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Rolle U, Bechstein WO, Fahlenbrach C, Heller G, Meyer HJ, Schuler E, Stier A, Waibel B, Jeschke E, Günster C, Maneck M. The Outcome of Laparoscopic Versus Open Appendectomy in Childhood. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:39-44. [PMID: 37967286 PMCID: PMC10979443 DOI: 10.3238/arztebl.m2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Appendectomy in children is performed either lapa - roscopically (LA) or by open surgery (OA). We studied whether, and how, the outcome is affected by the technique used and by the intraoperative conversion of LA to OA. METHODS We analyzed routine data from children and adolescents in three age groups (1-5 years, 6-12 years, and 13-17 years) who were insured by the AOK statutory health insurance carrier in Germany and who underwent appendectomy in the period 2017-2019. General surgical complications and reoperations within 90 days were assessed with relevant indicators. Associations between the surgical technique and these indicators were studied with logistic regression. RESULTS Of the 21 541 patients included in the study, general surgical complications were observed in 2.1% and reoperations in 1.8% overall. Broken down by age group, the corresponding figures were 5.4% and 4.4% (age 1 to 5), 2.5% and 1.8% (age 6 to 12), and 1.5% and 1.6% (age 13 to 17). The main risk factors for complications and reoperations were acute complicated appendicitis and conversion from LA to OA. Regression analysis revealed similar outcomes with OA compared to LA in the 1-to-5 age group, (odds ratios and 95% confidence intervals: 1.1 [0.6; 2.1] for general surgical complications and 1.5 [0.8; 2.7] for reoperations), but worse outcomes with OA in the other two age groups (age 6 to 12: 1.9 [1.2; 2.9] and 2.1 [1.5; 2.9]; age 13 to 17: 1.7 [1.0; 2.9] and 2.2 [1.4; 3.6]). When conversions were assigned to the LA group, the odds ratio (OA compared to LA) for reoperation across all age groups was 3.5 [2.8; 4.4] in patients with acute uncomplicated appendicitis and 4.2 [3.4; 5.3] in patients with complicated appendicitis. Complicated appendicitis also increased the rate of general surgical complications and the length of stay in hospital. CONCLUSION Among children in the two older age groups, LA was followed by fewer general surgical complications and reoperations than OA. These differences were less pronounced when conversions were counted as belonging to the LA group. Children aged 1-5 appear to benefit the least from the lapa - roscopic technique.
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Affiliation(s)
- Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplantation and Thoracic Surgery, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | | | - Günther Heller
- Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany
| | | | - Ekkehard Schuler
- Helios Kliniken, Division of Quality Management, Berlin, Germany
| | - Albrecht Stier
- Department of General and Visceral Surgery, HELIOS Hospital Erfurt, Erfurt, Germany
| | - Beate Waibel
- Medical Service of the Health Insurance Fund Baden-Württemberg, Freiburg, Germany
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Thompson L, Cohen BL, Wolde T, Yeh DD, Ramsey WA, Byers PM, Namias N, Meizoso JP. Open Versus Laparoscopic Appendectomy: A Post Hoc Analysis of the EAST Appendicitis MUSTANG Study. Surg Infect (Larchmt) 2023; 24:613-618. [PMID: 37646633 DOI: 10.1089/sur.2023.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Background: We sought to understand which factors are associated with open appendectomy as final operative approach. We hypothesize that higher American Association for the Surgery of Trauma (AAST) Emergency General Surgery (EGS) grade is associated with open appendectomy. Patients and Methods: Post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated and Gangrenous (MUSTANG) prospective appendicitis database was performed. All adults (age >18) undergoing appendectomy were stratified by final operative approach: laparoscopic or open appendectomy (including conversion from laparoscopic). Univariable analysis was performed to compare group characteristics and outcomes, and multivariable logistic regression was performed to identify demographic, clinical, or radiologic factors associated with open appendectomy. Results: A total of 3,019 cases were analyzed. One hundred seventy-five (5.8%) patients underwent open appendectomy, including 127 converted from laparoscopic to open. The median age was 37 (25) years and 53% were male. Compared with the laparoscopic group, open appendectomy patients had more comorbidities, higher proportion of symptoms greater than 96 hours, and higher AAST EGS grade. Moreover, on intraoperative findings, the open appendectomy group had a higher incidence of perforated and gangrenous appendicitis with purulent contamination, abscess/phlegmon, and purulent abdominal/pelvic fluid. On multivariable analysis controlling for comorbidities, clinical and imaging AAST grade, duration of symptoms, and intra-operative findings, only AAST Clinical Grade 5 appendicitis was independently associated with open appendectomy (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.24-25.55; p = 0.025). Conclusions: In the setting of appendicitis, generalized peritonitis (AAST Clinical Grade 5) is independently associated with greater odds of open appendectomy.
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Affiliation(s)
- Lauren Thompson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
- Department of Surgery, Florida Atlantic University, Boca Raton, Florida, USA
| | - Brianna L Cohen
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Tizeta Wolde
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - D Dante Yeh
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Patricia M Byers
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA
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Wu C, Fields AC, Zhao B, Castillo-Angeles M, Havens JM, Salim A, Askari R, Nitzschke SL. Early surgery for perforated appendicitis: Are we moving the needle on postoperative abscess? Am J Surg 2023; 226:256-260. [PMID: 37210329 DOI: 10.1016/j.amjsurg.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Perforated appendicitis is often managed nonoperatively though upfront surgery is becoming more common. We describe postoperative outcomes for patients undergoing surgery at their index hospitalization for perforated appendicitis. METHODS We used the 2016-2020 National Surgical Quality Improvement Program database to identify patients with appendicitis who underwent appendectomy or partial colectomy. The primary outcome was surgical site infection (SSI). RESULTS 132,443 patients with appendicitis underwent immediate surgery. Of 14.1% patients with perforated appendicitis, 84.3% underwent laparoscopic appendectomy. Intra-abdominal abscess rates were lowest after laparoscopic appendectomy (9.4%). Open appendectomy (OR 5.14, 95% CI 4.06-6.51) and laparoscopic partial colectomy (OR 4.60, 95% CI 2.38-8.89) were associated with higher likelihoods of SSIs. CONCLUSIONS Upfront surgical management of perforated appendicitis is now predominantly approached by laparoscopy, often without bowel resection. Postoperative complications occurred less frequently with laparoscopic appendectomy compared to other approaches. Laparoscopic appendectomy during the index hospitalization is an effective approach to perforated appendicitis.
