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Stumpfverschluss bei der laparoskopischen Appendektomie

Einfluss der endoskopischen Schlinge oder des Linearstaplers auf das Patientenoutcome

Stump closure in laparoscopic appendectomy

Influence of endoloop or linear stapler on patient outcome

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Zusammenfassung

Hintergrund

Die Appendektomie zählt zu den häufigsten viszeralchirurgischen Eingriffen. Obwohl die laparoskopische Operationstechnik klinisch etabliert ist, wird der Verschluss des Appendixstumpfes bisher nicht standardisiert gehandhabt. Ziel dieser retrospektiven Studie war es, die Verwendung von endoskopischen Schlingen (Endoloops) und Linearstaplern zum Appendixstumpfverschluss in Bezug auf Wundinfekte (WI) und intraabdominelle Abszesse (IAA) zu vergleichen.

Patienten und Methoden

Alle laparoskopischen Appendektomien im Zeitraum vom 01.01.2007 bis zum 31.05.2010 wurden nach der Technik der Appendixstumpfversorgung in eine Endoloop-Gruppe (ELG) und eine Linearstapler-Gruppe (LSG) aufgeteilt und bezüglich der Outcomeparameter WI und IAA analysiert.

Ergebnisse

Im Studienzeitraum wurden 430 Appendektomien durchgeführt, davon 105 laparoskopisch. Von diesen entfielen 47,6 % (50) auf die LSG und 52,4 % (55) auf die ELG. In der LSG entwickelte sich in 3,1 % (1) der Fälle ein WI, in der ELG in 10 % (n = 4; p = 0,256). In der LSG kam es in keinem Fall zu einem IAA, in der ELG in 5,1 % (n = 2; p = 0,307).

Schlussfolgerung

Die Appendixstumpfversorgung mittels EL ist eine sichere und kostengünstige Methode, die selektiv bei niedriggradigen Entzündungen zu empfehlen ist. Bei höhergradigen Entzündungen ist der Einsatz des LS zu favorisieren.

Abstract

Background

Even though laparoscopic appendectomy is one of the most frequent procedures in abdominal surgery, the technique of appendiceal stump closure is still not standardized. The aim of this retrospective study was to analyze the effect of the use of endoloops or linear staplers for appendiceal stump closure concerning surgical site infections (SSI) and intra-abdominal abscesses (IAA).

Patients and methods

All laparoscopic appendectomies between January 1st 2007 and May 31st 2010 were split into an endoloop group (ELG) and a linear stapler group (LSG). The groups were compared with respect to the outcome parameters SSI and IAA.

Results

A total of 430 appendectomies were performed in the study period of which 105 operations were conducted laparoscopically. In this study 47.6 % (n = 50) were alloted to the LSG and 52.4 % (n = 55) to ELG. In LSG 3.1 % (n = 1) developed an SSI versus 10.0 % (n = 4, p = 0.254) in ELG. No IAAs occurred in LSG compared to 2 (5.1 %, p = 0.499) in ELG.

Conclusion

The use of EL for appendiceal stump closure is safe and cost effective for low-grade appendicitis but high-grade appendicitis should be treated with LS.

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Authors and Affiliations

  1. Abteilung für Allgemein-, Gefäß- und Thoraxchirurgie, Chirurgische Klinik I, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    M. Sohn MD, M. Hoffmann, U. Pohlen MD, PhD, J.C. Lauscher MD, U. Zurbuchen MD, C. Holmer MD, H.J. Buhr MD, PhD, FACS & K.S. Lehmann MD

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  1. M. Sohn MD
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  2. M. Hoffmann
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  3. U. Pohlen MD, PhD
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  4. J.C. Lauscher MD
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  5. U. Zurbuchen MD
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  6. C. Holmer MD
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  7. H.J. Buhr MD, PhD, FACS
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  8. K.S. Lehmann MD
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Correspondence to M. Sohn MD.

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Sohn, M., Hoffmann, M., Pohlen, U. et al. Stumpfverschluss bei der laparoskopischen Appendektomie. Chirurg 85, 46–50 (2014). https://doi.org/10.1007/s00104-013-2549-1

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  • DOI: https://doi.org/10.1007/s00104-013-2549-1

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