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Doshi N, Bandyopadhyay S, Green M, Richardson E, Komber A, Chen SE, Shah R, Lakhoo K. The Risk of Adhesive Bowel Obstruction in Children With Appendicitis: A Systematic Review. J Pediatr Surg 2024:S0022-3468(24)00173-8. [PMID: 38565474 DOI: 10.1016/j.jpedsurg.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/09/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach. METHODS A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769). RESULTS Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). CONCLUSION Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Neel Doshi
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Soham Bandyopadhyay
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Madeline Green
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Edward Richardson
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Ahmad Komber
- Usher Institute, University of Edinburgh, 450 Old Dalkeith Rd, Edinburgh EH16 4SS, United Kingdom
| | - Si Emma Chen
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Rahul Shah
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Kokila Lakhoo
- University of Oxford and Oxford University Hospitals, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
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Destek S, Kundakcioglu H, Bektasoglu HK, Kunduz E, Yigman S, Tak AY, Gul VO, Deger KC. Comparison of open and laparoscopic techniques in the surgical treatment of acute appendicitis. North Clin Istanb 2023; 10:704-710. [PMID: 38328728 PMCID: PMC10846568 DOI: 10.14744/nci.2022.08941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Acute appendicitis (AA) is the most common cause of acute abdomen and appendectomy is one of the most common surgical procedures. In this study, we aimed to compare open appendectomy (OA) and laparoscopic (LA) surgical techniques in the treatment of AA. METHODS The data of 236 patients treated with the diagnosis of AA in 2019-2020 were analyzed. Of these patients, 85 patients who received OA and 84 patients who received LA were included in the study. Then, the two groups were compared in terms of demographic, laboratory, clinical, and surgical treatments. RESULTS A total of 169 patients were included in the study. The mean age was 34.9 years (range 16-78), and the male-to-female ratio was 0.69. Statistical analysis revealed that the OA group had more leukocytosis, more female gender, and longer operation time than the LA group, but the LA group's complication rate was lower (p<0.05). CONCLUSION LA offers less morbidity, a shorter duration of hospital stay, and a fast return to normal activities compared to OA. In the surgical treatment of AA, LA can be applied as a routine and first-line treatment.
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Affiliation(s)
- Sabahattin Destek
- Department of General Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkiye
| | - Hacer Kundakcioglu
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | | | - Enver Kunduz
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | - Samet Yigman
- Department of General Surgery, Koc University Faculty of Medicine, Istanbul, Turkiye
| | - Aysegul Yabaci Tak
- Department of Biostatistics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | - Vahit Onur Gul
- Department of General Surgery, Koru Hospital, Ankara, Turkiye
| | - Kamuran Cumhur Deger
- Department of General Surgery, Biruni University Faculty of Medicine, Istanbul, Turkiye
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Abstract
Nonoperative management (NOM) of acute appendicitis is becoming more popular, especially in resource-strapped locations, to minimize hospital system costs. In uncomplicated cases of appendicitis, NOM can effectively treat the patient. It does carry a 39.1% risk of recurrence in 5 years, and operative management (OM) does not increase morbidity or risk of complication, so the authors recommend laparoscopic OM for uncomplicated appendicitis. For complicated cases of appendicitis, the authors recommend initial NOM with interval appendectomy in all patients. All appendicitis patients should undergo surveillance endoscopy if older than 40 years to rule out a contributing neoplasm.
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Affiliation(s)
- Cpt Samuel Grasso
- Department of General Surgery, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79920, USA
| | - Ltc Avery Walker
- Department of General Surgery, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79920, USA.
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Nguyen ATM, Holland AJA. Paediatric adhesive bowel obstruction: a systematic review. Pediatr Surg Int 2021; 37:755-763. [PMID: 33876300 DOI: 10.1007/s00383-021-04867-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/17/2022]
Abstract
Adhesions following abdominal surgery remain a common cause of bowel obstruction. The incidence is between 1 and 12.6% in children who have had previous abdominal surgery. While conservative management is usually trialled in all patients (including children) suspected of having ASBO, the majority will require surgical intervention. New materials such as Seprafilm® have been studied in the paediatric population, with promising results of its use in index abdominal surgeries to prevent the formation of adhesions. In this article, we conducted a systematic review to present an overview of the current knowledge on the incidence, aetiology, pathophysiology, clinical presentation, and management of ASBO.
