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Zampieri N, Vestri E, Bianchi F, Peretti M, Patanè S, Cecchetto M, Mantovani A, Giambanco A, Farina F, Scirè G, Camoglio FS. Single port surgery in pediatric age: report of first 300 cases. Minerva Surg 2023; 78:23-29. [PMID: 35230038 DOI: 10.23736/s2724-5691.22.09315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent years, evolution of surgery has led to laparoscopy and then to single port surgery. In pediatric age, few papers have been published about single port procedures; in particular, no one has described the use of the Octoport device (Frankenman International Ltd., Suzhou, China). We present our experience using a new device. METHODS A retrospective analysis of first 300 cases was performed collecting the data of all patients treated with Octoport device from October 2017 to September 2021. Epidemiological data, diagnosis, operative times, and complications were analyzed. Postoperative pain was compared with standard laparoscopy. RESULTS A total of 300 procedures were performed during the study period. The age range was 1-17 years. The conversion rate was 3.6% (11 patients) including both conversion to traditional laparoscopy and to laparotomy. Pain management was comparable to traditional laparoscopy. The complication rate was 3.6%, in one case leading to re-do surgery. All the cases in our Unit were successfully completed, with complications mainly related to the original pathology rather than to the technique itself. CONCLUSIONS The learning curve for Octoport use proved to be functional as for standard laparoscopy. In this study, surgical indications for the use of single port laparoscopy were defined, discerning favorable and unfavorable procedures. A proven superiority of this technique over traditional laparoscopy is yet to be defined, but Octoport has proved to be a safe and easy tool to reduce invasiveness of procedures in pediatric surgery with better cosmetic results.
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Affiliation(s)
- Nicola Zampieri
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy -
| | - Elettra Vestri
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Federica Bianchi
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Marta Peretti
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Simone Patanè
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Mariangela Cecchetto
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Alberto Mantovani
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Annamaria Giambanco
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Fabiana Farina
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Gabriella Scirè
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Francesco S Camoglio
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Jiménez-Uribe AM, Rojas-Sánchez A, Fierro-Ávila F, Molina-Ramírez ID, Mora-Bendeck NGMB. Cirugía transumbilical asistida versus multipuerto en pacientes pediátricos con diagnóstico de apendicitis aguda. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La prevención de las complicaciones en el manejo de la apendicitis aguda sigue siendo un reto para el cirujano pediatra; por lo que es de gran importancia comparar las opciones de manejo quirúrgico, para saber si es posible prevenir dichos resultados, que finalmente llevan a un aumento en el uso de recursos necesarios para tratar a un paciente.
El objetivo de este estudio fue comparar las complicaciones postoperatorias y los costos de la laparoscopia transumbilical asistida y la laparoscopia multipuerto, en pacientes pediátricos en un hospital general de cuarto nivel de la ciudad de Bogotá, D.C., Colombia, entre octubre de 2011 y enero de 2019.
Métodos. Estudio observacional, descriptivo, retrospectivo, de corte transversal, con muestreo no probabilístico a conveniencia, en el que se incluyeron los pacientes entre 0 y 16 años de edad, con historia clínica completa y diagnóstico postquirúrgico de apendicitis aguda, los cuales fueron intervenidos mediante cirugía laparoscópica transumbilical asistida o por multipuerto. Se hizo un análisis descriptivo univariado y bivariado.
Resultados. De los 850 pacientes operados en ese periodo, la técnica quirúrgica más usada fue multipuerto (n=528, 62,1%) y se presentaron complicaciones en 59 (6,94%) de los pacientes. El diagnóstico postquirúrgico más frecuente fue apendicitis no perforada (n=762, 89,6%). Al comparar los dos grupos se encontró un valor de p de 0,9685 para la edad, 0,5364 para el diagnóstico postquirúrgico, 0,1127 para las complicaciones postoperatorias y 0,0085 para el costo.
Discusión. El costo de hospitalización y las complicaciones de los pacientes a quienes se les practicó apendicectomía transumbilical asistida es similar a la técnica por multipuerto.
