背景:今天,腹腔镜检查经常用于腹部急症,如急性阑尾炎。在腹腔镜阑尾切除术中,有几种方法可用于闭合阑尾残端。我们的目的是比较在资源有限的公立医院中使用手工制作的环和Hem-o-lok来关闭阑尾残端,在手术结果和成本方面。方法:在2020年1月至2022年12月之间,在我们的诊所进行腹腔镜阑尾切除术期间使用手工环和Hem-o-loks关闭阑尾残端的患者被纳入研究。共有638例患者(平均年龄:33±13.5岁,患者队列中有325名女性和313名男性)。人口统计学和临床数据,手术持续时间,并发症,住院,病理报告,死亡率,比较两组的耗材成本。结果:手工环组308例(160例女性,148名男性,平均年龄:33.7岁,范围:18-85岁)和Hem-o-lok组330名患者(166名女性,164名男性,平均年龄:32.5岁,范围:18-89年)。两组美国麻醉医师协会评分无显著差异,症状持续时间,住院,重症监护室逗留,术前实验室值,组织病理学结果,死亡率,和发病率(P>0.05)。手工环组的平均手术时间为48.76±16.16分钟,Hem-o-lok组为40.53±11.63分钟(p=0.001)。在成本方面,Hem-o-lok组的每例费用约为使用缝线组的25.8倍(31美元对1.2美元).结论:两种方法均可安全地用于腹腔镜阑尾切除术。Hem-o-lok的使用除了缩短操作时间之外没有任何优势。然而,它更昂贵。尤其是在资源有限的外围医院,使用手工循环关闭阑尾残端是一件容易的事,安全,和具有成本效益的方法。
Background: Today, laparoscopy is frequently used in abdominal emergencies such as acute appendicitis. There are several techniques used to close the appendiceal stump during laparoscopic appendectomy. We aimed to compare the use of handmade loop and Hem-o-lok used to close the appendiceal stump in public hospitals where resources are limited, in terms of surgical outcomes and cost. Methods: Between January 2020 and December 2022, patients for whom handmade loops and Hem-o-loks were used to close the appendiceal stump during laparoscopic appendectomy in our clinic were included in the study. There were a total of 638 patients (mean age: 33 ± 13.5 years, 325 females and 313 males) in the patient cohort. Demographic and clinical data, duration of surgery, complications, hospital stay, pathology reports, mortality, and cost of supplies were compared between the two groups. Results: There were 308 patients in the handmade loop group (160 females, 148 males, mean age: 33.7 years, range: 18-85 years) and 330 patients in the Hem-o-lok group (166 females, 164 males, mean age: 32.5 years, range: 18-89 years). There was no significant difference between the two groups for American Society of Anesthesiologists score, duration of symptom, hospital stay, intensive care unit stay, preoperative laboratory values, histopathological results, mortality, and morbidity (P > .05). The mean operation time was 48.76 ± 16.16 minutes in the handmade loop group and 40.53 ± 11.63 minutes in the Hem-o-lok group (p = 0.001). In terms of cost, the cost per case of Hem-o-lok group was about 25.8 times as much as the group that used sutures ($31 versus $1.2). Conclusions: Both methods can be used safely in laparoscopic appendectomy. The use of Hem-o-lok has no advantage other than shortening the operation time. However, it is costlier. Especially in peripheral hospitals where resources are limited, closing the appendiceal stump using a handmade loop is an easy, safe, and cost-effective method.