1
|
Al Tamr WJ, Ali S, Omran K. Noninflammatory obstructive appendicopathy: A rare presentation of abdominal pain. Clin Case Rep 2023; 11:e7431. [PMID: 37251740 PMCID: PMC10220386 DOI: 10.1002/ccr3.7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Patients with appendicitis-like abdominal pain but negative laboratory and radiological findings can have rare alternative aetiologies such as obstructive appendicopathy. A normal appendix may be seen in surgery, and removal with consent is curative.
Collapse
Affiliation(s)
| | - Sameh Ali
- NMC Royal HospitalSharjahUnited Arab Emirates
| | - Kareem Omran
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| |
Collapse
|
2
|
Di Buono G, Buscemi S, Galia M, Maienza E, Amato G, Bonventre G, Vella R, Saverino M, Grassedonio E, Romano G, Agrusa A. Acute appendicitis and situs viscerum inversus: radiological and surgical approach-a systematic review. Eur J Med Res 2023; 28:85. [PMID: 36805741 PMCID: PMC9940389 DOI: 10.1186/s40001-023-01059-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Acute appendicitis is one of the most frequent intra-abdominal diseases requiring emergency surgical consult and treatment. The diagnosis of this condition is based on clinical features and radiologic findings. One-third of patients with acute appendicitis present unusual symptoms. There are several circumstances that may cause misdiagnosis and unclear prognostic prediction. Among these, situs viscerum inversus totalis and midgut malrotation can be challenging scenarios, leading to a delay in treatment, especially when these conditions are unknown. We decided to carry on a systematic review of published cases of acute appendicitis in the context of anatomical anomalies. METHODS We used the MESH terms "appendicitis" AND "situs inversus" AND/OR "gut malrotation" to search for titles and abstracts. Inclusion criteria were patients with clinical and/or radiological diagnosis of acute appendicitis, with conservative or surgical management and with preoperative/intraoperative findings of situs viscerum inversus or gut malrotation. Additionally, previous reviews were examined. Exclusion criteria of the studies were insufficient patient clinical and demographic data. RESULTS We included in this review 70 articles concerning 73 cases of acute appendicitis with anatomical anomaly. Patients were aged from 8 to 86 years (median: 27.0 years). 50 were male and 23 were female. 46 patients (63%) had situs viscerum inversus, 24 (33%) had midgut malrotation, 2 (2.7%) had Kartagener's syndrome, one of them (1.4%) had an undetermined anomaly In 61 patients the anatomical anomaly was unknown previously (83.6%), while 16,4% already were aware of their condition. CONCLUSION Acute appendicitis can occur in association of rare anatomical anomalies and in these cases diagnosis can be challenging. Situs viscerum inversus and midgut malrotation should always be considered in the differential diagnosis of a patient with left lower quadrant pain, especially in younger population. Besides clinical features, it is fundamental to implement the diagnostic progress with radiological examination. Laparoscopic approach is useful to identify and treat acute surgical emergency and it is also a diagnostic tool and can be tailored in order to offer the best exposition of the operatory field for each single case.
Collapse
Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - Salvatore Buscemi
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Massimo Galia
- grid.10776.370000 0004 1762 5517Department of Radiology, University of Palermo, Palermo, Italy
| | - Elisa Maienza
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Giuseppe Amato
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Giulia Bonventre
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Roberta Vella
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Marta Saverino
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Emanuele Grassedonio
- grid.10776.370000 0004 1762 5517Department of Radiology, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| | - Antonino Agrusa
- grid.10776.370000 0004 1762 5517Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127 Palermo, Italy
| |
Collapse
|
3
|
Gupta V, Chauhan SPS, Gupta M, Verma R, Singh SP, Panday A. Efficacy and Safety of LigaSure in Laparoscopic Sutureless Appendectomy. Cureus 2022; 14:e24764. [PMID: 35755548 PMCID: PMC9216166 DOI: 10.7759/cureus.24764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
|
4
|
Haider N, Mehmood Z, Kumar V, Imran M, Ahmed M. Fecal Loading at Caecum as a New Radiological Sign for Diagnosing Acute Appendicitis. Cureus 2022; 14:e20903. [PMID: 35145807 PMCID: PMC8809636 DOI: 10.7759/cureus.20903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/07/2022] Open
|
5
|
Di Buono G, Maienza E, Buscemi S, Randisi B, Romano G, Agrusa A. Acute appendicitis in a patient with situs viscerum inversus totalis: Role of laparoscopic approach. A case report and brief literature review. Int J Surg Case Rep 2020; 77S:S29-S33. [PMID: 33208280 PMCID: PMC7876688 DOI: 10.1016/j.ijscr.2020.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis. We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case. Situs viscerum inversus and midgut malrotation should be taken into consideration in patients with findings of the physical examination suspicious for left-sided acute appendicitis.