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Single Incision Pediatric Endoscopic Surgery: From Myth to Reality a Case Series. ACTA ACUST UNITED AC 2019; 55:medicina55090574. [PMID: 31500274 PMCID: PMC6780980 DOI: 10.3390/medicina55090574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
Abstract
Laparoscopic surgery has continued to evolve to minimize access sites and scars in both the adult and pediatric populations. In children, single-incision pediatric endoscopic surgery (SIPES) has been shown to be effective, feasible, and safe with comparative results to multiport equivalents. Thus, the use of SIPES continues over increasingly complex cases, however, conceptions of its efficacy continue to vary greatly. In the present case series and discussion, we review the history of SIPES techniques and its current application today. We present this in the setting of five common myths about SIPES techniques: limitations against complex cases, restrictions to specialized training, increased morbidity outcomes, increased operative lengths, and increased operative costs. Regarding the myth of SIPES being limited in application to simple cases, examples were highlighted throughout the literature in addition to the authors’ own experience with three complex cases including resection of a lymphatic malformation, splenectomy with cholecystectomy, and distal pancreatectomy with splenectomy. A review of SIPES learning curves shows equivalent operative outcomes to multiport learning curves and advancements towards practical workshops to increase trainee familiarity can help assuage these aptitudes. In assessing comorbidities, adult literature reveals a slight increase in incisional hernia rates, but this does not correlate with single-incision pediatric data. In experienced hands, operative SIPES times average approximate multiport laparoscopic equivalents. Finally, regarding expenses, SIPES represents an equivalent alternative to laparoscopic techniques.
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Stundner-Ladenhauf H, Metzger R. Appendizitis im Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Golebiewski A, Anzelewicz S, Wiejek A, Lubacka D, Czauderna P. A Prospective Randomized Controlled Trial of Single-Port and Three-Port Laparoscopic Appendectomy in Children. J Laparoendosc Adv Surg Tech A 2019; 29:703-709. [PMID: 30945979 DOI: 10.1089/lap.2018.0560] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: This study aimed to evaluate single-port laparoscopic appendectomy (SPLA) in comparison with three-port laparoscopic appendectomy (3PLA) in children about the extent of surgical trauma after SPLA and 3PLA measured by serum interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations. Materials and Methods: A total of 50 patients with a median age of 11.5 were randomized to two groups. Experts in both methods performed the surgeries. The decision on the type of planned surgery was randomly determined. Serum IL-6 and CRP levels were measured using an enzyme-linked immunosorbent assay before, and at 12 and 36 hours after surgery. Furthermore, we compared operating time, hospital stay, postoperative pain, and complication rates. Results: The operative time in the 3PLA group was shorter than that in the SPLA group (P < .05). Preoperative IL-6 levels were not different between the two groups, but the rise (pre- versus postoperative) of IL-6 in the SPLA group was remarkably higher when compared with the 3PLA group (P < .05). Similar results were obtained for CRP; basal serum CRP levels were not different between the two groups, but the rise of CRP in the 3PLA group was significantly lower compared with that in the SPLA group. During the first 12 hours postoperative, the SPLA patients reported more severe postoperative pain and longer inpatient opiate usage was noted that after 3-PLA. Only one SPLA case was converted to 3PLA. There were no conversions to open surgery. The length of hospital stay and complication rate were not different between the two groups. Conclusions: SPLA in children is associated with longer operative times, increased pain level, and more severe surgical trauma as measured by postoperative CRP and IL-6 levels in comparison with a 3PLA. The two approaches were comparable regarding the length of hospital stay and complication rate.
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Affiliation(s)
- Andrzej Golebiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Stefan Anzelewicz
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Agnieszka Wiejek
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Dominika Lubacka
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University in Gdansk, Gdansk, Poland
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Moriguchi T, Machigashira S, Sugita K, Kawano M, Yano K, Onishi S, Yamada K, Yamada W, Masuya R, Kawano T, Nakame K, Mukai M, Kaji T, Ieiri S. A Randomized Trial to Compare the Conventional Three-Port Laparoscopic Appendectomy Procedure to Single-Incision and One-Puncture Procedure That Was Safe and Feasible, Even for Surgeons in Training. J Laparoendosc Adv Surg Tech A 2018; 29:392-395. [PMID: 30418099 DOI: 10.1089/lap.2018.0195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery has emerged; however, the procedures might be complicated for trainees. We compared the clinical outcomes of conventional three-port laparoscopic appendectomy (CLA) and single-incision and one-puncture laparoscopic appendectomy (SIOPLA) by attending pediatric surgeons (APSs) and surgeons in training (SITs). MATERIALS AND METHODS We reviewed the clinical outcomes of 72 randomized laparoscopic appendectomies that were consecutively performed by SITs and APSs for a 2-year period. The cases were categorized according to type of surgeon. Finally, 10 CLA and 18 SIOPLA procedures were performed by SITs, and 24 CLA and 20 SIOPLA procedures were performed by APSs. The operative time, blood loss, analgesic use, complications, and hospital stay were analyzed. RESULTS There were no significant differences in any of the evaluation points between CLA and SIOPLA. CONCLUSIONS SIOPLA is not inferior operation to CLA, and the postoperative outcomes of SIOPLA were satisfactory. Thus, SIOPLA was safe and feasible for young surgeons to perform.