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Affiliation(s)
- Christine Wu
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Adam C Fields
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Bixiao Zhao
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Joaquim M Havens
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Reza Askari
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Stephanie L Nitzschke
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA; Division of Trauma, Burn, Surgical Critical Care, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
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Brillantino A, Iacobellis F, Brusciano L, Abu-Omar A, Muto G, Amadu AM, Foroni F, Antropoli M, Antropoli C, Castriconi M, Renzi A, Pirolo L, Giuliani A, Scarano E, Docimo L, Scaglione M, Romano L. Accuracy of computed tomography in staging acute appendicitis and its impact on surgical outcome and strategy: a multi-center retrospective case-control study. LA RADIOLOGIA MEDICA 2023; 128:415-425. [PMID: 36940006 DOI: 10.1007/s11547-023-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach. METHODS This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared. RESULTS An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher's exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher's exact test). All the patients with grade 5 appendicitis were treated by laparotomy. CONCLUSIONS AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Luigi Brusciano
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Ahmad Abu-Omar
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Gianluca Muto
- Diagnostic Imaging Department, Hospitaux Universitaires de Genève, Geneva, Switzerland
| | - Antonio Matteo Amadu
- Diagnostic Imaging 1 Unit, University Hospital of Sassari, 07100, Sassari, Italy
| | - Fabrizio Foroni
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Massimo Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Carmine Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Maurizio Castriconi
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Adolfo Renzi
- Surgery Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | - Luigi Pirolo
- Radiology Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | | | - Enrico Scarano
- Radiology Department, "San Carlo" Hospital, Potenza, Italy
| | - Ludovico Docimo
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.,Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 112, 07199, Sassari, Italy
| | - Luigia Romano
- Radiology Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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Nikolovski A, Ulusoy C. Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:59-65. [PMID: 35843917 DOI: 10.2478/prilozi-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. Material and Methods: In this prospective interventional clinical study we compared the intraoperative data and the postoperative outcome of 77 patients presented with complicated appendicitis, operated with open and laparoscopic appendectomy within a period of 20 months. One surgeon performed all of the laparoscopic procedures and two other senior surgeons performed the open procedures. Results: Operative time was shorter in the laparoscopic group (p = 0.033). Conversion rate was 2.3%. Overall postoperative morbidity was 25.97%. There was one operative revision due to postoperative small bowel obstruction in the laparoscopic group. Appendicular stump leakage occurred in one patient in the open group. One intra-abdominal abscess occurred in the laparoscopic group (p = 0.38). Wound infection occurred only in the open group (p = 0.018). Length of stay was shorter in the laparoscopic group (p = 0.0052). One patient from the laparoscopic group was readmitted. Conclusions: Laparoscopy is a reliable method in the treatment of complicated appendicitis. It offers a shorter operative time, low conversion rate, an acceptable rate of major postoperative complications and a shorter length of stay.
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Affiliation(s)
- Andrej Nikolovski
- Department of Visceral Surgery, University Surgical Clinic "Sv. Naum Ohridski", University "Sv. Kiril i Metodij", Skopje, RN Macedonia
| | - Cemal Ulusoy
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Turkey
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Rasuli SF, Naz J, Azizi N, Hussain N, Qureshi PNAA, Swarnakari KM, Dost W, Zafar S, Qadar LT, Talpur AS. Laparoscopic Versus Open Appendectomy for Patients With Perforated Appendicitis. Cureus 2022; 14:e26265. [PMID: 35911350 PMCID: PMC9312283 DOI: 10.7759/cureus.26265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute appendicitis can lead to perforation which can be lethal. The present study assessed the outcomes of laparoscopic appendectomy versus open appendectomy in patients with perforated appendicitis. Methodology A comparative study was conducted at the Department of Surgery, Liaquat University of Medical & Health Sciences (LUMHS), between March 2, 2019 and July 7, 2020. The inclusion criteria consisted of a diagnosis of perforated appendicitis. Exclusion criteria consisted of intellectual disability hindering the procurement of informed consent, pediatric patients < 15 years of age, patients with an appendicular mass or abscess unsuited for laparoscopic appendectomy, severe sepsis or septic shock on presentation, and pregnant women. Patients were allocated to either open appendectomy (Group A) or laparoscopic appendectomy (Group B). The data gathering proforma recorded demographics, surgical findings, operating room (OR) time, length of inpatient care, requirement of analgesic, and any adverse events following surgery. All of the surgeries were conducted by an experienced surgical consultant with an experience of at least five years. Results A total of 85 patients were included in the laparoscopic appendectomy group, while 101 cases were included in the open appendectomy group. The use of analgesics thrice a day to manage the postoperative pain was significantly associated with the open appendectomy (p < 0.0001). Moreover, the postoperative length of hospitalization was substantially greater in patients who underwent open appendectomy than those who underwent laparoscopic procedure (p < 0.0001). Wound-related complications were considerably lower in patients who had laparoscopic appendectomy as compared to those who had open appendectomy (23.53% versus 40.5%; p = 0.013). Conclusion The length of stay was significantly lower in patients who underwent laparoscopic appendectomy. Moreover, laparoscopic appendectomy was also associated with a lower rate of wound infection postoperatively, thus giving the former an edge over the latter. Despite the finding that the postoperative pain was not considerably different between the two groups, patients who underwent open appendectomy group required significantly more painkillers to manage the postoperative pain.
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Köhler F, Reese L, Kastner C, Hendricks A, Müller S, Lock JF, Germer CT, Wiegering A. Surgical Site Infection Following Single-Port Appendectomy: A Systematic Review of the Literature and Meta-Analysis. Front Surg 2022; 9:919744. [PMID: 35756463 PMCID: PMC9213668 DOI: 10.3389/fsurg.2022.919744] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 12/29/2022] Open
Abstract
IntroductionSurgical site infections (SSIs) are one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. Numerous studies and meta-analyses have been published on the effect of open versus conventional laparoscopic appendectomy (CLA) reporting faster postoperative recovery and less postoperative pain for CLA. A development from CLA has been the single-port appendectomy (SPA), associated with a better cosmesis but seemingly having a higher risk of wound infections. The aim of this systematic literature review and meta-analysis is to investigate whether reduced port or SPA alters the ratio of SSIs.MethodsPubmed, Embase, and Cochrane databases were screened for suitable articles. All articles published between January 1, 2002, and March 23, 2022, were included. Articles regarding children below the age of 18 were excluded as well as manuscripts that investigated solemnly open appendectomies. Articles were screened for inclusion criteria by two independent authors. Incidence of SSI was the primary outcome. Duration of operation and length of hospital stay were defined as secondary outcomes.ResultsA total of 25 studies were found through a database search describing 5484 patients. A total of 2749 patients received SPA and 2735 received CLA. There was no statistical difference in the rate of SSI (P = 0.98). A total of 22 studies including 4699 patients reported the duration of operation (2223 SPA and 2476 CLA). There was a significantly shorter operation time seen in CLA. The length of hospital stay was reported in 23 studies (4735 patients: 2235 SPA and 2500 CLA). A shorter hospital stay was seen in the SPA group (P < 0.00001). Separately performed analysis of randomized controlled trials could not confirm this effect (P = 0.29).DiscussionSPA is an equally safe procedure considering SSI compared to CLA and does not lead to an increased risk of SSI. A longer operation time for SPA and a minor difference in the length of stay does lead to the use of SPA in selected patients only.