Introduction Abdominal pain due to acute appendicitis in one of the most causes of access to Emergency Room requiring surgical consult and treatment. The occurrence of anatomical anomalies should be considered especially when clinical and imaging features are misleading. In these cases laparoscopic surgery can be a safe tool in order to confirm uncertain diagnosis. Case report We report a case of acute appendicitis in a 23-year-old Caucasian men with situs viscerum inversus detected on radiological investigation. Laparoscopic approach was used to confirm the diagnosis and to perform appendectomy. Trocars placement was tailored for this peculiar case. Discussion One third of patient with acute appendicitis complains abdominal pain in an unexpected location due to various anatomical position of appendix. Left-sided acute appendicitis is a cause of misdiagnosis and it can occur in association with anatomical anomalies such as situs viscerum inversus and midgut malrotation. Laparoscopic surgery may represent a valuable approach in terms of differential diagnosis and treatment in these patients. Conclusion Left-sided acute appendicitis should always be considered in young male patients with left lower quadrant pain. Laparoscopic approach is useful and safe procedure both for diagnosis and treatment of these unclear clinical pictures.
Collapse
Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Elisa Maienza
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Brenda Randisi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Italy.
| |
Collapse
|
6
|
Kinnear N, Heijkoop B, Bramwell E, Frazzetto A, Noll A, Patel P, Hennessey D, Otto G, Dobbins C, Sammour T, Moore J. Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study. Int J Surg 2019; 72:185-191. [PMID: 31683040 DOI: 10.1016/j.ijsu.2019.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/08/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. We aimed to determine whether the acute surgical unit (ASU) model improved the management and disclosure of these findings. METHODS An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (Traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings, and communication of the findings to the patient and to their general practitioner (GP). RESULTS 1,214 patients underwent emergency appendicectomy; 465 in the Traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the Traditional and ASU group with regards to communication of the findings to the patient (p = 0.44) and their GP (p = 0.27), and there was no difference in the rates of appropriate management (p = 0.21). CONCLUSION The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during appendectomy.
Collapse
Affiliation(s)
- Ned Kinnear
- Dept of Surgery, Lyell McEwin Hospital, Adelaide, Australia; Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | | | - Eliza Bramwell
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia
| | - Alannah Frazzetto
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Amy Noll
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Prajay Patel
- Dept of Surgery, Port Augusta Hospital, Port Augusta, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Greg Otto
- Dept of Surgery, Lyell McEwin Hospital, Adelaide, Australia
| | | | - Tarik Sammour
- Dept of Surgery, Royal Adelaide, Hospital, Adelaide, Australia; Dept of Surgery, Faculty of Medical and Health Sciences, University of Adelaide, Adelaide, Australia
| | - James Moore
- Dept of Surgery, Royal Adelaide, Hospital, Adelaide, Australia; Dept of Surgery, Faculty of Medical and Health Sciences, University of Adelaide, Adelaide, Australia
| |
Collapse
|
7
|
Staplers vs. loop-ligature: a cost analysis from the hospital payer perspective. Surg Endosc 2019; 33:3419-3424. [PMID: 30604261 DOI: 10.1007/s00464-018-06639-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/19/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Presently, there is equipoise regarding the surgical technique used to manage the appendiceal stump during laparoscopic appendectomy. The purpose of this research was to determine whether the routine use of loop ligature, compared to stapling, is cost effective from a hospital payer perspective. METHODS A retrospective cohort study was conducted amongst patients undergoing emergency laparoscopic surgery for acute appendicitis at two major academic hospitals. In order to eliminate possible systematic bias arising from one technique being preferentially employed with more complex presentations, patients were divided into study groups based on the technique routinely employed by their surgeon, loop ligature (LLA) versus stapler (LSA). Pediatric patients and open appendectomies were excluded. Costs were determined using a previously published model derived from publicly available data from the Ontario Case Costing Initiative, in conjunction with local cost data for disposable procurement. Secondary outcomes included operating room time, length of stay, and complication rates. RESULTS Between Jan 1, 2014 and Dec 31, 2015, 567 adult patients had an emergency laparoscopic appendectomy for acute appendicitis. In comparing surgeons who routinely employed LLA to LSA, there was a significant decrease in total mean hospital cost with LLA ($1988 ± $143 vs. $2253 ± $99, p = 0.002). In addition, mean disposable cost was reduced for surgeons using LLA ($310 ± $27 vs. $668 ± $26, p < 0.001). This reduction in cost was not associated with a difference in length of stay (1.5 vs. 1.4 days, p = 0.28) or complication rates (8% vs. 10%, p = 0.43). CONCLUSIONS These findings suggest that surgeons who routinely use loop ligature to secure the appendiceal base during emergency laparoscopic appendectomy offer more cost-effective care compared to stapler users, saving their institution more than $200 per case with no clear disadvantages. A shift from routine use of staplers to loop ligature should result in significant overall cost savings to the hospital.