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Affiliation(s)
- Alexander T M Nguyen
- Liverpool Hospital, Liverpool, NSW, Australia.,South West Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Andrew J A Holland
- The Burns Unit, The Children's Hospital at Westmead Burns Research Institute, Westmead, NSW, Australia. .,Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, The University of Sydney, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia.
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Smith AM, O'Neil AC, Obiora C, Hope WW. Closed Loop Bowel Obstruction From a Loose Staple After Laparoscopic Appendectomy. Am Surg 2020:3134820972978. [PMID: 33350860 DOI: 10.1177/0003134820972978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander M Smith
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Ariel C O'Neil
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Chukwuemeka Obiora
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - William W Hope
- Department of Surgery, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
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Ding H, Li H, Yu H, Zhang W, Li S. Cytokines in abdominal exudate and serum predict small bowel obstruction following appendectomy. ANZ J Surg 2020; 90:1991-1996. [PMID: 32808444 DOI: 10.1111/ans.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to investigate the value of inflammatory markers for the prediction of small bowel obstruction (SBO) following appendectomy. METHODS We included cases of acute appendicitis that underwent laparoscopic appendectomy (LA) in the Qingdao Municipal Hospital between January 2017 and January 2019. The cases were divided into an SBO group and a non-SBO group depending on whether patients had or did not have SBO, and patients were followed up for at least 1 year. The levels of interleukin (IL)-1β, IL-6 and tumour necrosis factor-alpha (TNF-α) in abdominal exudate and venous blood were examined using enzyme-linked immunosorbent assay. RESULTS After 1 year of follow-up, there were 985 cases in the non-SBO group and 16 cases in the SBO group. The levels of IL-1β, IL-6 and TNF-α in abdominal exudate on post-operative day 1 in the SBO group were 172.5 ± 14.7, 2167.3 ± 372.1 and 253.9 ± 12.9 pg/mL, respectively, which were significantly higher than that in the non-SBO group. The serum levels of IL-1β, IL-6, TNF-α and C-reactive protein (CRP) in the SBO group were significantly higher than that in the non-SBO group before surgery. Post-operatively, the inflammatory markers above decreased significantly and became similar with time in both groups. The logistic regression showed that the levels of peritoneal IL-6, preoperative serum CRP and perforated appendicitis were significant risk factors of SBO. The specificity and sensitivity of peritoneal IL-6 were 0.81 and 0.921, respectively. CONCLUSION The IL-1β, IL-6, TNF-α and CRP in serum and abdominal exudate played an important role in SBO after LA. The peritoneal IL-6 was the most reliable prediction marker for SBO.
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Affiliation(s)
- Hui Ding
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Hongbo Li
- Department of Colorectal Surgery, Qingdao Municipal Hospital, Qingdao City, China
| | - Hualong Yu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Wenwei Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao City, China
| | - Siyuan Li
- The First Department of General Surgery, Qingdao Municipal Hospital, Qingdao City, China
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7
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Heeren N, Gass M. [Can Uncomplicated Adult Appendicitis Also Be Treated Conservatively?]. PRAXIS 2020; 109:465-470. [PMID: 32345175 DOI: 10.1024/1661-8157/a003452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Can Uncomplicated Adult Appendicitis Also Be Treated Conservatively? Abstract. For more than a century, appendectomy has been the first-line treatment for acute appendicitis. Despite modern imaging, it is not an easy disease to diagnose and is one of the most common emergency procedures worldwide. Conservative therapy for uncomplicated adult appendicitis is increasingly becoming the focus of discussion. Due to current data, a recommendation for conservative therapy of uncomplicated adult appendicitis can not be given. For the time being it should be reserved for a selected patient group.
