Comparison of the results of appendectomy using laparoscopic bipolar vessel sealing system with the results of open appendectomy. LAPAROSKOP?K B?POLAR DAMAR KAPATICI S?STEM KULLANIMI ?LE YAPILAN APENDEKTOM?N?N A?IK APENDEKTOM?YLE KIYASLANMASI.

摘要

Although there were advances in laparoscopic surgery in the last 20 years, it has not lived up to expectations in laparoscopic appendectomy. In our study, we aimed to compare classical open appendectomy with laparoscopic appendectomy using bipolar vessel sealing system in uncomplicated acute appendicitis patients. This study was planned in a prospective and randomized fashion and ethical committee approval was obtained. Eighty five uncomplicated acute appendicitis patients who presented to Afyon Kocatepe University Faculty of Medicine, Haseki Education and Research Hospital, Rize Education and Research Hospital between 2006-2009 were enrolled in this study. Both groups were given antibiotic prophylaxis. Laparoscopic appendectomy was started under general anesthesia using 3 trocars. Appendectomy was commenced by LABVC and extracorporeal suture technique using 2/0 vicryl. Appendix was pulled out using endobag. Open appendectomy was done under general anesthesia using classical Mc-Burney incision. Patients who could tolerate enteral feeding without complications were discharged at postoperative 1st day. Both groups were compared in regard of operation time, the need for analgesics, time to start oral feeding, the duration of hospital stay, and complications. Eighty five patients were enrolled. The mean age was 27 (Range 17-51). Male–female ratio was 48/37. Thirty five patients underwent laparoscopic, 50 underwent open appendectomy. Two cases had to be converted to open surgery. The mean time of operation was 58 minutes in laparoscopic and 37 minutes in the open group. The requirement for postoperative parenteral analgesics was 1dose/24hrs in the laparoscopic group and 2 doses/24hrs in the open group. In the laparoscopic group 1 patient had intraabdominal haematoma, 1 had gastroenteritis, and 2 had trocar entry site haematoma. In the open surgery group, 1 patient had ileus, and 1 had subcutaneous haematoma. Two patients (%6) in the laparoscopic and 4 patients (%8) in the open surgery group had wound infection. These patients received medical treatment and were discharged without further complications. The pathological examinations of the specimens revealed appendicitis. When LABVC and open appendectomy were compared, the laparoscopic technique was found to be superior in terms of analgesic requirements and time to oral feeding and the open technique was superior in terms of operation time. There were no significant differences regarding the duration of hospital stay and complications. In conclusion LABVC is a safe method for appendectomy. ?ZET Laparoskopik cerrahi son 20 y?l? a?k?n sürede ilerleme sa?lamas?na ra?men laparoskopik apendektomide bekleneni veremedi. ?al??mam?zda komplike olmam?? akut apandisit vakalar?nda laparoskopik bipolar damar kapat?c? sistem (BDKS) kullanarak ger?ekle?tirdi?imiz apendektomi ile a??k apendektomiyi k?yaslamay? ama?lad?k. ?al??ma lokal etik kuruldan onay al?nd?ktan sonra prospektif ve randomize olarak planland?. Afyon Kocatepe üniversitesi, Haseki E?itim ve Ara?t?rma Hastanesi, Rize E?itim ve Ara?t?rma Hastanesi’nde 2006-2009 y?llar? aras?nda acil poliklini?e müracaat eden, fizik muayene ve laboratuar bulgular?nda komplike olmayan 85 akut apandisit olgusu ?al??maya dahil edildi. Her iki guruba antibiyotik proflaksisi uyguland?. Laparoskopik apendektomiye genel anestezi alt?nda 3 trokar girilerek ba?land?. Apendektomi BDKS ve 2/0 vicryl ile ekstrakorporal dü?üm tekni?i kullan?larak ger?ekle?tirildi. A??k apendektomi tekni?i ise genel anestezi alt?nda klasik Mc-Burney insizyonu ile ger?ekle?tirildi. Oral g?da al?m?n? tolere eden ve komplikasyon geli?meyen hastalar ameliyat sonras? 1. günde taburcu edildi. Her iki gurup ameliyat süresi, analjezik ihtiyac?, oral g?da al?m?na ba?lama zaman?, hastanede kal?? süresi ve komplikasyonlar a??s?ndan de?erlendirildi. ?al??maya 85 hasta dahil edildi. Hastalar?n ortalama ya?? 27.2 (en kü?ük 17, en büyük 51) idi. Erkek kad?n oran? 52/33 olarak bulundu. Hastalar?n 35’ine laparoskopik, 50’sine a??k apendektomi uyguland?. Laparoskopik olarak ba?lanan iki hastada a???a d?nülmek zorunda kal?nd?. Ortalama ameliyat süresi laparoskopik gurupta 58 dakika, a??k gurupta ise 37 dakika idi. Ameliyat sonras? ortalama parenteral analjezik ihtiyac? laparoskopik gurupta 1 doz/24 saat iken, a??k gurupta 2 doz/24 saat olarak saptand?. Laparoskopi gurubunda 1 hastada kar?n i?i hematom, 1 hastada gastroenterit, 2 hastada ise trokar yeri hematomu geli?ti. A??k gurupta ise 1 hastada ileus, 1 hastada cilt alt?nda hematom geli?ti. Laparoskopik gurupta 2 (%6) hastada, a??k gurupta 4 (%8) hastada yara enfeksiyonu geli?ti. Bu hastalar medikal olarak takip edilerek taburcu edildi. Piyeslerin patolojik incelemesinde apandisit ile uyumlu bulgular tespit edildi. BDKS kullan?larak yap?lan apendektomi a??k apendektomi ile k?yasland???nda, analjezik ihtiyac? ve oral g?daya ge?i? zaman? a??s?ndan laparoskopik y?ntem, ameliyat süresi a??s?ndan ise a??k y?ntem avantajl? olarak bul