Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

Abstract

Objective To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. Methods The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People’s Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. Results There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). Conclusion Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients’ appendiceal stumps were treated with laparoscopic purse-string sutures.

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

“…Several reports have discussed methods of appendectomy in laparoscopic surgery [ 21 – 23 ]. Zorzetti N et al suggested the routine use of endloop for appendectomy even in case with complicated appendicitis because of cost effectivity and lower complications [ 21 , 22 ].…”

“…Zorzetti N et al suggested the routine use of endloop for appendectomy even in case with complicated appendicitis because of cost effectivity and lower complications [ 21 , 22 ]. Bao W et al reported that purse-string sutures effectively reduced the incidence of postoperative complications after a laparoscopic appendectomy for CA [ 23 ]. We usually use endloop, but sometimes use endstapler for cases with necrotic appendicitis.…”

Efficacy and Safety of Minimally Invasive Surgery Techniques in The Treatment of Acute Appendicitis: A literature review.

“…Because endloop surgery is less expensive and has fewer problems than open surgery, Zorzetti N et al recommended using it routinely for surgery, especially in cases of severe appendicitis (13) (14) . Pursestring sutures have been shown by Bao W et al to be an effective way to lower the incidence of postoperative problems after a laparoscopic appendectomy for CA (15) . In situations of necrotic appendicitis, we often employ endstapler instead of endloop.…”

Manejo del muñón apendicular en la actualidad

“…En China, Bao et al (2023) han estudiado 568 pacientes apendicentomizados por vía laparoscópica, en el 51,9% de estos se realizó cierre de muñón apendicular mediante sutura en bolsa de tabaco, mientras que el grupo control (48,1%) fue sometido a manejo de muñón remanente con empleo de pinza de Hem-O-Lok. La duración de la estancia en el centro hospitalario fue menor en el grupo de casos (p<0,05), no hubo diferencias en la duración de la cirugía y el inicio de la vía oral.…”