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Affiliation(s)
- Franziska Köhler
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Correspondence: Franziska Köhler
| | - Lena Reese
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Carolin Kastner
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
| | - Anne Hendricks
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Sophie Müller
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Johan F. Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg Medical Centre, Wuerzburg, Germany
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Appendectomy versus nonoperative management of simple appendicitis: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study using a hierarchical ordinal scale. J Trauma Acute Care Surg 2022; 92:1031-1038. [PMID: 35195095 DOI: 10.1097/ta.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Controversy exists about the preferred initial treatment of appendicitis. We sought to compare the two treatments for initial management of simple appendicitis. METHODS In this post hoc analysis of the Multicenter Study for the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, subjects were divided into appendectomy or nonoperative management (NOM; antibiotics only or percutaneous drainage) cohorts. A novel topic-specific hierarchical ordinal scale was created with eight mutually exclusive categories: mortality, reoperation, other secondary interventions, readmission, emergency department visit, wound complication, surgical site infection, and no complication. Pairwise comparisons of American Association for the Surgery of Trauma Imaging Severity Grade 1 (simple appendicitis) patients were compared using win-lose-tie scoring and the sums of appendectomy/NOM groups were compared. RESULTS A total 3,591 subjects were included: 3,262 appendectomy and 329 NOM, with significant differences in baseline characteristics between groups. Across 28 sites, the rate of NOM ranged from 0% to 48%, and the loss to follow-up rate was significantly higher for NOM compared with appendectomy (16.5% vs. 8.7%, p = 0.024). In the simple appendicitis hierarchical ordinal scale analysis, 2,319 subjects resulted in 8,714,304 pairwise comparisons; 75% of comparisons resulted in ties. The median (interquartile range) sums for the two groups are as follows: surgical, 400 (400-400), and NOM, 400 (-2,427 to 400) (p < 0.001). A larger proportion of appendectomy subjects (88.1%) had an outcome that was equivalent (or better) than at least half of the subjects compared with NOM subjects (NOM, 70.5%; OR [95% confidence interval], 0.3 [0.2-0.4]). CONCLUSION In contemporary American practice, appendectomy (compared with NOM) for simple appendicitis is associated with lower odds of developing clinically important unfavorable outcomes in the first year after illness. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Khawaja ZH, Gendia A, Adnan N, Ahmed J. Prevention and Management of Postoperative Ileus: A Review of Current Practice. Cureus 2022; 14:e22652. [PMID: 35371753 PMCID: PMC8963477 DOI: 10.7759/cureus.22652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 01/09/2023] Open
Abstract
Postoperative ileus (POI) has long been a challenging clinical problem for both patients and healthcare physicians alike. Although a standardized definition does not exist, it generally includes symptoms of intolerance to diet, lack of passing stool, abdominal distension, or flatus. Not only does prolonged POI increase patient discomfort and morbidity, but it is possibly the single most important factor that results in prolongation of the length of hospital stay with a significant deleterious effect on healthcare costs in surgical patients. Determining the exact pathogenesis of POI is difficult to achieve; however, it can be conceptually divided into patient-related and operative factors, which can further be broadly classified as neurogenic, inflammatory, hormonal, and pharmacological mechanisms. Different strategies have been introduced aimed at improving the quality of perioperative care by reducing perioperative morbidity and length of stay, which include Enhanced Recovery After Surgery (ERAS) protocols, minimally invasive surgical approaches, and the use of specific pharmaceutical therapies. Recent studies have shown that the ERAS pathway and laparoscopic approach are generally effective in reducing patient morbidity with early return of gut function. Out of many studies on pharmacological agents over the recent years, alvimopan has shown the most promising results. However, due to its potential complications and cost, its clinical use is limited. Therefore, this article aimed to review the pathophysiology of POI and explore recent advances in treatment modalities and prevention of postoperative ileus.
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Arutyunyan AS, Blagovestnov DA, Yartsev PA, Levitsky VD, Gulyaev AA, Kislukhina EV. [Safety and efficacy of laparoscopic approach for widespread appendicular peritonitis]. Khirurgiia (Mosk) 2022:24-32. [PMID: 35775842 DOI: 10.17116/hirurgia202207124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze treatment outcomes in patients with acute appendicitis complicated by widespread peritonitis. MATERIAL AND METHODS The study included 165 patients acute appendicitis complicated by widespread peritonitis. Inclusion criteria: acute appendicitis complicated by widespread peritonitis MIP grade 1-2 in reactive or toxic phase (grading system by Simonyan K.S.), abdominal cavity index ≤16. Exclusion criteria: MIP grade 3, terminal phase, abdominal cavity index ≥17. RESULTS Analysis of postoperative data revealed no correlation between surgical approach and incidence of postoperative intra-abdominal abscesses and infiltrates. In the main group, intra-abdominal abscesses occurred in 4.9% of patients (n=5), infiltrates - 12.8% (n=13). In the control group, these parameters were 4.6% (n=2) and 18.2% (n=8), respectively. We have developed and introduced into clinical practice a differentiated approach to surgical treatment of widespread appendicular peritonitis based on laparoscopic data. Abdominal cavity was intraoperatively assessed. The proposed method included 5 criteria with establishment of appropriate points (min 3, max 14). In case of total score 3-8, laparoscopic approach was preferred. Overall score 9-11 required laparoscopic surgery with subsequent elective repeated laparoscopy, ≥12 scores - intraoperative conversion and open surgery. Thus, subject to the rules of surgical intervention, the number of intra-abdominal complications between laparoscopic and open methods is equalized. CONCLUSION The developed differentiated surgical strategy for patients with appendicular peritonitis is effective and reduces the incidence of wound infection, extra-abdominal complications, and hospital-stay, as well as contributes to early rehabilitation of patients.
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Affiliation(s)
- A S Arutyunyan
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - D A Blagovestnov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - P A Yartsev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - V D Levitsky
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - A A Gulyaev
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Penza Institute for Advanced Training of Doctors, Penza, Russia
| | - E V Kislukhina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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11
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Mejri A, Arfaoui K, Mseddi MA, Slima MB, Saad S, Yahyaoui M. The management of appendicular abscesses in a Tunisian Tertiary Care Hospital. BMC Surg 2021; 21:427. [PMID: 34922528 PMCID: PMC8684085 DOI: 10.1186/s12893-021-01424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
Background This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management. Methods This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi2 test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05. Results The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful. Conclusion Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.
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Affiliation(s)
- Atef Mejri
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia. .,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Khaoula Arfaoui
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Ali Mseddi
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Mohamed Ben Slima
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
| | - Sarra Saad
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
| | - Marwen Yahyaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department B of General Surgery, Rabta Hospital, Tunis, Tunisia
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12
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Nikolovski A, Otljanski A, Seljmani R, Antovic S, Jankulovski N. Mastering the learning curve significantly reduces operative time for laparoscopic treatment of complicated appendicitis. Arch Public Health 2021. [DOI: 10.3889/aph.2021.6000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic appendectomy is the preferred operative method for acute appendicitistreatment. In terms of complicated appendicitis it can be effective in hands of an experiencedlaparoscopist that overwhelmed the learning curve for the method. Aim: Тhis retrospectivestudy examines whether the operative time for laparoscopic appendectomy for complicatedappendicitis is shortened after mastering the learning curve. Material and methods: A totalnumber of 196 patients were operated for the diagnosis of acute appendicitis, of whom 77were diagnosed with complicated appendicitis. They were subsequently divided in two groups(laparoscopic and open). Operative time in both groups was measured and the conversionand postoperative complications were noted. Results: Conversion rate was 2.3%. Operativetime was shorter in the laparoscopic group (67.4 ± 22.9 vs. 77.9 ± 17.9 minutes; p = 0.033).Overall postoperative morbidity was 25.97% with wound infection present only in the opengroup (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopicgroup (0.38%). Length of hospital stay was shorter in the laparoscopic group (4.3 ± 2.2 vs. 5.7 ± 2.1, p = 0.0052).
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13
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Laparoscopic Partial Cecal Resection With an Endoscopic Linear Stapler in Complicated Appendicitis: A Single Center Experiences. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00027.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
It can be challenging to perform an appendectomy laparoscopically in patients with complicated appendicitis with severe inflammation or perforation of the appendix base. This study aimed to introduce a simple alternative surgical treatment that can be used safely in difficult appendectomy cases.