Collapse
|
8
|
Revishvili AS, Fedorov AV, Sazhin VP, Olovyannyi VE. [Emergency surgery in Russian Federation (in Russian only)]. Khirurgiia (Mosk) 2019:88-97. [PMID: 30938363 DOI: 10.17116/hirurgia201903188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. We discovered a change in the correlation between acute abdominal diseases, particularly a significant reduction in the occurrence of acute appendicitis and perforated peptic ulcer. Reduction in the number of emergency surgeries by 27.8% annually was also observed. Mortality rate decreased in cases of strangulated hernia, acute cholecystitis and acute pancreatitis, while it is stable for bowel obstruction and acute appendicitis and increasing in perforated peptic ulcer cases. The total annual number of lethal outcomes due to acute abdominal diseases was decreased by 1900 cases. Significant changes were observed in mortality rate and minimally invasive surgeries proportions between federal districts and individual regions of the country. The range of administrative measures was proposed.
Collapse
Affiliation(s)
- A Sh Revishvili
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - A V Fedorov
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| | - V P Sazhin
- Pavlov Ryazan State Medical University of Ministry of Health of Russia, Ryazan, Russia
| | - V E Olovyannyi
- Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
9
|
Sotelo-Anaya E, Sánchez-Muñoz MP, Ploneda-Valencia CF, de la Cerda-Trujillo LF, Varela-Muñoz O, Gutiérrez-Chávez C, López-Lizarraga CR. Acute appendicitis in an overweight and obese Mexican population: A retrospective cohort study. Int J Surg 2016; 32:6-9. [PMID: 27321379 DOI: 10.1016/j.ijsu.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION México is the second place in overweight and obese adults. Acute appendicitis (AA), is the most common indication for an emergency surgery around the world, with an estimated lifetime incidence of 7-14%. Laparoscopic appendectomy (LA) has been described as a safe and good surgery approach for this group of patients. Nevertheless, in México, there is not any evidence supporting these outcomes in our population. METHODS All the patients that came to the ER from July to December 2014 with age >16-year, body mass index (BMI) > 25 kg/m(2) (overweight) and, BMI >30 kg/m(2) (obese) were included in the study. We recorded the age, gender, BMI, grade of appendicitis, complications classified by the Clavien-Dindo Classification, and a follow-up period of 7-day, 30-day, 6-month, and 1-year. RESULTS 27 patients met the inclusion criteria, five had overweight (18.5%), and twenty-two were obese (81.5%). No surgical conversion was needed. The overall complications rate was 29.6%%, with 22.2% mild complications and 7.4% of moderate complication. The average in-hospital cost for the procedure was $15,860 MXN (range $12,860-$22,860 MXN). The surgical time was ≈53.7 ± 19.93 h and the LOS ≈1.6 ± 0.6 days. CONCLUSION The outcomes in the Mexican adult obese population with acute appendicitis when a laparoscopic appendectomy is performed are as good as reported in other countries.
