Laparoscopic drainage versus interventional radiology for management of appendicular abscess: a randomized controlled trial

S. Negm, Ahmed Farag, E. A. Allah, Amr A. Abdelghani
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Abstract

Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like a complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at the same session, better cosmesis, decreased incidence of wound infection, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. This randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and were referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by the Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9871/26-9-2022), and was retrospectively submitted to clinicaltrials.gov in June 2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal groups, a laparoscopic group involved 86 patients (group 1) and an interventional radiology group involved 86 patients (group 2). Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 SD 12.2 years-old, while group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 SD 10.9 years-old. The incidence of reported complications in group (1) was 1 (1.2%) for bowel injury, 3 (3.5%) for fecal fistula, 0 (0%) for recurrence, 0 (0%) for pelvic collection and 0 (0%) for mortality while in group (2) were 5 (5.8%) for bowel injury, 0 (0%) for fecal fistula, 3 (3.5%) for recurrence, 8 (9.3%) for pelvic collection and 1 (1.2%). The incidence rates of quality of life in group (1) were 48 (55.8%) for excellent quality of life, 38 (44.2%) for good quality of life and 0 (0%) for poor quality of life, unlike group (2), the incidence rates of quality of life were 12 (14%) for excellent quality of life, 59 (68.6%) for good quality of life and 15 (17.4%) for poor quality of life. Laparoscopic management of appendicular abscess was safely applied in a good experienced hand without the need for interval appendectomy.
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腹腔镜引流术与介入放射学治疗阑尾脓肿:随机对照试验
腹腔镜阑尾脓肿引流术已成为一种新型技术,因为它比介入放射学技术更有优势,比如可对腹部进行全面探查、排除其他病变、在同一次手术中切除阑尾、更好的外观、降低伤口感染的发生率、更好地观察手术区域、精细处理水肿组织以及引流多处脓肿。 这项随机对照临床试验包括 2020 年 1 月至 2022 年 2 月期间所有出现阑尾脓肿表现并转诊至扎加齐格大学医院急诊科的患者。该研究已获得扎加齐格大学医学院机构审查委员会的前瞻性批准(批准号:9871/26-9-2022),并于2022年6月向clinicaltrials.gov提交了回顾性报告(ClinicalTrials.gov ID:NCT05419440)。样本量为172例患者,分为两组,腹腔镜组86例(第1组),介入放射学组86例(第2组)。 第一组(腹腔镜引流组)包括 86 名患者:男性占 55.8%,平均年龄为 41.2 SD 12.2 岁;第 2 组(介入放射学组)包括 86 名患者:男性占 51.2%,平均年龄为 36.8 SD 10.9 岁。第 1 组报告的并发症发生率为:肠损伤 1 例(1.2%),粪瘘 3 例(3.5%),复发 0 例(0%),盆腔积液 0 例(0%),死亡率 0 例(0%);第 2 组报告的并发症发生率为:肠损伤 5 例(5.8%),粪瘘 0 例(0%),复发 3 例(3.5%),盆腔积液 8 例(9.3%),死亡率 1 例(1.2%)。第(1)组的生活质量发生率为:生活质量优 48 例(55.8%)、生活质量良 38 例(44.2%)、生活质量差 0 例(0%),而第(2)组的生活质量发生率为:生活质量优 12 例(14%)、生活质量良 59 例(68.6%)、生活质量差 15 例(17.4%)。 腹腔镜治疗阑尾脓肿在经验丰富的医生手中得到了安全应用,无需进行间隔性阑尾切除术。
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