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Affiliation(s)
| | - Markus Gass
- Abteilung für Viszeralchirurgie, Luzerner Kantonsspital, Luzern
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Kim R, Moore R, Schmidt L, Martin K, Sjoholm LO, Mason L, Beard J. Volvulus caused by a free intraperitoneal staple after laparoscopic appendectomy: A case report. Int J Surg Case Rep 2019; 65:259-261. [PMID: 31743842 PMCID: PMC6864125 DOI: 10.1016/j.ijscr.2019.10.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/27/2019] [Indexed: 12/22/2022] Open
Abstract
Free intraperitoneal staples are usually inert but can have complications. Early obstructive symptoms after appendectomy should warrant prompt work-up. Volvulus can occur due to free staples after laparoscopic appendectomy. Small bowel necrosis due to a free malformed staple required small bowel resection. We recommend removing free staples when seen in order to prevent complications.
Introduction Laparoscopic appendectomies are routinely performed using linear staplers. Few case reports have discussed complications from free intraperitoneal staples after appendectomy. We present the first case of a volvulus caused by a free staple that subsequently required bowel resection. Presentation of case A 27-year-old female underwent laparoscopic appendectomy for uncomplicated appendicitis. The base of the appendix was divided using a laparoscopic gastrointestinal anastomosis (GIA) stapler and the mesoappendix was divided using a LigaSure device. The patient was discharged the following day. Eight days later, the patient returned to the emergency department with severe abdominal pain, emesis, and peritoneal signs. Computed tomography (CT) showed significant pneumoperitoneum and nonspecific small bowel edema. Exploratory laparotomy was performed revealing a necrotic small bowel segment from a malformed, free staple caught on the peritoneum of the small bowel mesentery causing a closed loop obstruction. After reduction and detorsion, the small bowel segment was not viable and required resection. She was discharged on postoperative day four with no additional perioperative complications. Discussion Mechanical staplers are commonly used in laparoscopic appendectomy and free intraperitoneal staples are generally considered inert. A high index of suspicion should be maintained for the early postoperative appendectomy patient with obstructive symptoms. Conclusion Inspection of the staple line, choosing the appropriate staple size and cartridge, and removing free malformed staples if seen should be employed during appendectomy to prevent rare but devastating complications.
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Affiliation(s)
- Rachel Kim
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
| | - Ryan Moore
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
| | - Lauren Schmidt
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
| | - Katherine Martin
- Lewis Katz School of Medicine Physician Assistant Program, 3500 N. Broad Street, Suite 124, Philadelphia, PA 19140, USA.
| | - Lars Ola Sjoholm
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
| | - Leonard Mason
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
| | - Jessica Beard
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Parkinson Pavilion, Suite C405, Philadelphia, PA 19140, USA.
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9
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Delestre M, Barbieux J, Paisant A. Small bowel obstruction due to residual appendix. J Visc Surg 2019; 156:527-528. [PMID: 31606447 DOI: 10.1016/j.jviscsurg.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Delestre
- Service de chirurgie viscérale et endocrinienne, CHU Angers, 4, rue Larrey cedex 1, 49100, Angers, France; Faculté de Médecine, Université d'Angers, rue Haute de Reculée, 49045 Angers, France
| | - J Barbieux
- Service de chirurgie viscérale et endocrinienne, CHU Angers, 4, rue Larrey cedex 1, 49100, Angers, France; Faculté de Médecine, Université d'Angers, rue Haute de Reculée, 49045 Angers, France.
| | - A Paisant
- Faculté de Médecine, Université d'Angers, rue Haute de Reculée, 49045 Angers, France; Service de radiologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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10
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Less Pain and Reduced Risk of Early Postoperative Ileus After Clipless Versus Conventional Laparoscopic Appendectomy. Surg Laparosc Endosc Percutan Tech 2019; 29:543-547. [PMID: 31568256 DOI: 10.1097/sle.0000000000000721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Laparoscopic appendectomy (LA) is perceived as a procedure requiring a short hospital stay; however, some patients require prolonged hospitalization because of postoperative ileus and pain; therefore, we introduced clipless LA, using only an ultrasonic energy device only for coagulation. A total of 1013 patients (clipless LA; n=290 and conventional LA; n=723) who underwent LA at our hospital between January 2015 and February 2018 were analyzed. The mean operative time was shorter (P<0.001), and postoperative pain score at 24 hours was lower (P<0.001) for clipless than for conventional LA. There were no significant differences in postoperative complications, except with regard to early postoperative ileus (clipless LA; 18.1% vs. conventional LA; 31.6%, P=0.025), and the operative method had significantly influenced early postoperative ileus (relative risk, 0.505; 95% confidence interval, 0.257-0.994; P=0.048). Clipless LA is comparable to conventional LA with regard to operative safety but results in significantly less pain and postoperative ileus.
