grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2021-180-4-106-111grekov-1740Research ArticleОБЗОРЫREVIEWSСпособ обработки культи червеобразного отростка при лапароскопической аппендэктомии (обзор литературы)Method for appendix stump closure during laparoscopic appendectomy (literature review)https://orcid.org/0000-0003-4446-2082ОтдельновЛ. А.OtdelnovL. A.

Отдельнов Леонид Александрович, кандидат медицинских наук, доцент кафедры госпитальной хирургии им. Б. А. Королева

г. Нижний Новгород

Otdelnov Leonid A., Cand. of Sci. (Med.), Associate Professor of the Department of Surgery named after B. A. Korolev

Nizhny Novgorod

leonotdelnov@yandex.ruhttps://orcid.org/0000-0003-2336-8900МухинА. С.MukhinA. S.

Мухин Алексей Станиславович, доктор медицинских наук, профессор, зав. кафедрой госпитальной хирургии им. Б. А. Королева

г. Нижний Новгород

Mukhin Aleksey S., Dr. of Sci. (Med.), Professor, Head of the Department of Surgery named after B. A. Korolev

Nizhny Novgorod

prof.mukhin@mail.ruhttps://orcid.org/0000-0001-7093-6822МурановЕ. В.MuranovE. V.

Муранов Евгений Владимирович, ординатор кафедры госпитальной хирургии им. Б. А. Королева

г. Нижний Новгород

Muranov Evgeny V., Resident of the Department of Surgerynamed after B. A. Korolev

Nizhny Novgorod

yvm16@mail.ruhttps://orcid.org/0000-0002-3359-9406ПаруновС. Д.ParunovS. P.

Парунов Сергей Дмитриевич, студент лечебного факультета

г. Нижний Новгород

Parunov Sergey D., Student of Medical Faculty

Nizhny Novgorod

9040623512@yandex.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Приволжский исследовательский медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияPrivolzhsky Research Medical UniversityRussian Federation2021010720211804106111Copyright © Отдельнов Л.А., Мухин А.С., Муранов Е.В., Парунов С.Д., 20212021Отдельнов Л.А., Мухин А.С., Муранов Е.В., Парунов С.Д.Otdelnov L.A., Mukhin A.S., Muranov E.V., Parunov S.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/1740

Лапароскопическая аппендэктомия в настоящее время признана «золотым стандартом» оперативного лечения острого аппендицита. Применение лапароскопического доступа позволяет снизить частоту послеоперационных осложнений (прежде всего, за счет уменьшения частоты инфекций области хирургического вмешательства), ускорить послеоперационную реабилитацию пациентов. Ключевым моментом лапароскопической аппендэктомии является обработка культи червеобразного отростка. Именно с этим этапом операции ассоциировано наибольшее число интраабдоминальных осложнений. В этой связи вопрос выбора наиболее безопасного способа обработки культи аппендикса является практически важным, но решается он по-разному. В практике находят применение лигатурный способ, клипирование, использование аппаратного шва, а также лапароскопическое погружение культи с помощью интракорпорального шва. В настоящем обзоре литературы освещены достоинства и недостатки каждого из представленных способов. Рассмотрены наиболее крупные исследования, сравнивающие их между собой. Показано, что, с точки зрения безопасности, существующие способы не имеют достоверных отличий. В этой связи факторами, определяющими выбор способа обработки культи червеобразного отростка в каждом конкретном случае, могут быть особенности анатомии, экономическая составляющая и личный опыт хирурга использования того или иного способа.

Currently, the laparoscopic appendectomy is the preferred method for treatment of acute appendicitis. Laparoscopic approach resulted in a decrease of postoperative morbidity (especially for reducing the frequency of surgical site infection), allows to faster postoperative recovery of patients. The method of closure of the appendix stump is the main step of laparoscopic appendectomy. The risk of intra-abdominal complications is considered high during this step. Therefore, it is important to choose the safest method of closure of the appendix stump among the number of available options. The four prominent management options are endoloops, staplers, endoclips and inversion of appendix stump with intracorporal sutures. This literature review presents the advantages and disadvantages of these methods. The results of randomized studies and meta-analysis comparing the methods are also presented. It is shown that there is no evidence pointing to any of the existing methods to be a safer option. It is suggested that factors such as anatomy features, cost efficiency and personal experience of the surgeon using these methods are considered to determine the choice.

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The authors declare that there are no conflicts of interest present.