A NEW METHOD OF TREATMENT FOR APPENDICEAL STUMP

Abstract

Background.In 30% of acute destructive appendicitis, the disease is accompanied by typhlitis, which makes it difficult to perform classical methods of appendiceal stump treatment.Aim of study.To improve the way of appendiceal stump treatment in the destructive form of acute appendicitis complicated by significant typhlitis.Material and methods.We studied 57 cases of acute destructive appendicitis complicated by typhlitis, which were divided into two groups depending on the method of treatment. The first group (comparison group) consisted of 30 patients who underwent a standard method for treating the appendiceal stump after appendectomy, such as ligation at the base and putting the stump into the cupula of the cecum and fixing it with interrupted serous-muscular sutures or with a purse and Z-shaped sutures. The second (main) group included 27 patients, who were treated by the method we proposed. The essence of the method is successive U-shaped stitching of the stump. After that, the stump curls in the form of a cochlea, peritonizes, reaching the necessary tightness without going into the cupula of the cecum. In this case, the abdominal cavity of patients in both groups was adequately sanitized and drained.Results.In the first group of patients there were technical difficulties associated with immersion of the appendiceal stump, which caused the serous damage, hematoma of the cupula of the cecum in 7 (23.3%) patients. In the second group of patients, due to the developed method of forming the appendiceal stump, technical difficulties did not arise, there were no complications. The duration of appendectomy in the first group of patients with standart treatment (interrupted serous-muscular sutures or purse and Z-shaped stiches) was 28.7±5.4 minutes, and in the second group of patients appendectomy with stump management with the suggested method lasted 20.3±6.1 minutes, p <0.05, which reduced the operation time by 8 minutes on the average. Purulent-inflammatory wound complications in the first group were detected in 7 patients (23.3%), and in 1 (3.7%) patient of the second group, which is significantly less by 19.6%.Conclusion.The proposed method is technically simple, as peritonization of the stump is performed without putting it into the cupula of the cecum. The use of this method is indicated in destructive forms of acute appendicitis complicated by severe typhlitis, which significantly reduces the operation trauma and contributes to reduction in the number of postoperative wound purulent-inflammatory complications by 19.6%. Findings The proposed method for treating the appendiceal stump during appendectomy for acute destructive appendicitis complicated by typhlitis is simple enough, reliable, characterized by low traumatism and shortens the duration of surgery by 8 minutes on the average (p <0.05).