecks Arch Surg 2019;404:711-716. https://doi.org/10.1007/s00423-019-01814-w
11. Gomes CA, Junior CS, de Peixoto RO, Netto JM, Gomes CC, Gomes FC. Appendiceal stump closure by metal endoclip in the management of complicated acute appendicitis. World J Emerg Surg 2013;8:35. https://doi.org/10.1186/1749-7922-8-35
12. Juan HL, Nicolas AM, Daniela CL, et al. Use of a bipolar device (LigaSure) to seal the appendiceal stump in pediatric laparoscopic appendectomy: 10-year Latin-American experience. J Pediatr Surg 2022;11:1-5. https://doi.org/10.1016/j.jpedsurg.2022.10.005
13. Aslan A, Karaveli C, Elpek O. Laparoscopic appendectomy without clip or ligature. An experimental study. Surg Endosc 2008;22:2084-2087. https://doi.org/10.1007/s00464-007-9712-z
14. Mayir B, Ensari CÖ, Bilecik T, Aslaner A, Oruç MT. Methods for closure of appendix stump during laparoscopic appendectomy procedure. Ulus Cerrahi Derg 2015;31:229-31. https://doi.org/10.5152/UCD.2015.2768
15. Kuehnel F, Marusch F, Koch A, Gastinger I. Retained loose linear cutter staples after laparoscopic appendectomy as the cause of mechanical small bowel obstruction. Int J Colorectal Dis 2007;22:717-718. https://doi.org/10.1007/s00384-005-0759-9
16. Soll C, Wyss P, Gelpke H, Raptis DA, Breitenstein S. Appendiceal stump closure using polymeric clips reduces intra-abdominal abscesses. Langenbecks Arch Surg 2016;401:661-666. https://doi.org/10.1007/s00423-016-1459-3
17. Ozdemir H, Sunamak O. Comparison of the non-absorbable polymer clips, knot-tying, and loop ligature appendiceal stump closure methods in laparoscopic appendectomy. Cir Cir 2022;90:193-196. https://doi.org/10.24875/CIRU.20001419
18. Partecke LI, Kessler W, Patrzyk M, Heidecke CD, Bernstorff WV. Comparison among different closure methods of the appendicular stump in laparoscopic appendectomy. Surg Technol Int 2011;21:85-91.