Case presentation
We retrospectively reviewed the medical records of 14 patients who underwent laparoscopic partial resection of the cecum with a linear stapler between January 2015 and December 2016 in our hospital. Fourteen patients were included in this study, and no surgical complications were observed. Enteral feeding was resumed on the third or fourth postoperative day, and the average length of hospital stay was 7.6 days (range, 5 to 12 days).
Conclusion
The results suggest that laparoscopic partial cecal resection with an endostapler is a safe, simple surgical procedure that can be a good alternative in patients with complicated appendicitis.
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14
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Mulita F, Plachouri KM, Liolis E, Kehagias D, Kehagias I. Comparison of intra-abdominal abscess formation after laparoscopic and open appendectomy for complicated and uncomplicated appendicitis: a retrospective study. Wideochir Inne Tech Maloinwazyjne 2021; 16:560-565. [PMID: 34691306 PMCID: PMC8512505 DOI: 10.5114/wiitm.2021.103942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Acute appendicitis (AA) is one of the most common causes of acute abdominal pain seen in emergency departments and appendectomy has been the preferred treatment of this disease for decades. Postoperative intra-abdominal abscess (PIAA) complicates 3% to 25% of appendectomies and the risk is highest following complicated appendicitis. However, the risk for intra-abdominal abscess formation after appendectomy is still a matter of debate. AIM To evaluate PIAA formation after open appendectomy (OA) and laparoscopic appendectomy (LA), in particular in complicated appendicitis. MATERIAL AND METHODS From January 2003 to December 2018, records of patients who underwent appendectomy with diagnosis of appendicitis were retrieved from a computer database for analysis. RESULTS During the study period, 1809 appendectomies were performed in our institution (939 LAs and 850 OAs). Twenty conversion cases were recorded. There was no difference between the incidences of PIAA (LA, 3.73% (35/939) and OA, 3.41% (29/850); p > 0.05). The incidence of PIAA in those with complicated appendicitis was: LA, 11/212 (5.19%) vs. OA 14/198 (7.07%); p > 0.05. CONCLUSIONS This retrospective study shows that the technique of appendectomy does not appear to affect the incidence of IAAs either in uncomplicated or in complicated appendicitis. However, laparoscopic appendectomy has the advantages of laparoscopic procedures, such as lower hospital stay and earlier return to activities, and should therefore be preferred for acute appendicitis.
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Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital of Patras, Patras, Greece
| | - Dimitris Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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15
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Shalaby R, Elsawaf MI, Mohamad S, Hamed A, Mahfouz M. Needlescopic Appendectomy in Children and Adolescents Using 14-Gauge Needles: A New Era. J Laparoendosc Adv Surg Tech A 2021; 31:497-504. [PMID: 33651634 DOI: 10.1089/lap.2020.1011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: We are presenting a very minimally invasive technique for laparoscopic appendectomy (needlescopic appendectomy [NAP]) in children and adolescents using suture grasper device, epidural needle, and homemade isolated long diathermy probe without any conventional laparoscopic instruments. Patients and Methods: NAP was attempted in 48 patients with uncomplicated acute appendicitis at Al-Azhar, Tanta University Hospitals and other allied hospitals during the period from May 2017 to November 2018. The study included patients with acute appendicitis and patients scheduled for interval appendectomy. Exclusion criteria were patients with concealed appendix, patients with appendicular abscess or appendicular mass, patients with acute appendicitis complicated with generalized peritonitis, and patients unfit for laparoscopy. The appendix was brought outside through the umbilical port and the operation was completed extracorporeally. In cases of appendicitis with tethered cecum, the whole procedure was completed intracorporeally. Results: Forty-eight patients with acute uncomplicated appendicitis were treated by NAP. They were 36 males and 12 females with a mean age of 9 ± 3.7 years (range = 4-15 years). Two cases with concealed appendix and one case with appendicular mass were diagnosed during initial laparoscopy and excluded from the study. Thirty-two cases (71.11%) were completed intracorporeally and 13 cases (28.89%) were completed by extracorporeal NAP. The mean operative time was 33.29 ± 3.95 minutes (range = 27-40 minutes) for intracorporeal NAP and 20.9 ± 7.01 minutes (range = 14-40 minutes) for extracorporeal NAP. Degrees of cosmetic satisfaction of the patients and parents were excellent in 93.33% (N = 42/45 patients), and very good in 6.67% (N = 3/45 patients) of patients. Conclusion: NAP using needles only is a new technique that is very minimally invasive, very cheap, safe, reproducible, and easy to be done with outstanding cosmetic results.
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Affiliation(s)
- Rafik Shalaby
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mohamed I Elsawaf
- Department of Pediatric Surgery, Tanta University Hospital, Tanta, Egypt
| | - Soliman Mohamad
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Ashraf Hamed
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mohamad Mahfouz
- Department of Pediatric Surgery, Al-Azhar University Hospitals, Cairo, Egypt
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16
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Beyersdorffer P, Kunert W, Jansen K, Miller J, Wilhelm P, Burgert O, Kirschniak A, Rolinger J. Detection of adverse events leading to inadvertent injury during laparoscopic cholecystectomy using convolutional neural networks. ACTA ACUST UNITED AC 2021; 66:413-421. [PMID: 33655738 DOI: 10.1515/bmt-2020-0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/16/2021] [Indexed: 01/17/2023]
Abstract
Uncontrolled movements of laparoscopic instruments can lead to inadvertent injury of adjacent structures. The risk becomes evident when the dissecting instrument is located outside the field of view of the laparoscopic camera. Technical solutions to ensure patient safety are appreciated. The present work evaluated the feasibility of an automated binary classification of laparoscopic image data using Convolutional Neural Networks (CNN) to determine whether the dissecting instrument is located within the laparoscopic image section. A unique record of images was generated from six laparoscopic cholecystectomies in a surgical training environment to configure and train the CNN. By using a temporary version of the neural network, the annotation of the training image files could be automated and accelerated. A combination of oversampling and selective data augmentation was used to enlarge the fully labeled image data set and prevent loss of accuracy due to imbalanced class volumes. Subsequently the same approach was applied to the comprehensive, fully annotated Cholec80 database. The described process led to the generation of extensive and balanced training image data sets. The performance of the CNN-based binary classifiers was evaluated on separate test records from both databases. On our recorded data, an accuracy of 0.88 with regard to the safety-relevant classification was achieved. The subsequent evaluation on the Cholec80 data set yielded an accuracy of 0.84. The presented results demonstrate the feasibility of a binary classification of laparoscopic image data for the detection of adverse events in a surgical training environment using a specifically configured CNN architecture.
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Affiliation(s)
| | - Wolfgang Kunert
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Kai Jansen
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Johanna Miller
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Peter Wilhelm
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Oliver Burgert
- Department of Medical Informatics, Reutlingen University, Reutlingen, Germany
| | - Andreas Kirschniak
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
| | - Jens Rolinger
- Department of Surgery and Transplantation, Tübingen University Hospital, Tübingen, Germany
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17
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Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis-a systematic review. Int J Colorectal Dis 2021; 36:2283-2286. [PMID: 33852068 PMCID: PMC8045433 DOI: 10.1007/s00384-021-03927-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over the last years, laparoscopic appendectomy has progressively replaced open appendectomy and become the current gold standard treatment for suspected, uncomplicated appendicitis. At the same time, though, it is an ongoing discussion that antibiotic therapy can be an equivalent treatment for patients with uncomplicated appendicitis. The aim of this systematic review was to determine the safety and efficacy of antibiotic therapy and compare it to the laparoscopic appendectomy for acute, uncomplicated appendicitis. METHODS The PubMed database, Embase database, and Cochrane library were scanned for studies comparing laparoscopic appendectomy with antibiotic treatment. Two independent reviewers performed the study selection and data extraction. The primary endpoint was defined as successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and incidence of complications. RESULTS No studies were found that exclusively compared laparoscopic appendectomy with antibiotic treatment for acute, uncomplicated appendicitis. CONCLUSIONS To date, there are no studies comparing antibiotic treatment to laparoscopic appendectomy for patients with acute uncomplicated appendicitis, thus emphasizing the lack of evidence and need for further investigation.