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11
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Yamamoto R, Mokuno Y, Matsubara H, Kaneko H, Iyomasa S. Feasibility and Safety of Laparoscopic Appendectomy Performed by Residents with No Experience in Open Appendectomy. JMA J 2019; 2:54-59. [PMID: 33681513 PMCID: PMC7930708 DOI: 10.31662/jmaj.2018-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/12/2018] [Indexed: 01/07/2023] Open
Abstract
Introduction: Open appendectomy for acute appendicitis is a common procedure for surgical residents to perform at the beginning of their training. Recently, many programs have moved to laparoscopic appendectomy as the initial training procedure. However, the feasibility and safety of laparoscopic appendectomy for acute appendicitis performed by surgical residents without any experience of open appendectomy remains controversial. Methods: The records of patients who underwent laparoscopic appendectomy for acute appendicitis between August 2006 and March 2017 were retrospectively reviewed. Patients were assigned to two groups according to whether their procedure was performed by a surgical resident, with no experience of open appendectomy, or a surgical fellow, with adequate open appendectomy experience but no experience with laparoscopic appendectomy. Results: A total of 130 patients were included. Five residents performed 104 procedures, and three fellows performed 26 procedures. The baseline patient characteristics were comparable between groups. The median operative time was comparable (77.0 min vs. 65.5 min; p = 0.771). There were no significant differences in overall complications; with 14 patients (13%) in the resident group and five patients (19%) in the fellow group experienced complications (p = 0.535). No patient required reoperation, and there were no fatalities. The median length of stay was similar (5.0 days vs. 5.5 days; p = 0.430). Conclusions: Laparoscopic appendectomy for acute appendicitis is feasible and safe when performed by surgical residents with no prior open appendectomy experience. It may be performed as the first procedure during surgical training with no adverse effect on patients.
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Affiliation(s)
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, Anjo, Japan
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Del Pino C, Muñoz R, Rada G. Laparoscopic versus open appendectomy for complicated appendicitis. Medwave 2018; 18:e7370. [PMID: 30550534 DOI: 10.5867/medwave.2018.08.7369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/27/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The treatment of acute appendicitis using laparoscopy reduces the risk of wound infection, hospitalization time and return to normal activity. However, it increases the risk of intra-abdominal abscess, which is one the main complications of complicated appendicitis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including 55 studies overall, of which four were randomized trials. We concluded that the used of laparoscopy, compared to open appendectomy, probably reduces the time of hospital stay, and may reduce the risk of wound infection, but there's no clarity regarding the incidence of intra-abdominal abscess due to the very low certainty of the evidence available.
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Affiliation(s)
| | - Rodrigo Muñoz
- Proyecto Epistemonikos, Santiago, Chile; Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gabriel Rada
- Proyecto Epistemonikos, Santiago, Chile; Centro Evidencia UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. . Address: Centro Evidencia UC, Pontificia Universidad Católica de Chile, Diagonal Paraguay 476, Santiago, Chile
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13
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Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2018; 11:CD001546. [PMID: 30484855 PMCID: PMC6517145 DOI: 10.1002/14651858.cd001546.pub4] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The removal of the acute appendix is one of the most frequently performed surgical procedures. Open surgery associated with therapeutic efficacy has been the treatment of choice for acute appendicitis. However, in consequence of the evolution of endoscopic surgery, the operation can also be performed with minimally invasive surgery. Due to smaller incisions, the laparoscopic approach may be associated with reduced postoperative pain, reduced wound infection rate, and shorter time until return to normal activity.This is an update of the review published in 2010. OBJECTIVES To compare the effects of laparoscopic appendectomy (LA) and open appendectomy (OA) with regard to benefits and harms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE and Embase (9 February 2018). We identified proposed and ongoing studies from World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and EU Clinical Trials Register (9 February 2018). We handsearched reference lists of identified studies and the congress proceedings of endoscopic surgical societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing LA versus OA in adults or children. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed the risk of bias, and extracted data. We performed the meta-analyses using Review Manager 5. We calculated the Peto odds ratio (OR) for very rare outcomes, and the mean difference (MD) for continuous outcomes (or standardised mean differences (SMD) if researchers used different scales such as quality of life) with 95% confidence intervals (CI). We used GRADE to rate the quality of the evidence. MAIN RESULTS We identified 85 studies involving 9765 participants. Seventy-five trials included 8520 adults and 10 trials included 1245 children. Most studies had risk of bias issues, with attrition bias being the largest source across studies due to incomplete outcome data.In adults, pain intensity on day one was reduced by 0.75 cm on a 10 cm VAS after LA (MD -0.75, 95% CI -1.04 to -0.45; 20 RCTs; 2421 participants; low-quality evidence). Wound infections were less likely after LA (Peto OR 0.42, 95% CI 0.35 to 0.51; 63 RCTs; 7612 participants; moderate-quality evidence), but the incidence of intra-abdominal abscesses was increased following LA (Peto OR 1.65, 95% CI 1.12 to 2.43; 53 RCTs; 6677 participants; moderate-quality evidence).The length of hospital stay was shortened by one day after LA (MD -0.96, 95% CI -1.23 to -0.70; 46 RCTs; 5127 participant; low-quality evidence). The time until return to normal activity occurred five days earlier after LA than after OA (MD -4.97, 95% CI -6.77 to -3.16; 17 RCTs; 1653 participants; low-quality evidence). Two studies showed better quality of life scores following LA, but used different scales, and therefore no pooled estimates were presented. One used the SF-36 questionnaire two weeks after surgery and the other used the Gastro-intestinal Quality of Life Index six weeks and six months after surgery (both low-quality evidence).In children, we found no differences in pain intensity on day one (MD -0.80, 95% CI -1.65 to 0.05; 1 RCT; 61 participants; low-quality evidence), intra-abdominal abscesses after LA (Peto OR 0.54, 95% CI 0.24 to 1.22; 9 RCTs; 1185 participants; low-quality evidence) or time until return to normal activity (MD -0.50, 95% CI -1.30 to 0.30; 1 RCT; 383 participants; moderate-quality evidence). However, wound infections were less likely after LA (Peto OR 0.25, 95% CI 0.15 to 0.42; 10 RCTs; 1245 participants; moderate-quality evidence) and the length of hospital stay was shortened by 0.8 days after LA (MD -0.81, 95% CI -1.01 to -0.62; 6 RCTs; 316 participants; low-quality evidence). Quality of life was not reported in any of the included studies. AUTHORS' CONCLUSIONS Except for a higher rate of intra-abdominal abscesses after LA in adults, LA showed advantages over OA in pain intensity on day one, wound infections, length of hospital stay and time until return to normal activity in adults. In contrast, LA showed advantages over OA in wound infections and length of hospital stay in children. Two studies reported better quality of life scores in adults. No study reported this outcome in children. However, the quality of evidence ranged from very low to moderate and some of the clinical effects of LA were small and of limited clinical relevance. Future studies with low risk of bias should investigate, in particular, the quality of life in children.
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Affiliation(s)
- Thomas Jaschinski
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Christoph G Mosch
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS)Department of Evidence‐based medicineTheodor‐Althoff‐Straße 47EssenNorth Rhine WestphaliaGermany51109
| | - Edmund AM Neugebauer
- Brandenburg Medical School Theodor Fontane 3Fehrbelliner Str 38NeuruppinBrandenburgGermany16816
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care (IQWiG)Department of Non‐Drug InterventionsIm Mediapark 8CologneGermany50670
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14
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Becker P, Fichtner-Feigl S, Schilling D. Clinical Management of Appendicitis. Visc Med 2018; 34:453-458. [PMID: 30675493 DOI: 10.1159/000494883] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Ever since the first appendectomy has been performed, surgery has been the standard of care for acute appendicitis, with antibiotic therapy being reserved for special situations. Recent studies have shown the feasibility of antibiotic therapy for uncomplicated appendicitis. Methods This clinical therapeutic review is based both on author expertise and a selective literature survey in PubMed based on the term 'appendicitis', combined with the terms 'acute', 'complicated', 'conservative', 'non-operative', 'therapy', 'surgery', and 'strategy'. According to these search results as well as to the treatment guidelines from the American College of Surgeons, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, European Association of Endoscopic Surgery, and World Society of Emergency Surgery, we present an interdisciplinary treatment concept. Results Approximately 90% of patients treated with antibiotics are able to avoid surgery during the initial admission. The other 10% that fail to respond to antibiotics require a rescue appendectomy. Recurrence rates of non-operated patients within 1 year are as high as 20-30%. Conclusion In uncomplicated appendicitis without risk factors for failure of non-operative management, a shared decision based on the patient's preferences should be made. In cases with risk factors, appendectomy is still the treatment recommended. If the diagnosis is uncertain or clinical symptoms are rather mild, antibiotic therapy should be started. In complicated appendicitis, management depends on the clinical state, with either immediate surgery or primarily antibiotic therapy and combined with drainage of abscess, being followed by interval appendectomy in some cases.