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Affiliation(s)
- Tomoe Moriguchi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Seiro Machigashira
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Masato Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ryuta Masuya
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Kazuhiko Nakame
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Motoi Mukai
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Binet A, Braïk K, Lengelle F, Laffon M, Lardy H, Amar S. Laparoscopic one port appendectomy: Evaluation in pediatric surgery. J Pediatr Surg 2018; 53:2322-2325. [PMID: 29370892 DOI: 10.1016/j.jpedsurg.2017.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Appendectomy is a well-established surgical procedure in pediatric surgery used in the management of acute appendicitis. With the continuous advancement in the field of minimal invasive surgery, the recent focus is on single incision laparoscopic (SIL) surgery. SILA also goes further in order to decrease pain, improve recovery and enhance patient satisfaction. However, this approach is still not a well-established technique and not widely practiced, especially in pediatric surgery. METHODS We prospectively recorded the data in our pediatric universitary hospital center since January, 01 2017 to July, 01 2017. Patients included in this study were randomized in two groups: SILA group (managed by one-port laparoscopy, n=40) and LA group (conventional laparoscopy using three trocars, n=40). RESULTS The mean operative time for SILA was significantly lower. There were no postoperative complications in SILA group. If peritonitis was associated with appendicitis, the operative duration was not significantly different between each group. The duration in recovery room after surgery was significantly lower in SILA group. The morphine consumption was significantly lower for SILA group according to patient weight. SILA is less painful significantly than CLA for the first postoperative 6 h. After, even if SILA appears less painful, difference is not significant. The hospital length of stay was significantly higher in LA than SILA group CONCLUSIONS: SILA procedure for appendectomy appears to be safe and efficient for appendicitis management in children. This technique could be applied in routine as in emergency tome. TYPE OF STUDY Prospective comparative study LEVEL OF EVIDENCE: II.
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Affiliation(s)
- Aurelian Binet
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
| | - Karim Braïk
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Francois Lengelle
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Marc Laffon
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Hubert Lardy
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Sarah Amar
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
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Escolino M, Becmeur F, Saxena A, Till H, Masieri L, Cortese G, Holcomb GW, Esposito C. Infectious Complications After Laparoscopic Appendectomy in Pediatric Patients with Perforated Appendicitis: Is There a Difference in the Outcome Using Irrigation and Suction Versus Suction Only? Results of a Multicentric International Retrospective Study. J Laparoendosc Adv Surg Tech A 2018; 28:1266-1270. [PMID: 29906215 DOI: 10.1089/lap.2018.0061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Francois Becmeur
- Division of Pediatric Surgery, Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - Amulya Saxena
- Division of Paediatric Surgery, Chelsea Children's Hospital, London, United Kingdom
| | - Holger Till
- Division of Pediatric Surgery, Medical University of Graz, Graz, Austria
| | - Lorenzo Masieri
- Division of Pediatric Surgery and Urology, Meyer Children Hospital, Florence, Italy
| | - Giuseppe Cortese
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - George W. Holcomb
- Division of Pediatric Surgery, Mercy Children's Hospital, Kansas City, Missouri
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
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Sekioka A, Takahashi T, Yamoto M, Miyake H, Fukumoto K, Nakaya K, Nomura A, Yamada Y, Urushihara N. Outcomes of Transumbilical Laparoscopic-Assisted Appendectomy and Conventional Laparoscopic Appendectomy for Acute Pediatric Appendicitis in a Single Institution. J Laparoendosc Adv Surg Tech A 2018; 28:1548-1552. [PMID: 30088968 DOI: 10.1089/lap.2018.0306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Single-incision laparoscopic appendectomy (SILA) is a potentially safe and feasible alternative to conventional laparoscopic appendectomy using three ports (CLA). However, the safety and efficacy of SILA for complicated appendicitis (gangrenous and perforated) remain unclear. The aim of this study was to evaluate the outcomes of transumbilical laparoscopic-assisted appendectomy (TULAA) not only for simple appendicitis but also for complicated appendicitis, and to compare them with the outcomes of CLA. Methods: All cases of acute pediatric appendicitis who underwent laparoscopic appendectomies in our hospital from 2007 to 2016 were retrospectively reviewed. CLA was performed between January 2007 and October 2011, and TULAA was performed between November 2011 and December 2016. In this study, patients' demographics and operative outcomes for simple appendicitis (catarrhal and phlegmonous) and complicated appendicitis were analyzed, comparing the results of TULAA and CLA. Results: In total, 262 patients underwent laparoscopic appendectomy: CLA in 103 patients and TULAA in 159 patients. All appendectomies were performed in the acute phase. Complicated appendicitis accounted for 60 CLA cases and 81 TULAA cases. There were no significant differences in patients' demographics. Mean operative time in simple appendicitis was significantly shorter in TULAA than in CLA. In addition, complication rates in complicated appendicitis were significantly lower in TULAA than in CLA. Moreover, in each comparison, the postoperative hospital stay was significantly shorter in TULAA than in CLA. Conclusion: In our institution, TULAA has shown to be a safe and effective alternative for both simple and complicated appendicitis in children compared with CLA.