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18
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Seqsaqa M, Rozeik AE, Khalifa M, Ashri HNA. Laparoscopic versus open appendectomy in complicated appendicitis in children: a single center study. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00034-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute complicated appendicitis is a common abdominal emergency in children. Unlike simple appendicitis, laparoscopic appendectomy has not been considered yet the first choice in management of complicated appendicitis. This prospective randomized controlled clinical trial was conducted at Pediatric Surgery Department, Zagazig University Hospitals, Egypt, during the period from December 2018 to August 2019. The aim of the study was to evaluate the role of laparoscopic appendectomy in such cases compared to open appendectomy.
Results
Sixty patients were included in the study, divided randomly into 2 equal groups: laparoscopic and open appendectomy groups. The mean operative time was significantly longer with laparoscopic appendectomy than open appendectomy, 85 vs. 61 min, respectively (p < 0.001**). The time taken to start oral intake was significantly shorter with laparoscopic appendectomy than open appendectomy, 1.9 vs. 2.73 days, respectively (p = 0.025*). The mean hospital stay was significantly lower with laparoscopic appendectomy than open appendectomy, 4.23 vs. 5.13, respectively (p = 0.044*). There were no statistical differences between the two groups regarding wound infection, occurrence of postoperative ileus, intraperitoneal collection, or readmission.
Conclusions
Laparoscopic appendectomy is safe, feasible, and effective procedure in the management of complicated appendicitis in children, with no evidence of any increase in the postoperative complications.
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19
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Outcomes after appendectomy in children with acute appendicitis treated at a tertiary paediatric centre: results from a retrospective cohort study. Langenbecks Arch Surg 2020; 406:163-169. [PMID: 32860108 PMCID: PMC7870764 DOI: 10.1007/s00423-020-01976-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/23/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE In general, an appendectomy is presumed to have a limited burden of disease. However, in current literature, reported complication rates vary. This study aims to provide additional insights in the incidence of post-appendectomy complications in children with acute appendicitis. METHODS This retrospective cohort study included children (0-17 years old) that underwent appendectomy at our tertiary referral centre for suspected acute appendicitis (January 2011-December 2018). Children referred to our centre, and those that underwent non-operative treatment were excluded. Post-appendectomy complications were recorded from electronic medical charts using predefined definitions and classified as severe (Clavien-Dindo III-IV) or less severe (Clavien-Dindo I-II). RESULTS A total of 131 children were included. Simple and complex appendicitis was diagnosed in 66 (50%) and 60 (46%) children, respectively. A non-inflamed appendix was seen in five (4%) children. One or more complications were identified in 33 (25%) patients. Eight (12%) children with simple appendicitis developed a complication, three of these were severe. In children with complex appendicitis, 23 (38%) children developed a complication, 14 of these were severe. CONCLUSION This study shows a high rate of complications compared with current literature, both in children with simple and complex appendicitis. This is probably the result of our definition of complications and being a tertiary referral centre receiving more severe appendicitis cases. However, these results still show that appendectomy is not always a routine procedure with only few complications. Substantiating the need to keep optimizing treatment for children with appendicitis.
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20
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Tartaglia D, Fatucchi LM, Mazzoni A, Miccoli M, Piccini L, Pucciarelli M, Di Saverio S, Coccolini F, Chiarugi M. Risk factors for intra-abdominal abscess following laparoscopic appendectomy for acute appendicitis: a retrospective cohort study on 2076 patients. Updates Surg 2020; 72:1175-1180. [PMID: 32338352 DOI: 10.1007/s13304-020-00749-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intra-abdominal abscesses (IAA) may develop after laparoscopic appendectomies (LA) for acute appendicitis. The identification of risk factors for postoperative IAA could lead to a decrease in the readmission rate and surgery redoes after LA for acute appendicitis. MATERIALS AND METHODS The present study retrospectively analyzed patients undergone LA for acute appendicitis during the period 2001-2017. Clinical, intraoperative, and postoperative outcomes were described. Comparison between groups was made via univariate and multivariate analyses. RESULTS The charts of 2076 patients undergone LA were reviewed. Thirty-seven patients (1.8%) developed a postoperative IAA. Male gender (p < 0.05), ASA score ≥ 2 (p < 0.05), a gangrenous or perforated appendicitis (p < 0.0001), abscess or pelvic peritonitis (p < 0.0001), clipping the mesoappendix (p < 0.0001), appendix division by mechanical stapler (p < 0.05), prolonged antibiotic therapy (p < 0.05), and piperacillin/tazocin regimen (p < 0.0001) were significantly more frequent in the group of patients with IAA. In terms of multivariate analysis, only pelvic peritonitis (p = 0.010), perforated appendicitis (p = 0.0002), and clipping the mesoappendix (p = 0.0002) were independent predictive factors for postoperative IAA. CONCLUSION Patients with peritonitis or a perforated appendicitis, and those who had their mesoappendix clipped showed a higher likelihood of developing an IAA. At risk patients should be provided with careful follow-up for the early detection and management of this complication.
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Affiliation(s)
- Dario Tartaglia
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Lorenzo Maria Fatucchi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alessio Mazzoni
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Piccini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Marsia Pucciarelli
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Salomone Di Saverio
- Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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21
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Watanabe R, Otsuji A, Nakamura Y, Higuchi T, Takahashi A, Saito T, Enomoto T, Quero G, Diana M, Dallemagne B, Marescaux J, Saida Y, Kusachi S. Superior outcomes (but at higher costs) of non-operative management with interval appendectomy over immediate surgery in appendicitis with abscess: Results from a large adult population cohort. Asian J Endosc Surg 2020; 13:186-194. [PMID: 31267689 DOI: 10.1111/ases.12726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of this study was to compare surgical outcomes and hospitalization costs between immediate surgery and non-operative management followed by interval appendectomy in adults presenting with appendicitis with abscess. METHODS From 2003 to 2015, 3316 patients presented with appendicitis, including 101 who presented with appendicular abscess. Between 2003 and 2006, 33 patients with appendicular abscess were managed with emergency operations (emergency group). Non-operative management followed by interval appendectomy was implemented in 2007 and offered to 68 patients during the study period. Of these patients, 64 patients underwent the procedure (interval group), and 4 patients refused. RESULTS Non-operative management was successful in 76.6% of cases (49/64 patients) in the interval group. Operative time and length of hospital stay were similar between the emergency and interval groups. In the interval group, blood loss, the need for extended resection, and overall postoperative morbidity were significantly lower than in the emergency group (P < 0.01, respectively). Medical costs for surgery in the interval group were lower than in the emergency group ($4512 vs $6888, P = 0.002), but this group's total medical costs were higher ($9591 vs $6888, P < 0.01). CONCLUSION The interval strategy is associated with a reduced need for extended resection, lower postoperative morbidity, and a shorter length of hospital stay. However, total medical costs for the interval strategy are higher than those for emergency operations in cases of appendicular abscess in adults.