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Affiliation(s)
- Peter Becker
- Medizinische Klinik II, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Stefan Fichtner-Feigl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg i.Br., Germany
| | - Dieter Schilling
- Medizinische Klinik II, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
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Skoglar A, Gunnarsson U, Falk P. Band adhesions not related to previous abdominal surgery - A retrospective cohort analysis of risk factors. Ann Med Surg (Lond) 2018; 36:185-190. [PMID: 30505438 PMCID: PMC6249350 DOI: 10.1016/j.amsu.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
Background Postoperative intra-abdominal adhesion formation is a common cause of small bowel obstruction (SBO). Adhesions causing SBO are classed as either matted adhesions or solitary band adhesions. The aim of this study was to investigate the prevalence of previous abdominal surgery in a cohort of patients operated for bowel obstruction and to analyze the causes of obstruction discovered at surgery. Materials and methods The study was performed at a county hospital with a catchment population of 120 000 inhabitants. Records of operations performed for bowel obstruction over a period of 70 months were retrieved. Results Of the 196 surgical procedures for intestinal obstruction included, 108 (55%) were caused by adhesions. In this group, 42 (39%) were due to solitary band adhesions and 66 (61%) were due to matted adhesions. Ten of 18 male patients (56%) with a solitary obstructing band had not undergone previous abdominal surgery (p < 0.05). In the cohort as a whole, a significant number of surgical procedures were performed for solitary band adhesions in patients without prior history of surgery (p < 0.01). Conclusion In male patients, not only previous abdominal surgery but also other factors appear to increase the risk for bowel obstruction due to a solitary band. For intestinal obstruction caused by matted adhesions, however, previous abdominal surgery is the main risk factor in both genders. Patients with signs of SBO but without previous abdominal surgery should be managed bearing in mind that solitary band adhesion and thereby strangulation may be present regardless of previous surgery or not. Post-operative abdominal adhesions are a common reason for small bowel obstruction. Abdominal adhesions can develop without undergoing previous surgery. Band adhesions occurs without prior surgery – gender seems to be of importance.
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Affiliation(s)
- Andreas Skoglar
- Surgical and Orthopedic Clinic, Kungälvs Hospital, Region Västra Götaland, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Peter Falk
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Binet A, Braïk K, Lengelle F, Laffon M, Lardy H, Amar S. Laparoscopic one port appendectomy: Evaluation in pediatric surgery. J Pediatr Surg 2018; 53:2322-2325. [PMID: 29370892 DOI: 10.1016/j.jpedsurg.2017.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Appendectomy is a well-established surgical procedure in pediatric surgery used in the management of acute appendicitis. With the continuous advancement in the field of minimal invasive surgery, the recent focus is on single incision laparoscopic (SIL) surgery. SILA also goes further in order to decrease pain, improve recovery and enhance patient satisfaction. However, this approach is still not a well-established technique and not widely practiced, especially in pediatric surgery. METHODS We prospectively recorded the data in our pediatric universitary hospital center since January, 01 2017 to July, 01 2017. Patients included in this study were randomized in two groups: SILA group (managed by one-port laparoscopy, n=40) and LA group (conventional laparoscopy using three trocars, n=40). RESULTS The mean operative time for SILA was significantly lower. There were no postoperative complications in SILA group. If peritonitis was associated with appendicitis, the operative duration was not significantly different between each group. The duration in recovery room after surgery was significantly lower in SILA group. The morphine consumption was significantly lower for SILA group according to patient weight. SILA is less painful significantly than CLA for the first postoperative 6 h. After, even if SILA appears less painful, difference is not significant. The hospital length of stay was significantly higher in LA than SILA group CONCLUSIONS: SILA procedure for appendectomy appears to be safe and efficient for appendicitis management in children. This technique could be applied in routine as in emergency tome. TYPE OF STUDY Prospective comparative study LEVEL OF EVIDENCE: II.