Collapse
Affiliation(s)
- Eduardo Sotelo-Anaya
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | | | | | | | - Oscar Varela-Muñoz
- Department of General Surgery, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Mexico
| | | | | |
Collapse
|
10
|
Bozkurt MA, Ünsal MG, Kapan S, Kankaya B, Kalaycı MU, Alış H. Two Different Methods for Appendiceal Stump Closure: Metal Clip and Hem-o-lok Clip. J Laparoendosc Adv Surg Tech A 2014; 24:571-3. [PMID: 25007288 DOI: 10.1089/lap.2013.0543] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mustafa Gökhan Ünsal
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Selin Kapan
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Burak Kankaya
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Uygar Kalaycı
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Halil Alış
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Laparoscopy in elective and emergency management of ovarian pathology in children and adolescents. Wideochir Inne Tech Maloinwazyjne 2014; 9:164-9. [PMID: 25097682 PMCID: PMC4105671 DOI: 10.5114/wiitm.2014.41626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/21/2013] [Accepted: 11/24/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ovaries are one of the most common locations of tumor masses in children. Some of them require surgery due to the risk of malignancy or necrosis. This organ seems to be ideal for the laparoscopic approach. AIM To evaluate the usefulness of laparoscopy in surgery of lesions located in the ovaries in patients under 18 years of age and assess the risk of changes in the ovaries in girls with acute abdominal symptoms. MATERIAL AND METHODS Retrospective evaluation of hospital records of the period 1996-2012 from a single hospital was performed. 105 laparoscopic procedures of ovarian pathology in patients aged 0-18 (mean: 13.5) years were reviewed. The overall sample was divided into groups depending on the indication and mode of surgery. Group I: elective or emergency surgery, imaging findings of ovarian cysts bigger than 5 cm or causing pain. Group II: elective surgery, the ovarian tumor visible in imaging (solid mass or mixed). Group III: treatment for acute abdomen, without visible ovarian pathology in the preoperative imaging studies. Group IV: elective treatment of other indications, incidental finding. RESULTS There were no deaths or major complications. There were no conversions. Average length of hospital stay after surgery was 2.5 days. The risk of appendicitis in patients referred for surgery due to ovarian cysts visualized in ultrasound, in the factual absence of ovarian pathology (false positive ultrasound), in the presented material was 5.2%. The risk of lesions in the ovaries in patients operated on due to acute abdominal pain, with no findings in the pre-operative ultrasound (false negative ultrasound), in the presented material was 7.4%. The risk of coexistence of changes in the ovaries with appendicitis found during the procedure due to acute abdominal pain in the study group was 6%. CONCLUSIONS The laparoscopic treatment for ovarian masses is safe and efficient. The risk of wrong preoperative diagnosis (ovary mass vs. appendicitis) is in any direction between 5 and 8%, which is a number large enough to be taken into consideration when surgical training and legislation is concerned.
Collapse
|
12
|
Costa-Navarro D, Jiménez-Fuertes M, Illán-Riquelme A. Laparoscopic appendectomy: quality care and cost-effectiveness for today's economy. World J Emerg Surg 2013; 8:45. [PMID: 24180475 PMCID: PMC3842793 DOI: 10.1186/1749-7922-8-45] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/21/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Open appendectomy (OA) has traditionally been the treatment for acute appendicitis (AA). Beneficial effects of laparoscopic appendectomy (LA) for the treatment of AA are still controversial. AIM To present our technique for LA and to determine whether LA should be the technique of choice of any case of AA instead of OA. MATERIAL AND METHODS All cases operated for AA (February 2011 through February 2012) by means of LA or OA were prospectively evaluated. Data regarding length of stay, complications, emergency department consultation after discharge or readmission were collected. Patients were classified into four groups depending on the severity of the appendicitis. Economic data were obtained based on the cost of the disposable material. Cost of hospital stay was calculated based on the Ley de Tasas of the Generalitat Valenciana according to the DRG and the length of stay. RESULTS One hundred and forty-two cases were included. Ninety-nine patients underwent OA and 43 LA. Average length of stay for LA group was 2,6 days and 3,8 for OA. Average cost of the stay for OA was 1.799 euros and 1.081 euros for LA. Global morbidity rate was 16%, 5% for LA and 20% for OA. CONCLUSIONS LA is nowadays the technique of choice for the treatment of AA.