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Affiliation(s)
- Ryohei Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.,University Hospital Institute (IHU)- Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Ayako Otsuji
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoichi Nakamura
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tadashi Higuchi
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Asako Takahashi
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tomoaki Saito
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyuki Enomoto
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Giuseppe Quero
- University Hospital Institute (IHU)- Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Michele Diana
- University Hospital Institute (IHU)- Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | | | - Jacques Marescaux
- University Hospital Institute (IHU)- Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shinya Kusachi
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
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22
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Shalaby R, Elsawaf MI, Mohamad S, Hamed A, Mahfouz M. Needlescopic Appendectomy in Children and Adolescents Using 14G Needles: A New Era. J Laparoendosc Adv Surg Tech A 2020; 30:355-361. [PMID: 32091962 DOI: 10.1089/lap.2019.0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We are presenting a new very minimally invasive technique for laparoscopic appendectomy (needlescopic appendectomy [NAP]) in children and adolescents using suture grasper device, epidural needle, and homemade isolated long diathermy probe without any conventional laparoscopic instruments. Patients and Methods: NAP was attempted in 48 patients with uncomplicated acute appendicitis at Al-Azhar, Tanta University Hospitals and other allied hospitals during the period from May 2017 to November 2018. The study included patients with acute appendicitis and patients scheduled for interval appendectomy. Exclusion criteria were patients with concealed appendix, patients with appendicular abscess or appendicular mass, patients with acute appendicitis complicated with generalized peritonitis, and patients unfit for laparoscopy. The appendix was brought outside through the umbilical port and the operation was completed extracorporeally. In cases of appendicitis with tethered cecum, the whole procedure was completed intracorporeally. Results: Forty-eight patients with acute uncomplicated appendicitis were treated by NAP. They were 36 males and 12 females with a mean age 9 ± 3.7 years (range = 4-15 years). Two cases with concealed appendix and one case with appendicular mass were diagnosed during initial laparoscopy and excluded from the study. Thirty-two cases (71.11%) were completed intracorporeally and 13 cases (28.89%) were completed by extracorporeal NAP. Mean operative time was 33.29 ± 3.95 minutes (range = 27-40 minutes) for intracorporeal NAP and 20.9 ± 7.01 minutes (range = 14-40 minutes) for extracorporeal NAP. Degrees of cosmetic satisfaction of the patients and parents were excellent in 93.33% (N = 42/45 patients), and very good in 6.67% (N = 3/45 patients) of patients. Conclusion: NAP using needles only is a new technique that is very minimally invasive, very cheap, safe, reproducible, and easy to be done with outstanding cosmetic results.
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Affiliation(s)
- Rafik Shalaby
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mohamed I Elsawaf
- Pediatric Surgery Department, Tanta University Hospitals, Tanta, Egypt
| | - Soliman Mohamad
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
| | - Ashraf Hamed
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
| | - Mohmed Mahfouz
- Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt
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Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study. Updates Surg 2020; 72:185-191. [PMID: 32077062 DOI: 10.1007/s13304-020-00711-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 12/29/2022]
Abstract
Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46-895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.
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24
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Big colon surgery, little incisions: Minimally invasive techniques in emergent colon surgery. J Trauma Acute Care Surg 2020; 89:e1-e6. [PMID: 32068715 DOI: 10.1097/ta.0000000000002616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Laparoscopic Lavage Versus Aspiration Alone in Perforated Acute Appendicitis: A Prospective Randomized Controlled Study. Surg Laparosc Endosc Percutan Tech 2019; 30:14-17. [PMID: 31855922 DOI: 10.1097/sle.0000000000000745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Ding X, Lan J, Chen B, Qiu L, Guo C. Clinical benefit of oral lactulose for postoperative care of pateints with complicated appendicitis using propensity score matching analysis. BMC Gastroenterol 2019; 19:159. [PMID: 31470799 PMCID: PMC6716916 DOI: 10.1186/s12876-019-1073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to investigate the effect of oral lactulose for pediatric patients with complicated appendicitis, who underwent appendectomy. Background Oral lactulose was widely used for gastrointestinal function regulation. However, clinical benefit for oral lactulose regarding its effects on recent postoperative gastrointestinal (GI) recovery and long term adhesive small bowel obstruction (ASBO) incidence, especially in the postoperative pediatric population has not yet defined. Methods A total of 525 pediatric patients with complicated appendicitis underwent appendectomy were retrospectively reviewed. Among them, 317 cases were subjected to oral lactulose management and 208 patients without, served as control. Propensity score 1:1 matching was carried out to adjust for any potential baseline variables. In 189 paired patients, clinical outcomes, including gastrointestinal recovery variables, incidence of ABSO, as well as adverse events, were compared according to the oral lactulose administration or not. Results Patients who received oral lactulose administration achieved early gastrointestinal function recovery, including, first bowel movement (Risk ratio [RR], 1.34; 95% confidence interval [CI] 1.02–2.63, p = 0.005) and first solid feeding (RR, 1.26; 95% CI, 1.01–1.92, p = 0.012). A lower occurrence of ASBO (OR, 0.47; 95% CI, 0.25–0.87; p = 0.011) and lower constipation (Odds ratio [OR], 0.25; 95% CI, 0.13–0.46; p < 0.001), were noted in patients received oral lactulose than in patients without. Furthermore, significantly fewer patients required readmission (OR, 0.56; 95% CI, 0.32–0.99; p = 0.031) and reoperation (OR, 0.29; 95% CI, 0.09–0.92; p = 0.022) in the patients who received oral lactulose administration. Conclusions Beneficial effects of oral lactulose administration in pediatric patients undergone appendectomy were indicated, such as accelerating gastrointestinal function recovery, reducing the postoperative incidence of ASBO and constipation, so reduced readmission and reoperation.
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Affiliation(s)
- Xin Ding
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, 136 Zhongshan 2nd Rd, Chongqing, 400014, People's Republic of China
| | - Jiaming Lan
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, 136 Zhongshan 2nd Rd, Chongqing, 400014, People's Republic of China
| | - Bailin Chen
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, 136 Zhongshan 2nd Rd, Chongqing, 400014, People's Republic of China
| | - Lin Qiu
- Department of Burns and Plastic Surgery, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children'ss Hospital, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Chunbao Guo
- Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing, 136 Zhongshan 2nd Rd, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Children'ss Hospital, Chongqing Medical University, Chongqing, People's Republic of China. .,Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.
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Vuille-Dit-Bille R, Soll C, Mazel P, Staerkle RF, Breitenstein S. Appendiceal stump closure with polymeric clips is a reliable alternative to endostaplers. J Int Med Res 2019; 48:300060519856154. [PMID: 31234666 PMCID: PMC7140204 DOI: 10.1177/0300060519856154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Polymeric (Hem-o-lok) clips represent a novel technique with which to ligate
the appendiceal stump following laparoscopic appendectomy. We compared the
outcomes of using polymeric clips versus endostaplers for complicated and
uncomplicated appendicitis. Methods Six hundred seventy-three consecutive patients undergoing laparoscopic
appendectomy with polymeric clips or endostaplers for acute appendicitis
were assessed. The primary outcome was the incidence of intra-abdominal
abscesses. Predictors of postoperative intra-abdominal abscesses were
calculated using univariate and multivariate analyses. Results Polymeric clips were used in 65% of patients and endostaplers were used in
35%. Hem-o-lok clips were not only applied in patients with uncomplicated
appendicitis (83%), but also in those with complicated appendicitis (26%).