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Affiliation(s)
- Aurelian Binet
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France.
| | - Karim Braïk
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Francois Lengelle
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Marc Laffon
- Pediatric anaesthetic Unit, Hospital Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Hubert Lardy
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
| | - Sarah Amar
- Pediatric Surgery Unit, Hospital, Universitary Center of Tours, Gatien de Clocheville Hospital, 37000 Tours, France
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Som R, Seymour N, Thrumurthy SG, Khattak S, Joshi S, Sorelli PG. Establishing the need for clinical follow-up after emergency appendicectomy in the modern era: Retrospective case series of 145 patients. Ann Med Surg (Lond) 2018; 34:23-27. [PMID: 30191061 PMCID: PMC6125798 DOI: 10.1016/j.amsu.2018.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Emergency appendicectomy (EA) is a commonly performed operation, with an increasing number of EAs being performed as day-case. The aim of this study is to establish if there is a need for post-operative follow-up and if this could prevent adverse outcomes. Methods A retrospective analysis of patients who underwent EA at multiple centres over a six-month period was undertaken. They were contacted by telephone and a standardised questionnaire was used to ascertain post-operative outcomes, including duration of analgesia use, duration before return to normal daily activity (ADLs), surgical site infection rates (SSI) and rates of re-presentation to medical services. Patients were stratified into those who underwent laparoscopic versus open appendicectomy, smokers versus non-smokers, and body mass index (BMI). Results A total of 145 patients were included in the study. Patients undergoing open surgery (vs. laparoscopic surgery) required analgesia for significantly longer periods, with a significantly longer return to ADLs. Smokers, when compared to non-smokers experienced a significantly longer return to work/school; and significantly higher risk of SSI and re-presenting to accident & emergency; as did patients with a BMI >30 when compared to those with a BMI <30. Conclusion Most patients do not need formal outpatient assessment after EA. However, there is clearly a subset of higher risk patients who may benefit from this - patients who are smokers or obese. They have prolonged recovery times, and are at greater risk of SSI. Earlier surgical outpatient follow-up of these patients could prevent adverse outcomes.
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Affiliation(s)
- Robin Som
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Nicky Seymour
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Sri G Thrumurthy
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Sophia Khattak
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Shivani Joshi
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
| | - Paolo G Sorelli
- Lewisham and Greenwich NHS Trust, Department of General Surgery, Queen Elizabeth Hospital, Stadium Road, Woolwich, London SE18 4QH, United Kingdom
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Sylthe Pedersen E, Stornes T, Rekstad LC, Martinsen TC. Is there a role for routine colonoscopy in the follow-up after acute appendicitis? Scand J Gastroenterol 2018; 53:1008-1012. [PMID: 29979091 DOI: 10.1080/00365521.2018.1485732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mechanical obstruction of the appendiceal lumen is proposed as a possible factor in the pathogenesis of acute appendicitis. Hence, patients over the age of 40 are often referred to a follow-up colonoscopy after admission for acute appendicitis. The use of CT scans question whether routine colonoscopy still has a place in follow-up for these patients. METHODS All patients aged over 40 years with confirmed acute appendicitis admitted to St. Olav's Hospital in the period from 2010 to 2015 were included in this retrospective study. Findings and distribution of significant colorectal neoplasms (cancer and advanced adenomas) within three years after the admission were evaluated. RESULTS Fifty-four (7.4%) of the 731 patients were found to have colonic neoplasms; 9 patients (1.2%) were found to have colorectal cancer of which 7 were located on the right side, 22 patients (3.0%) were found to have advanced adenomas and 23 patients (3.1%) were found to have non-advanced adenomas. The sensitivity and specificity for CT to discover cancer was 0.25 and 0.97, respectively. A total of 316 patients (43.2%) had colonoscopy within three years after admission. CONCLUSION There may be an increased risk of colorectal neoplasms in patients over the age of 40 admitted with acute appendicitis. There seems to be an increased proportion of right-sided cancer relatively to other colonic locations. The sensitivity for CT scans to discover colorectal cancer in this group is low. Further studies are needed to decide whether routine colonoscopy is indicated after acute appendicitis in patients over 40 years.
