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Satomi A, Tanimizu T, Takahashi S, Kawase H, Murai H, Yonekawa H, Takahashi H, Sakai M, Ikeda R, Hinoki A. One-Port Laparoscopy-Assisted Appendectomy in Children with Appendicitis: Experience with 100 Cases. ACTA ACUST UNITED AC 2001. [DOI: 10.1089/10926410152776351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Akira Satomi
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Takemaru Tanimizu
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Shigeki Takahashi
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Hirokazu Kawase
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Hideaki Murai
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Hironobu Yonekawa
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Hiroshi Takahashi
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Masato Sakai
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Rie Ikeda
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Saitama Medical School, Saitama, Japan
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2
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Popp LW. Gynecologically indicated single-endoloop laparoscopic appendectomy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1998; 5:275-81. [PMID: 9668150 DOI: 10.1016/s1074-3804(98)80032-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A prospective, observational study was performed to define the laparoscopic appearance of chronic or recurrent appendicitis, and to evaluate a new, simplified technique for laparoscopic appendectomy. Chronic appendicitis was assumed in 42 women with long-term or recurrent lower abdominal pain, and appendectomy was performed when two or all three of the following pathologic changes, which were highly predictive of the diagnosis, were present: vascular injection of appendiceal peritoneum, periappendiceal adhesions, and induration of the appendix. After thorough periappendiceal adhesiolysis, a catgut no. 2 endoloop was placed around the base of the appendix and mesoappendix. The appendix was skeletonized, crushed distal to the ligature, regrasped further distally while simultaneously closing the appendiceal lumen, and cut in the crushed area. It was removed retrograde through the left suprapubic 10-mm port. Iodine was applied to the stump. No major intraoperative or postoperative complications occurred. During mean observation of 12.6 months, 74% of women were free of abdominal pain, 12% had partial relief in a mean of 15.4 months' observation, and 12% experienced no change in abdominal pain. This technique is safe, simple, and effective when chronic or recurrent appendicitis is assumed during diagnostic laparoscopy for chronic lower abdominal pain.
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Affiliation(s)
- L W Popp
- Clinic Dr. Guth, Jurgensallee 44, D-22609 Hamburg, Germany
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Horwitz JR, Custer MD, May BH, Mehall JR, Lally KP. Should laparoscopic appendectomy be avoided for complicated appendicitis in children? J Pediatr Surg 1997; 32:1601-3. [PMID: 9396535 DOI: 10.1016/s0022-3468(97)90462-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, recent literature on adults suggests that laparoscopic appendectomy may increase the risk for postoperative infectious complications in complicated (gangrenous or perforated) cases. This study was undertaken to compare the results of open versus laparoscopic appendectomy for complicated appendicitis in children. METHODS A retrospective review from two institutions was performed for all children treated operatively for complicated appendicitis from January 1994 through November 1996. RESULTS Fifty-six cases were identified. Twenty-seven children underwent laparoscopic appendectomy, whereas 22 underwent open appendectomy. Seven children underwent conversion from laparoscopic to open surgery. Operating times and length of hospital stay did not differ significantly between the laparoscopic and open groups. Postoperative complications developed in 24 children (42.8%). Complications were more frequent after laparoscopic appendectomy compared with open appendectomy (56% v 18%, P = .002). A postoperative intraabdominal abscess (IAA) developed in 14 children (25%). An IAA occurred in two children after open appendectomy compared with 11 children after laparoscopic appendectomy (9% v 41%, P = .01). CONCLUSION The findings suggest that laparoscopic appendectomy should be avoided in children who have complicated appendicitis because of the increased risk for postoperative intraabdominal abscesses. The authors propose a prospective, randomized trial to verify this finding.
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Affiliation(s)
- J R Horwitz
- University of Texas-Houston Medical School and Hermann Children's Hospital, 77030, USA
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Mutter D, Vix M, Bui A, Evrard S, Tassetti V, Breton JF, Marescaux J. Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study. Surgery 1996; 120:71-4. [PMID: 8693426 DOI: 10.1016/s0039-6060(96)80243-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with right iliac fossa pain. However, the precise role of laparoscopic appendectomy in men is unclear, and this study was therefore undertaken to examine this specific issue in a prospective randomized trial. METHODS One hundred men between the ages of 16 and 65 years who had suspected appendicitis were recruited and randomized to undergo either open or laparoscopic appendectomy. Both groups were compared in terms of their clinical parameters, duration of anesthetic and operation times, postoperative pain, duration of ileus, and length of hospital stay. RESULTS The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes versus 25 minutes) compared with open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no significant difference was seen between the laparoscopic and open appendectomy groups in the recovery of bowel function (24.7 hours versus 21 hours) and in the length of hospital stay (4.9 days versus 5.3 days). CONCLUSIONS The results of this prospective randomized trial showed that there were no significant advantages of laparoscopic appendectomy over open appendectomy for the treatment of male patients with suspected appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients.
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Affiliation(s)
- D Mutter
- Department of Surgery A, Hôpitaux Universitaires, Strasbourg, France
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Bouillot JL, Salah S, Fernandez F, al-Hajj G, Dehni N, Dhote J, Badawy A, Alexandre JH. Laparoscopic procedure for suspected appendicitis. A prospective study in 283 consecutive patients. Surg Endosc 1995; 9:957-60. [PMID: 7482212 DOI: 10.1007/bf00188450] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Between September 1990 and December 1993, 283 consecutive patients were admitted with clinical symptoms of acute appendicitis. These patients underwent primary laparoscopic approach so that an appendicectomy could be performed by this method. In 49 cases (17.3%), primary laparoscopic examination corrected the preoperative diagnosis and the appendix was left in situ. Appendicectomy was performed in 234 cases (149 women, 85 men) with a mean age of 30 years. Requirement for open surgery occurred in 29 cases. The main cause of unsuccessful procedures was inflammation due to local or generalized peritonitis. Median operative time for a successful procedure was 60 min (range, 25-160). Four postoperative complications (one related to laparoscopic procedure), one case of wound infection, and no mortality resulted. After laparoscopic appendicectomy, the median hospital stay was 3 days (range, 1-16). These results suggest that a laparoscopic approach for suspected appendicitis is reliable, allowing abdominal exploration and safe appendicectomy.