The frequency of intra-abdominal abscesses using polymeric clips and
endostaplers was similar in both patients with uncomplicated appendicitis
(1% vs. 3%, respectively) and complicated appendicitis (2% vs. 6%,
respectively). The univariate and multivariate analyses showed that the
stump closure technique was not a risk factor for postoperative
abscesses. Conclusions Closure of the appendiceal stump using the nonabsorbable Hem-o-lok ligation
system in patients with both uncomplicated and complicated appendicitis is a
safe alternative to the application of endostaplers.
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Affiliation(s)
- Raphael Vuille-Dit-Bille
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Christopher Soll
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Peter Mazel
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Ralph F Staerkle
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Is single-incision laparoscopic appendectomy suitable for complicated appendicitis? A comparative analysis with standard multiport laparoscopic appendectomy. Asian J Surg 2019; 43:282-289. [PMID: 31130501 DOI: 10.1016/j.asjsur.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite emerging evidences on the feasibility and efficacy of single-incision laparoscopic appendectomy (SILA) for managing simple appendicitis, advancing its use for treating complicated appendicitis remains unwarranted. This study aimed to evaluate the surgical outcome of SILA compared with that of standard multiport laparoscopic appendectomy (MPLA) in the management of complicated appendicitis. METHODS Between July 2013 and September 2017, 40 patients who underwent SILA and 150 patients who underwent MPLA for the treatment of complicated appendicitis, defined as AAST grades II-V, were recruited for this study. The demographic characteristics, intraoperative and recovery parameters were retrospectively recorded. No routine drainage was placed in the SILA group. RESULTS SILA was smoothly performed without requiring conversion to MPLA. No significant difference was observed between the 2 groups in demography and preoperative severity. The operation duration was approximately 8 min shorter in the SILA group than in the MPLA group, without a statistical difference (60.03 ± 21.01 vs. 68.04 ± 32.03 min, p = 0.222). The recovery parameters, including soft diet intake and postoperative hospitalization, were more favorable in the SILA group (p < 0.001). Despite the absence of routine drainage in the SILA group, only 1 patient developed an intra-abdominal hematoma necessitating further computed tomography-guided drainage. CONCLUSION SILA is safe and feasible for the management of complicated appendicitis. SILA had non-inferior results to MPLA in terms of time to resume oral intake and postoperative hospital stay. Furthermore, this study posted a question on the concept of routine postoperative drainage in complicated appendicitis.
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Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surg Endosc 2019; 34:907-914. [PMID: 31139982 DOI: 10.1007/s00464-019-06847-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The advantages of laparoscopic appendectomy did not meet the same acceptance in the setting of perforated appendicitis as in uncomplicated appendicitis in the general surgical community. The aim of this study was to compare the clinical outcome of laparoscopic and open appendectomy in perforating appendicitis. METHODS A randomized controlled study was conducted on 126 patients presenting with perforated appendicitis. Sixty patients were subjected to laparoscopic appendectomy (LA) and 66 patients underwent traditional open appendectomy (OA). RESULTS 65 (51.6%) patients were female, and 61 (48.4%) patients were male in whom the mean age was 37.6 + 8.5 years. A significant difference was calculated in the domains of postoperative pain, less need for analgesics, hospital stay, and return to daily activities. The mean operative time was shorter in OA 94 ± 10.4 min than LA 120.6 ± 17.7 min. No statistically significant difference between both groups was detected as regard occurrence of intra-abdominal collection. CONCLUSION In view of its clinical outcomes, laparoscopy should be considered in the context of perforated appendicitis. The possibility of intra-abdominal collection should not be a barrier against the widespread practice of this surgical procedure amidst laparoscopic surgeons if adequate precautions are employed.
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Quah GS, Eslick GD, Cox MR. Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis. Surg Endosc 2019; 33:2072-2082. [PMID: 30868324 DOI: 10.1007/s00464-019-06746-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the last three decades, laparoscopic appendicectomy (LA) has become the routine treatment for uncomplicated acute appendicitis. The role of laparoscopic surgery for complicated appendicitis (gangrenous and/or perforated) remains controversial due to concerns of an increased incidence of post-operative intra-abdominal abscesses (IAA) in LA compared to open appendicectomy (OA). The aim of this study was to compare the outcomes of LA versus OA for complicated appendicitis. METHODS A systematic literature search following PRISMA guidelines was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database for randomised controlled trials (RCT) and case-control studies (CCS) that compared LA with OA for complicated appendicitis. RESULTS Data from three RCT and 30 CCS on 6428 patients (OA 3,254, LA 3,174) were analysed. There was no significant difference in the rate of IAA (LA = 6.1% vs. OA = 4.6%; OR = 1.02, 95% CI = 0.71-1.47, p = 0.91). LA for complicated appendicitis has decreased overall post-operative morbidity (LA = 15.5% vs. OA = 22.7%; OR = 0.43, 95% CI: 0.31-0.59, p < 0.0001), wound infection, (LA = 4.7% vs. OA = 12.8%; OR = 0.26, 95% CI: 0.19-0.36, p < 0.001), respiratory complications (LA = 1.8% vs. OA = 6.4%; OR = 0.25, 95% CI: 0.13-0.49, p < 0.001), post-operative ileus/small bowel obstruction (LA = 3.1% vs. OA = 3.6%; OR = 0.65, 95% CI: 0.42-1.0, p = 0.048) and mortality rate (LA = 0% vs. OA = 0.4%; OR = 0.15, 95% CI: 0.04-0.61, p = 0.008). LA has a significantly shorter hospital stay (6.4 days vs. 8.9 days, p = 0.02) and earlier resumption of solid food (2.7 days vs. 3.7 days, p = 0.03). CONCLUSION These results clearly demonstrate that LA for complicated appendicitis has the same incidence of IAA but a significantly reduced morbidity, mortality and length of hospital stay compared with OA. The finding of complicated appendicitis at laparoscopy is not an indication for conversion to open surgery. LA should be the preferred treatment for patients with complicated appendicitis.
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Affiliation(s)
- Gaik S Quah
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Michael R Cox
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
- Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
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Siotos C, Stergios K, Prasath V, Seal SM, Duncan MD, Sakran JV, Habibi M. Irrigation Versus Suction in Laparoscopic Appendectomy for Complicated Appendicitis: A Meta-analysis. J Surg Res 2018; 235:237-243. [PMID: 30691801 DOI: 10.1016/j.jss.2018.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/09/2018] [Accepted: 10/02/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Acute appendicitis is currently one of the most common surgical emergencies. Intra-abdominal abscesses (IAA) are a fearsome complication, which may occur. Irrigation during the appendectomy is one of the factors suggested to affect the rates of IAA. We sought to investigate the evidence regarding the use of irrigation versus suction alone and the development of IAA after laparoscopic appendectomy for complicated appendicitis. METHODS We searched PubMed, Scopus, Embase, Cochrane, and the Web of Science through November 10, 2017, according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including rates of postoperative (IAA), and performed meta-analysis using random-effects model using the RevMan software. RESULTS We identified five eligible studies with 2511 patients in total. Use of irrigation overall did not demonstrate significant increase in IAA (odds ratio [OR] = 2.39, 95% confidence interval [CI; 0.49, 11.74], P = 0.28). For the adult subpopulation, the use of irrigation was associated with nonsignificant lower odds of IAAs (OR = 0.42, 95% CI [0.15, 1.16]), whereas in pediatric with nonsignificant higher risk (OR = 2.98, 95% CI [0.25, 35.34]). Performance of irrigation led to the addition of, on average, 7 min to the duration of the operation (mean difference = 7.16, 95% CI [3.23, 11.09], P < 0.001). Irrigation did not affect postoperative length of stay (mean difference = -0.80, 95% CI [-2.30, 0.69], P = 0.29). CONCLUSIONS Performance of irrigation during laparoscopic appendectomy does not seem to prevent the development of IAA in neither adults nor pediatric patients.
