[Simple ligation superior to inversion of the appendiceal stump; a prospective randomized study]. / Simpel onderbinden beter dan instulpen van de appendixstomp; een prospectief gerandomiseerd onderzoek.

OBJECTIVE: To compare two methods of treatment of the appendix stump after appendectomy for acute appendicitis. DESIGN: A prospective randomised trial of 134 consecutive appendectomies in which the appendix stump was either simply ligated or ligated and doubly invaginated. SETTING: Department of General Surgery, St Joseph Hospital, Veldhoven, the Netherlands. PATIENTS AND METHODS: During a period of 15 months all patients in whom an appendectomy for acute appendicitis was performed were allocated at random to the two groups. The following data were recorded: age, sex, histological diagnosis, hospital stay and occurrence of complications. All patients were followed until 6 months after the operation. The data were analysed statistically with the chi-square-test and the Mann-Whitney test. P less than 0.05 was considered significant. RESULTS: The appendix stump was ligated in 79 patients and invaginated in 55. Both groups were similar with respect to age, sex, degree of appendiceal inflammation, antibiotic treatment and hospital stay. There were significantly more wound infections in the 'invagination' group (p = 0.017). The other complications showed no statistical intergroup difference. CONCLUSION: Simple ligation facilitates and shortens appendectomy. It is a safe procedure, preventing deformation of the caecal wall and possibly reducing the risk of postoperative ileus due to adhesions. We therefore recommend simple ligation as the standard procedure at appendectomy.

Thermographic assessment of perforating arteries. A preoperative screening method for fasciocutaneous and musculocutaneous flaps.

Pre-operative localization of the involved perforating arteries in the planning of musculocutaneous or fasciocutaneous flaps may lead to a higher survival rate of the whole skin island. This in particular will be of importance in donor areas with changed haemodynamics. A noninvasive method is described for the accurate preoperative localization of the perforating arteries of the trunk and extremities; a method which causes minimal discomfort to the patient, but which will help in preparing for a successful operation. We have used this method since 1983 for all high-risk patients, and it has proved to be very useful in our hands.