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Affiliation(s)
- Akinori Sekioka
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Kengo Nakaya
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yutaka Yamada
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoto Urushihara
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
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Endoloop versus endostapler: what is the best option for appendiceal stump closure in children with complicated appendicitis? Results of a multicentric international survey. Surg Endosc 2018; 32:3570-3575. [PMID: 29404732 DOI: 10.1007/s00464-018-6081-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a limited and conflicting evidence about the most appropriate method for appendiceal stump closure during laparoscopic appendectomy (LA). We aimed to compare endoloop (EL) versus endostapler (ES) for stump closure during LA for complicated perforated appendicitis in children. METHODS We retrospectively reviewed the records of 708 patients (463 boys and 245 girls with an average age of 9.8 years) who underwent LA for complicated appendicitis in 5 international centers of Pediatric Surgery over a 5-years period (January 2011-December 2016). The appendix was perforated with localized peritonitis in 470 cases and diffuse peritonitis in 238 patients. EL was used in 374 cases (G1), whereas ES was adopted in 334 cases (G2). RESULTS No intra-operative complication occurred in both groups but 5 conversions to open surgery were reported in G1 (1.3%) and 4 in G2 (1.1%) (OR 1.1; 95% CI 0.30-4.19). Use of EL was significantly associated with higher incidence of intra-abdominal abscess (OR 1.36; 95% CI 0.84-2.18), postoperative ileus (OR 3.61; 95% CI 0.76-17.11), and re-operations/readmissions (OR 6.46; 95% CI 1.46-28.62) compared to ES. The average cost of supplies for LA was significantly higher in G2 (€ 915.60) compared to G1 (€ 578.36) (p = 0.0001). The average cost of re-operations/readmissions was significantly higher in G1 (€ 4.091,39) compared to G2 (€ 2.127,88) (p = 0.0001) (OR 1.72; 95% CI 1.47-2.01). CONCLUSIONS Our study is the first in the pediatric population to demonstrate that the method used for appendiceal stump closure may influence the outcome of LA in complicated appendicitis. Although ES is more expensive compared to EL, our results demonstrated that appendix stump closure should be performed using ES rather than EL in complicated perforated appendicitis since its use was associated with a lower incidence of postoperative intra-abdominal abscess and postoperative ileus and lower re-operations and readmissions rates and costs.
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11
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Bertozzi M, Appignani A. The evolving surgical approaches in challenged resource settings. Afr J Paediatr Surg 2018; 15:58-59. [PMID: 30829313 PMCID: PMC6419551 DOI: 10.4103/ajps.ajps_13_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
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12
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Lee SM, Park DJ, Yoon JH, Tae SY, Yang SS, Im YC. Evaluating the Feasibility of Single Incision Laparoscopic Appendectomy Performed by a Resident Based on Propensity Score Matching. J Laparoendosc Adv Surg Tech A 2017; 27:1031-1037. [PMID: 28409666 DOI: 10.1089/lap.2017.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Conventional laparoscopic appendectomy (CLA) has been considered the standard for the treatment of acute appendicitis. Recently, single incision laparoscopic appendectomy (SILA) has become an alternative option. There are few reports on the results of SILA performed by residents during the training period. The present study, we report our residents' experience. MATERIALS AND METHODS We reviewed clinical characteristics and outcomes of 1005 patients who underwent appendectomy between October 2013 and April 2016. Every operation was performed by only residents. Clinical characteristics and operative outcomes between SILA and CLA group were reviewed after propensity score matching. RESULTS SILA was used more frequently in younger patients (23.3 versus 36.4 years, P = .000), women (66.4% versus 45.9%, P = .000), and patients with lower body mass index (20.2 versus 22.9 kg/m2, P = .043). After propensity score matching, the rate of complicated appendicitis was lower (12.9% versus 15.5%, P = .573), and the mean operative time was slightly shorter in the SILA group than in the CLA group (56.68 versus 59.09 minutes, P = .068), although these differences were not statistically significant. There were no significant differences between the two groups in hospitalization period (2.7 versus 2.9 days, P = .380), the use of analgesics (2.0 versus 2.1 times, P = .128), and wound complication rate (10.3% versus 14.6%, P = .333). CONCLUSION It is a safe and relatively easy procedure with an acceptable postoperative cosmetic outcome that can be incorporated into the routine surgical training.
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Affiliation(s)
- Sung Min Lee
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea
| | - Dong Jin Park
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Jong Hee Yoon
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Soon Young Tae
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Song Soo Yang
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
| | - Yeong Cheol Im
- 1 Department of Surgery, Ulsan University Hospital , Ulsan, Korea.,2 Department of Surgery, University of Ulsan College of Medicine , Ulsan, Korea
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