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Affiliation(s)
- Charalampos Siotos
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Stergios
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of General Surgery, Watford General Hospital NHS Trust, Watford, UK
| | - Vishnu Prasath
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Stella M Seal
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland
| | - Mark D Duncan
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Joseph V Sakran
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
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Wu TC, Lu Q, Huang ZY, Liang XH. Efficacy of emergency laparoscopic appendectomy in treating complicated appendicitis for elderly patients. Saudi Med J 2018; 38:1108-1112. [PMID: 29114698 PMCID: PMC5767613 DOI: 10.15537/smj.2017.11.20469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To assess the therapeutic effects of emergency laparoscopic appendectomy (LA) in treating complicated appendicitis (CA) for elderly patients (defined as age 65 years and above). Methods: We conducted a retrospective study of 115 elderly patients with CA who underwent surgical therapy in the Affiliated Huizhou Hospital of Sun Yat-Sun University, Huizhou, Guangdong Province, China between September 2014 and August 2016. Of these, 59 patients consented to open appendectomy (OA), and LA was performed in the other 56 patients. The perioperative and follow-up variables of the 2 groups were analyzed. Results: The operative time in the LA group was longer than the OA group (LA: 70.5±16.0 min versus [vs.] OA: 59.3±12.0 min, p greater than 0.001). The LA group had lower chances of incision infections (LA: 8.9% vs OA: 28.8 %, p=0.007) and shorter hospital stay (LA: 6.1± 2.5 days vs. OA: 9.6±3.5 days, p greater than 0.001). Return to soft diet (LA: 1.4 ± 0.8 days vs OA: 3.0 ± 1.6 days, p greater than 0.001) and time to out of bed (LA: 1.3±0.5 days vs OA: 2.5±0.9 days, p greater than 0.001) was faster in the LA group. The incidence of complications and 30-day readmission rate in the LA group was much lower than the OA group. Conclusion: Emergency LA in treating elderly patients with CA has the advantages of less trauma, definite curative effect, low complication rates, and fast recovery when compared with OA.
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Affiliation(s)
- Tian-Chong Wu
- Department of Hepatobiliary and Pancreatic Surgery, Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong Province, China. E-mail.
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Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J, Suzuki S. Comparison of clinical outcome of laparoscopic versus open appendectomy, single center experience. Heliyon 2018; 4:e00635. [PMID: 29872767 PMCID: PMC5986549 DOI: 10.1016/j.heliyon.2018.e00635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/26/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Laparoscopic appendectomy (LA) is now a treatment of choice in patients with appendicitis. This study compares the treatment outcomes of LA and open appendectomies (OA) in our department. Patients and Methods From January 2006 to April 2016 a total of 185 patients underwent appendectomy at our institution. We divided the patients into two groups; LA group (LAG) and OA group (OAG). Following parameters were analyzed: age, gender, preoperative clinicolaboratory characteristics, operative factors, interval appendectomy, length of hospital stay (LHS), and surgical site infections (SSI). Results There were 93 patients in LA G and 92 in OAG. According to the Univariate analysis, there were statistically significant differences among age (p = 0.037), LHS (p = 0.0001), duration till resuming oral intake (p = 0.016), blood loss (p = 0.038), SSI ratio (p = 0.044) and CRP level (p = 0.038) between the LAG and the OAG. According to the Multivariate analysis, blood loss (p = 0.038) and LHS (p = 0.023) were significantly different between both groups. Conclusion LA was decreasing blood loss and LHS.
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Affiliation(s)
- Mitsugi Shimoda
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Tsunehiko Maruyama
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Kazuomi Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Tomoya Tago
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Shuji Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
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Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study. Surg Endosc 2018. [PMID: 29623470 PMCID: PMC6061087 DOI: 10.1007/s00464-018-6064-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION NCT02179112.
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Helling TS, Soltys DF, Seals S. Operative versus non-operative management in the care of patients with complicated appendicitis. Am J Surg 2017; 214:1195-1200. [PMID: 28941724 DOI: 10.1016/j.amjsurg.2017.07.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/08/2017] [Accepted: 07/31/2017] [Indexed: 12/26/2022]
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Reinisch A, Heil J, Woeste G, Bechstein W, Liese J. The meteorological influence on seasonal alterations in the course of acute appendicitis. J Surg Res 2017; 217:137-143. [PMID: 28599958 DOI: 10.1016/j.jss.2017.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Hori T, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Sasaki M, Takamatsu Y, Kitano T, Hisamori S, Yoshimura T. Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy. World J Gastroenterol 2017; 23:5849-5859. [PMID: 28932077 PMCID: PMC5583570 DOI: 10.3748/wjg.v23.i32.5849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
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Affiliation(s)
- Tomohide Hori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Maho Sasaki
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeo Hisamori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
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38
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Guercio G, Augello G, Licari L, Dafnomili A, Raspanti C, Bagarella N, Falco N, Rotolo G, Fontana T, Porello C, Gulotta G. Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit. G Chir 2017; 37:174-179. [PMID: 27938536 DOI: 10.11138/gchir/2016.37.4.174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute appendicitis is common in an Emergency Surgery Unit. Although the laparoscopic approach is a method accepted for its treatment, no strong data are available for determining how many procedures must an experienced surgeon carry out for obtaining all the advantages of this technique and if this approach can become the gold standard in the activity of a general emergency unit with senior surgeons variously skilled on the basic laparoscopy. 142 patients that underwent appendectomy (90 laparoscopic, 52 conventional) for acute appendicitis were enrolled in this institutional retrospective cohort study. The surgeons were classified with a descriptor-based grading and divided in two groups regarding the skill. The only relevant result of our study was the significant reduction of conversion rate in case of laparoscopic approach. No strong differences were found concerning the duration of the procedure and the hospital stay between the two groups. The rate of complications were very low in both groups. In conclusion, the experienced surgeons can easily perform a laparoscopic approach independently from the specific skill in this approach.
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39
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Abstract
Pelvic organ prolapse affects approximately 8% of women, and the demand for pelvic organ prolapse surgery is expected to increase by nearly 50% over the next 40 years. The surgical techniques used to correct pelvic organ prolapse have evolved over the last 10 years, with multiple well-designed studies addressing the risks, outcomes, reoperation rates, and optimal surgical approaches. Here we review the most recent evidence on the route of access, concomitant procedures, and synthetic materials for augmenting the repair. Ultimately, this review highlights that there is no optimal method for correcting pelvic organ prolapse and that the risks, benefits, and approaches should be discussed in a patient-centered, goal-oriented approach to decision-making.
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Affiliation(s)
- Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois, USA
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