Collapse
Affiliation(s)
- David Costa-Navarro
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
| | - Montiel Jiménez-Fuertes
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
| | - Azahara Illán-Riquelme
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
| |
Collapse
|
13
|
Partecke LI, Thiele A, Schmidt-Wankel F, Kessler W, Wodny M, Dombrowski F, Heidecke CD, von Bernstorff W. Appendicopathy--a clinical and diagnostic dilemma. Int J Colorectal Dis 2013; 28:1081-9. [PMID: 23516073 DOI: 10.1007/s00384-013-1677-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The term "neurogenic appendicopathy" has been used for patients operated on for acute appendicitis with their appendices lacking signs of acute inflammation. The aim of this retrospective study was to clarify the presence of potential neurogenic appendicopathies, analyzing patients' clinical symptoms and their corresponding appendiceal specimens. METHODS One hundred twenty-one patients were identified showing a histological diagnosis of chronic appendicitis. Eventually, 40 patients qualified for the potential diagnosis "neurogenic appendicopathy." Appendix specimens were immunohistochemically examined for the expression of S-100, vasoactive intestinal polypeptide (VIP), and substance P. Controls consisted of 110 patients with acute appendicitis and 120 patients following appendectomies operated on for other reasons. RESULTS Eventually, 40 of 120 patients qualified for the potential diagnosis "neurogenic appendicopathy." Compared to patients with acute appendicitis, there was only little difference in clinical symptoms. Histologically, neuromas, thought of being characteristic of neurogenic appendicopathy, were demonstrated significantly more often in the control group (p = 0.01). S-100 was significantly more expressed in the appendicopathy group (p = 0.0024), but nearly 50% of control specimens showed an intense staining, too. S-100(+) neurofibers were significantly (p = 0.00122) more often found in the mucosa of appendicopathy specimens, but this was true for only 25% of specimens. VIP was more strongly expressed in control specimens (p = 0.0211). Substance P was of no diagnostic value. CONCLUSIONS Our study could not confirm the neurogenic origin of appendicopathies. Yet, clinical data strongly suggest the existence of the entity "appendicopathy." Therefore, we suggest removing a macroscopically unaffected appendix in patients with appendicitis-like symptoms if, on laparoscopy, no other cause can be found.
Collapse
Affiliation(s)
- Lars Ivo Partecke
- Department of General, Visceral, Thoracic and Vascular Surgery, University Medicine, Greifswald, Ernst-Moritz-Arndt-University, Ferdinand Sauerbruchstraße 8, 17475 Greifswald, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Bulian DR, Knuth J, Sauerwald A, Ströhlein MA, Lefering R, Ansorg J, Heiss MM. Appendectomy in Germany-an analysis of a nationwide survey 2011/2012. Int J Colorectal Dis 2013; 28:127-38. [PMID: 22932909 DOI: 10.1007/s00384-012-1573-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although appendectomies are frequently performed and new procedural techniques have emerged, no nationwide analysis exists after the cessation of the German quality control in 2004. METHODS One thousand eight hundred seventy surgical hospitals in Germany were asked to answer questions anonymously concerning the size of the department, applied procedural techniques, various technical details, as well as the approach to the intraoperative finding of an inconspicuous appendix. RESULTS We received 643 questionnaires (34.4 %) for evaluation. Almost all hospitals (95.5 %) offer laparoscopic appendectomy (LA), 15.4 % offer single-port (SPA), and 2.2 % (hybrid-) NOTES technique (NA). LA is the standard procedure in 85.2 % of male and in 89.1 % for female patients. In an open procedure (OA), the appendix and mesoappendix are mostly ligated (93.8 and 91.5 %). A Veress needle and open access are employed equally for LA. In 66.6 % of LA, the appendix is divided using an Endo-GIA, the mesoappendix in 45.5 % with bipolar coagulation. Almost half of the hospitals routinely flush the site in OA and LA. In open surgery with an inconspicuous appendix but a pathological finding elsewhere in the abdomen, it is resected "en principe" in 64.7 % and in the absence of any pathological finding in 91.2 %. For laparoscopic procedures, the numbers are 54.8 and 88.4 %. CONCLUSIONS Most German hospitals perform appendectomies laparoscopically regardless of patients' gender. Usage of an Endo-GIA is widely established. SPA has not gained much acceptance, nor is NA widely used yet. In the absence of any pathological findings in particular, the macroscopically inconspicuous appendix results in an appendectomy "en principe" in most German hospitals.
