2007, Number 1
Comparison between simple ligation and invagination of the appendiceal stump after appendectomy: A systematic review of randomized controlled trials
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ABSTRACTObjective: 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.
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