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Affiliation(s)
- J L Bouillot
- Department of General Surgery, University Paris VI, Hospital Broussais, France
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6
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Neugebauer E, Troidl H, Kum CK, Eypasch E, Miserez M, Paul A. The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements--September 1994. The Educational Committee of the European Association for Endoscopic Surgery. Surg Endosc 1995; 9:550-63. [PMID: 7676385 DOI: 10.1007/bf00206852] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.
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Affiliation(s)
- E Neugebauer
- II. Department of Surgery, University of Cologne, Germany
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Laycock WS, Oddsdottir M, Franco A, Mansour K, Hunter JG. Laparoscopic Nissen fundoplication is less expensive than open Belsey Mark IV. Surg Endosc 1995; 9:426-9; discussion 430. [PMID: 7660269 DOI: 10.1007/bf00187166] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Laparoscopic Nissen fundoplication is a relatively new technique used to treat gastroesophageal reflux disease (GERD). The purpose of this study was to compare the cost to the patient and insurer of a laparoscopic Nissen fundoplication (LN) to an open Belsey Mark IV (B4), the previous standard operation for GERD at Emory University Hospital. A retrospective review of 20 consecutive patients undergoing LN or B4 for GERD was performed. Patients were well matched for age, severity of disease, and comorbid illness. The data were analyzed using an unpaired Student's t-test or Wilcoxon signed rank analysis. The results are as follows (mean +/- SD): [table: see text] We conclude that the charges for laparoscopic Nissen fundoplication are significantly less than the charges for Belsey Mark IV. The majority of the savings resulted from a shortened hospital stay.
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Affiliation(s)
- W S Laycock
- Department of Surgery, Emory University Hospital, Atlanta GA 30322, USA
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8
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Meinke AK, Kossuth T. What is the learning curve for laparoscopic appendectomy? Surg Endosc 1994; 8:371-5; discussion 376. [PMID: 8073350 DOI: 10.1007/bf00642433] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
When contemplating converting from open to laparoscopic appendectomy, a prudent surgeon should consider the anticipated learning curve. To evaluate this we reviewed our experience with 20 sequential patients representing this transition. We found the learning curve was brief and did not compromise clinical results. A reduction in hospitalization time without a rise in total hospital costs should encourage the experienced laparoscopic surgeon to consider laparoscopic appendectomy as a viable alternative to standard laparotomy in the resection of the acutely inflamed appendix.
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Affiliation(s)
- A K Meinke
- Department of Surgery, Norwalk Hospital, CT 06856
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9
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McDermott JP, Gorey TF. Laparoscopic appendicectomy--review of the first decade. Ir J Med Sci 1994; 163:171-2. [PMID: 8200779 DOI: 10.1007/bf02967222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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10
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Gawenda M, Said S. [Laparoscopic appendectomy. A review of the literature]. LANGENBECKS ARCHIV FUR CHIRURGIE 1994; 379:145-51. [PMID: 8052055 DOI: 10.1007/bf00680110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Laparoscopic methods are becoming increasingly popular in surgery. In the course of a review concerning laparoscopic appendectomy undertaken up to 31 December 1993 all publications were evaluated by computer-assisted research. Out of a total of 90 publications only 14 deal with the comparison of the laparoscopic versus open appendectomy. Two prospective randomized studies are published. Because of the low number of patients the evaluation of the laparoscopic method is not yet definite.
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Affiliation(s)
- M Gawenda
- Klinik und Poliklinik für Chirurgie, Universität Köln
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Schirmer BD, Schmieg RE, Dix J, Edge SB, Hanks JB. Laparoscopic versus traditional appendectomy for suspected appendicitis. Am J Surg 1993; 165:670-5. [PMID: 8506965 DOI: 10.1016/s0002-9610(05)80785-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We compared the results of concurrently performed laparoscopic versus open appendectomy as treatments for suspected acute appendicitis. The 68 laparoscopic procedures resulted in 62 appendectomies, 47 by the laparoscopic (LA) technique and 15 by the open (LO) technique. Another 54 patients underwent open appendectomy (OA). Significantly more females underwent laparoscopy (LA and LO: 52% versus OA: 33%, p = 0.047). Operative duration was shortest for OA (81 +/- 3 minutes), which was shorter than for LO (108 +/- 7 minutes), but not different than LA (86 +/- 6 minutes). The postoperative length of stay was not different for LA (3.5 +/- 0.5 days) compared with OA (5.9 +/- 1.6 days) or LO (4.8 +/- 1.3 days). One death occurred in the OA group. Wound complication rates were not significantly different for LA (4.3%) compared with OA (9.4%) and LO (13.3%). Overall complication rates were lower for LA (10.6%) and OA (18.9%) compared with LO (46.7%, p < 0.01). Median hospital cost for LO ($10,425) was higher (p < 0.02) than for either LA ($5,899) or OA ($5,220). When appendicitis was not present, definitive confirmation of pathology was achieved in 9 of 18 patients undergoing LA versus 4 of 14 patients having OA (p = not significant). We conclude that when laparoscopy and laparoscopic appendectomy can be performed, the procedure is safe and produces results comparable with those of open appendectomy without significant overall cost differences.
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Affiliation(s)
- B D Schirmer
- Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22901
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