Collapse
Affiliation(s)
- Dirk Rolf Bulian
- Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
15
|
Hue CS, Kim JS, Kim KH, Nam SH, Kim KW. The usefulness and safety of Hem-o-lok clips for the closure of appendicular stump during laparoscopic appendectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 84:27-32. [PMID: 23323232 PMCID: PMC3539106 DOI: 10.4174/jkss.2013.84.1.27] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 10/16/2012] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to investigate the safety and usefulness of the Hem-o-lok clip for the closure of appendicular stumps and limitations of the Hem-o-lok clip. METHODS From May 2010 to August 2011, 105 consecutive patients underwent laparoscopic appendectomies by three surgeons. XL size Hem-o-lok clips were used for the closure of appendicular stumps by one surgeon. The remaining surgeons used double endoloop ligatures. Prospectively collected data from patients who underwent laparoscopic appendectomy due to acute appendicitis were retrospectively reviewed. RESULTS A total of 105 laparoscopic appendectomies were performed. The endoloop group consisted of 66 patients (mean age, 34.6 years; range, 16 to 82 years), while the Hem-o-lok group consisted of 39 patients (mean age, 43.5 years; range, 11 to 88 years). In three cases, the Hem-o-lok clip was not used due to enlargement and severe inflammation of the appendix base. No specific intraoperative or postoperative complications were observed in either group. CONCLUSION The use of Hem-o-lok clips for the closure of appendicular stumps in laparoscopic appendectomy is a feasible, safe, fast and cost-effective procedure in patients with a mildly to moderately inflamed appendix base of less than 10 mm in diameter.
Collapse
Affiliation(s)
- Chang Sik Hue
- Department of Surgery, Inje University Haeundae Paik Hopsital, Inje University College of Medicine, Busan, Korea
| | | | | | | | | |
Collapse
|
16
|
Fortea-Sanchis C, Martínez-Ramos D, Escrig-Sos J, Daroca-José JM, Paiva-Coronel GA, Queralt-Martín R, García-Calvo R, Rivadulla-Serrano MI, Salvador-Sanchis JL. [Laparoscopic apendicectomy vs open approach for the treatment of acute appendicitis]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:76-81. [PMID: 22672851 DOI: 10.1016/j.rgmx.2012.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/26/2011] [Accepted: 02/14/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is no international consensus on the approach of choice for performing appendectomy. AIMS To analyze and compare open and laparoscopic approaches in the surgical treatment of acute appendicitis. MATERIAL AND METHODS A retrospective study was carried out on patients over 14-years-old operated on for suspected acute appendicitis between January 2007 and December 2009. Variables were: age, sex, body mass index, specialized surgeon or resident in training, progression duration, conversion rate, use of drains, abdominal cavity irrigation, macroscopic appearance of the appendix, onset time of anesthesia, ASA classification, postoperative hospital stay, resumption of intake of liquids, and complications. The patients were divided into two groups: laparoscopic approach (LA) and open approach (OA). RESULTS A total of 533 patients were enrolled (290 LA and 243 OA). Onset time of anesthesia was 75 min (30-190 min) in LA vs 55 min (20-160 min) in OA (p<0,0001). COMPLICATIONS intraabdominal abscesses in 17 LA cases vs 13 OA cases (p=0,79); surgical wound alterations in 16 LA cases vs 47 OA cases (p=0,0001); incisional hernias in 2 LA cases (1%) vs 10 OA cases (p=0,008). There were no statistically significant differences in postoperative hospital stay (3 days), resumption of intake of liquids (1 day) or readmission rate (8%). CONCLUSIONS There are fewer surgical wound alterations and incisional hernias with the laparoscopic approach, but there is higher cost, lengthier surgery duration, and a longer learning curve. Our results cannot provide a clear indication for one approach or the other, and therefore each case must be evaluated on an individual basis.
Collapse
Affiliation(s)
- C Fortea-Sanchis
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España.
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Partecke LI, Kessler W, von Bernstorff W, Diedrich S, Heidecke CD, Patrzyk M. Laparoscopic appendectomy using a single polymeric clip to close the appendicular stump. Langenbecks Arch Surg 2010; 395:1077-82. [PMID: 20577759 DOI: 10.1007/s00423-010-0671-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 06/14/2010] [Indexed: 01/12/2023]
Affiliation(s)
- Lars Ivo Partecke
- Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital, Ernst-Moritz-Arndt-University, Greifswald, Germany.
| | | | | | | | | | | |
Collapse
|