Role of Laparoscopic Appendectomy Radix Ligation Techniques on the Formation of Inner Abdomen Abscess

Objectives: Our aim was to study whether laparoscopic appendectomy radix ligation techniques were eutrophic in the development of intra-abdominal abscess.
Methods: Between September 2009 and April 2017, all emergency cases admitted to our surgery polyclinic were reviewed, and the results of the patients who underwent laparoscopic appendectomy were collected. Appendectomy radix ligation techniques were reviewed from surgical notes on discharge reports. Postoperative controls were also reviewed, and any cases with abscess formation were reported.
Results: A total of 350 patients were included in the study. Of these cases, 207 were males, and 143 were females. The mean age of the patients was 26.89±4.9 years. One hundred eighty-nine cases were found to have two endoloops placed on top of each other, whereas 161 cases had a 2 mm distance left in between the two endoloops and tied. None of the 189 cases who had endoloops placed on top of each other developed abscess formation. However, of the 161 cases who had endoloops with a 2 mm distance in between, 8 reported with abscess formation in the inner abdomen. Of these eight cases, seven had percutaneous abscess drainage by an interventional radiologist, whereas one was treated with relaparoscopy.
Conclusion: In the present study, patients who had endoloops placed on top of each other developed no abscess formation, whereas in the literature’s gold standard procedure, those with a 2 mm distance left between two endoloops developed an inner abdominal abscess formation in 8 (4.9%) of the patients. We believe that this 2 mm dead space distance left between the two endoloops contributes to the formation of the abscess.

Laparoskopik Appendektomide Güdük Baðlanma Tekniklerinin Batýn Ýçi Abse Geliþimindeki Rolü

Amaç
Laparoskopik appendektomide güdük baðlanma tekniklerinin batýn içi abse geliþiminde etkili olup olmadýðýný araþtýrmak.
Gereç ve Yöntem
Eylül 2009-Nisan 2017 tarihleri arasýnda acil cerrahi polikliniðimize baþvurmuþ olan tüm olgularýn verileri geriye dönük incelendi ve laparoskopik apendektomi ameliyatý geçiren tüm hastalarýn verileri toplandý. Epikrizlerdeki ameliyat notlarýnda apendiks güdüðünün nasýl baðlandýðý incelendi ve kaydedildi. Ameliyat sonrasý kontroller de incelendi ve abse geliþen olgular kaydedildi.
Bulgular
Toplam 350 hasta çalýþmaya dahil edildi. Olgularýn 207’si erkek, 143’ü kadýn idi. Yaþ ortalamasý 26.89±4.9 yýl idi. 189 olguya iki endo-loop üst üste konulup, 161 olguya ise iki endo-loop’un arasýnda ikiþer milimetre mesafe býrakýlarak baðlandýðý görüldü. Endo-loop üst üste konulup ameliyat edilen 189 olgunun hiç birinde batýn içi abse saptanmadý, endo-loop’ larýn arasýnda ikiþer milimetre mesafe býrakýlarak baðlanýp ameliyat edilen 161 olgunun 8’inde batýn içi abse saptandý. Bu 8 olgudan 7’sinin tedavisi giriþimsel radyoloji tarafýndan perkütan abse drenajý ile, birinin ise laparoskopi ile yapýldýðý saptandý.

Sonuç
Bu çalýþmada, endo-loop üst üste konulup ameliyat edilen hastalarda hiç abse formasyonu gözlemlenmezken, literatürde altýn standart olarak tarif edilen endo-loop’un arasýnda ikiþer milimetre mesafe býrakýlarak baðlanýp ameliyat edilen hastalarýn 8(%4.9)’ inde batýn içi abse geliþtiði görüldü. Ýki loop’ un arasýnda ölü mesafe býrakýlarak ameliyat edilen hastalarda bu ölü mesafenin batýn içi abse geliþimine katkýda bulunduðuna inanmaktayýz.