López VRG, Flores SR

Language: Spanish
References: 21
Page: 42-49
PDF size: 94.78 Kb.

ABSTRACT

Objective: To compare simple ligation (SL) versus invagination (INV) of the appendiceal stump after appendectomy, testing the hypothesis that there is no difference in the complication rate.
Design: A systematic review of randomized controlled trials.
Statistical analysis: The meta-analysis was performed using risk difference (Peto odds ratio) and weighted average difference (with their respective 95% confidence intervals).
Survey strategy: Systematic revision of the worldwide literature, without restriction on language, dates or other considerations. The sources of information used were: Embase, Lilacs, Medline, Cochrane Controlled Clinical Trials Database.
Selection criteria: The studies included for review were selected according to randomization criteria. The external validity of the studies was investigated via the characteristic of participants, the interventions and variables analyzed. Selection of clinical studies was performed focusing on analysis of adult patients, on an elective basis made by the two reviewers.
Data collection and analysis: The methodological quality of the studies was assessed by the same reviewers, using the Jadad score. Variables analyzed were: surgical time, wound infection, postoperative pyrexia without wound infection, pelvic abscess, postoperative paralytic and adherent ileus and incisional hernia.
Results: Eight clinical trials were selected. A total of 2,484 patients were included, of whom 1,281 underwent simple ligation and 1,203 the invagination technique. No statistical difference was found between the variables, except for operation time (faster in ligation group, p ‹ 0.05) and postoperative paralytic ileus (lower in ligation group, p ‹ 0.0013).
Conclusion: The evidence found is sufficient to demonstrate that, in relation to appendiceal stump handling either with simple SL or INV, there is no difference in complication rates (wound infection, postoperative pyrexia, pelvic abscess, adherent ileus or incisional hernia), but that the former is faster to perform and has a lower rate of paralytic ileus.

REFERENCES

1. Chaudhary IA, Samiullah, Mallhi AA, Afridi Z, Bano A. Is it necessary to invaginate the stump after appendicectomy. Pak J Med Sci 2005; 21: 35-38.

2. Engström L, Fenyö G. Appendicectomy: Assessment of stump invagination versus simple ligation: a prospective, randomized trial. Br J Surg 1985; 72: 971-2.

3. Osime U, Ofili OP, Duze A. A prospective randomized comparison of simple ligation and stump invagination during appendicectomy in Africans. J Pak Med Assoc 1988; 38: 134-6.

4. Lavonius MI, Liesjärvi S, Niskanen RO, Ristkari SK, Korkala O, Mokka RE. Simple ligation vs stump inversion in appendicectomy. Ann Chir Gynaecol 1996; 85: 222-224.

5. Street D, Bodai BI, Owens LJ, Moore DB, Walton CB, Holcroft JW. Simple ligation vs stump inversion in appendectomy. Arch Surg 1988; 123: 689-690.

6. Dass HP, Wilson SJ, Khan S, Parlade S, Uy A. Appendicectomy stumps: “to bury or not to bury”. Trop Doct 1989; 19: 108-9.

7. Sinha AP. Appendicectomy: an assessment of the advisability of stump invagination. Br J Surg 1977; 64: 499-500.

8. Meissner K. Inversion versus amputation of the appendix: an objective comparison of 440 randomized cases. Langenbecks Arch Chir 1980; 353: 129-38.

9. Kingsley DP. Some observations on appendicectomy with particular reference to technique. Br J Surg 1969; 56: 491-496.

10. Ambrose NS, Donovan IA, Wise R, Lowe P. Metronidazole and ticarcillin in the prevention of sepsis after appendicectomy. Am J Surg 1983; 146: 346-8.

11. Grant C, Twum-Danso K, al-Awami MS, al-Breiki H, Wosornu L. Prophylaxis against post-appendicectomy wound infection. A controlled clinical trial of intravenous (i.v.) metronidazole versus i.v. metronidazole-ampicillin-gentamicin. Int Surg 1989; 74: 129-32.

12. Burkitt DS, Donovan IA, Wise R, Lowe P. A comparison between imipenem and metronidazole prophylaxis against sepsis following appendicectomy. J Hosp Infect 1990; 15: 283-6.

13. al-Dhohayan A, al-Sebayl M, Shibl A, al-Eshalwy S, Kattan K, al-Saleh M. Comparative study of augmentin versus metronidazole/gentamicin in the prevention of infections after appendicectomy. Eur Surg Res 1993; 25: 60-4.

14. Zbar RI, Crede WB, McKhann CF, Jekel JF. The postoperative incidence of small bowel obstruction following standard, open appendectomy and cholecystectomy: a six-year retrospective cohort study at Yale-New Haven Hospital. Conn Med 1993; 57: 123-7.

15. Riber C, Soe K, Jorgensen T, Tonnesen H. Intestinal obstruction after appendectomy. Scand J Gastroenterol 1997; 32: 1125-8.

16. Andersson RE. Small bowel obstruction after appendicectomy. Br J Surg 2001; 88: 1387-91.

17. Tingstedt B, Johansson J, Nehez L, Andersson R. Late abdominal complaints after appendectomy—readmissions during long-term follow-up. Dig Surg 2004; 21: 23-7.

18. Watkins BP, Kothari SN, Landercasper J. Stump appendicitis: case report and review. Surg Laparosc Endosc Percutan Tech 2004; 14: 167-171.

19. Khairy GA, Afzal MF, Murshid KR, Guraya S, Ghallab A. Post appendectomy small bowel obstruction. Saudi Med J 2005; 26: 1058-60.

20. Watters DA, Walker MA, Abernethy BC. The appendix stump: should it be invaginated? Ann R Coll Surg Engl 1984; 66: 92-3.

21. Jacobs PP, Koeyers GF, Bruyninckx CM. Simple ligation superior to inversion of the appendiceal stump: a prospective randomized study. Ned Tijdschr Geneeskd 1992; 136: 1020-3.