A new approach to laparoscopic appendectomy in children-clipless/sutureless Harmonic scalpel laparoscopic appendectomy
A new approach to laparoscopic appendectomy in children-clipless/sutureless Harmonic scalpel laparoscopic appendectomy
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DOI：
10.1007/s00423-021-02389-1
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发表时间：
2021-11-29
影响因子：
2.3
通讯作者：
Susnjar, Tomislav
中科院分区：
文献类型：
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作者：
Pogorelic, Zenon;Beara, Vedran;Susnjar, Tomislav
背景本研究的目的是研究Harmonic超声刀在腹腔镜阑尾切除术中闭合儿童阑尾根部的性能。方法对312例腹腔镜阑尾切除术患者进行前瞻性双中心临床研究。根据用于闭合阑尾根部的技术，将患者分为两个研究组。在第一组（n = 197）中，使用聚合物夹固定阑尾基底，而在第二组（n = 115）中，使用Harmonic超声刀以逐步方式密封基底，不放置任何夹或缝线。比较两组的治疗结果，包括并发症发生率、手术时间和住院时间。结果共纳入312例患者，中位年龄为11岁（IQR 8，15）。其中191人为男性（61.2%）。两组患者的基线特征对称。聚合物夹组共记录了10例（5.1%）术后并发症（术后脓肿n = 7，肠梗阻n = 3），而无夹组患者无术后并发症（P = 0.015）。在接受聚合物夹阑尾切除术的组中，分别有16名（8.1%）和12名（6.1%）儿童记录到持续0-72 h和> 72 h的发热，而在无夹组中，分别有2名（1.7%）和5名（4.3%）儿童观察到发热（P = 0.048）。无成形夹组的手术时间显著短于聚合物成形夹组（21 min（IQR 18，25）vs. 30 min（IQR 22，40），P < 0.0001）。此外，无结扎夹组患者的住院时间显著更短（2天（IQR 2，3）vs. 3天（IQR 2，4），P < 0.0001）。结论无夹式超声刀腹腔镜阑尾切除术是治疗小儿急性阑尾炎的一种安全有效的方法，与夹闭阑尾根部的腹腔镜阑尾切除术相比，并发症少，手术时间短。
Background The aim of this study was to investigate Harmonic scalpel performance in laparoscopic appendectomy for sealing the base of the appendix in children. Methods During the study period, a total of 312 patients who underwent laparoscopic appendectomy were included in prospective bicenter clinical trial. The patients were divided in two study groups in regard to technique used for appendiceal base closure. In the first group (n = 197) the appendiceal base was secured using a polymeric clip while in the second group (n = 115) the Harmonic scalpel was used for sealing the base in a stepwise manner, without placing any clip or suture. Outcomes of treatment, including complication rates, duration of surgery and length of hospital stay were compared between the groups. Results A total of 312 patients with a median age of 11 years (IQR 8, 15) were included in study. Of these, 191 were males (61.2%). Both groups were symmetric in regard to baseline characteristics of the patients. A total of 10 (5.1%) postoperative complications (postoperative abscess n = 7 and ileus n = 3) were recorded in the polymeric clip group while none of the patients from the clipless group had postoperative complications (P = 0.015). In the group who received a polymeric clip appendectomy, fever lasting 0-72 h and > 72 h was recorded in 16 (8.1%) and 12 (6.1%) children, respectively, while in the clipless group, it was observed in 2 (1.7%) and 5 (4.3%) children, respectively (P = 0.048). Significantly shorter surgical times were found in the clipless group compared to the polymeric clip group (21 min (IQR 18, 25) vs. 30 min (IQR 22, 40), P < 0.0001). Also, length of hospital stay was significantly shorter in the clipless group of the patients (2 days (IQR 2, 3) vs. 3 days (IQR 2, 4), P < 0.0001). Conclusion Clipless harmonic scalpel laparoscopic appendectomy is a safe and effective method in children for treatment of acute appendicitis with lesser number of complications and shorter duration of surgery compared to laparoscopic appendectomy in which the appendiceal base is secured with clip.