Ligadura simples vs. ligadura com confecção de bolsa e sepultamento para tratamento do coto: estudo prospectivo comparativo randomizado

Abstract

Although acute appendicitis is one of the most common surgical diseases, the best treatment of appendicular stump is still undefined. At laparotomy for appendectomy, the stump is preferably treated by ligation and burial and in laparoscopic surgery, by simple ligation or clamping. The aim of this study was to compare two techniques for the treatment of appendicular stump in laparotomy appendectomy (simple ligation vs. ligation with purse suture and burial) by a prospective and randomized trial. Between the years 2003 and 2005, 113 patients were enrolled. The appendiceal stump was treated by simple ligation in 49 cases and by ligation and burial in 64 cases. The two groups were similar in terms of average age, gender, preoperative symptoms and signs, leukocyte count, time to disease progression and stage of appendicitis diagnosed by both the surgeon and by histopathological examination. There was no statistically significant difference (p <0.05) between the two groups regarding the duration of operation, complications (wound infection, wound dehiscence, abscess formation, intestinal obstruction, fistula and seroma) or hospital stay. We conclude that both techniques are equally safe for treatment of appendicular stump. We recommend simple ligation because it is simpler and does not change the anatomy of the cecum.