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Affiliation(s)
- Eirik Sylthe Pedersen
- a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Tore Stornes
- a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.,b Department of Surgery, St. Olav's hospital , Trondheim University Hospital , Trondheim , Norway
| | - Lars Cato Rekstad
- a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.,b Department of Surgery, St. Olav's hospital , Trondheim University Hospital , Trondheim , Norway
| | - Tom Christian Martinsen
- a Department of Cancer Research and Molecular Medicine , NTNU, Norwegian University of Science and Technology , Trondheim , Norway.,c Department of Medicine, St. Olav's hospital , Trondheim University Hospital , Trondheim , Norway
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Spinal/epidural block as an alternative to general anesthesia for laparoscopic appendectomy: a prospective randomized clinical study. Wideochir Inne Tech Maloinwazyjne 2018; 13:148-156. [PMID: 30002746 PMCID: PMC6041592 DOI: 10.5114/wiitm.2018.72684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/14/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems. Aim To compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain. Material and methods Fifty patients, aged 18–65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) groups. Perioperative and postoperative adverse events, postoperative pain level, and patient satisfaction were compared between the groups. Results None of the patients needed conversion to an open procedure or conversion from SEA to GA. In the SEA group we encountered shoulder pain in 6 (24%) patients, abdominal discomfort/pain in 4 (16%) patients, anxiety in 4 (16%) patients, and hypotension in 2 (8%) patients intraoperatively. Also, post-spinal headache was observed in 5 (20%) patients in the SEA group. Postoperative right shoulder pain was significantly higher in the GA group compared to the SEA group (32% vs. 8%; p = 0.037). In the SEA group the incidence of urinary retention and in the GA group the incidence of postoperative nausea and vomiting (PONV) were higher, but these differences were not statistically significant. The postoperative surgical pain level was significantly lower in the SEA group (p < 0.001). Conclusions Spinal/epidural anesthesia is effective and safe in ASA I healthy patients undergoing LA. Less postoperative pain, PONV and shoulder pain are the advantages of SEA compared to GA.
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Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature. World J Surg 2018; 41:3083-3099. [PMID: 28717908 DOI: 10.1007/s00268-017-4123-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To review and compare the outcomes of laparoscopic (LA) versus open appendicectomy (OA) in complicated appendicitis in adult patients, eight years after the last literature review. METHODS The PRISMA guidelines were adhered to. Pre-defined inclusion and exclusion criteria were used to search the PubMed, Scopus and Cochrane databases and extract relevant data. Methodological and quality assessment was undertaken with outcome meta-analysis and subgroup analyses of methodological quality, type of study and year of study. Assessment of clinical and statistical heterogeneity and publication bias was conducted. RESULTS Three randomised control trials (RCTs) (154LA vs 155OA) and 23 case-control trials were included (2034LA vs 2096OA). Methodological quality was low to average but with low statistical heterogeneity. Risk of publication bias was low, and meta-regression indicated shorter length of hospital stay (LOS) in more recent studies, Q = 7.1, P = 0.007. In the combined analysis LA had significantly less surgical site infections [OR = 0.30 (0.22,0.40); p < 0.00001] with reduced time to oral intake [WMD = -0.98 (-1.09,-0.86); P < 0.00001] and LOS [WMD = -3.49(-3.70,-3.29); p < 0.00001]. There was no significant difference in intra-abdominal abscess rates [OR = 1.11(0.85,1.45); p = 0.43]. Operative time was longer during LA [WMD = 10.51 (5.14,15.87); p = 0.0001] but did not reach statistical significance (p = 0.13) in the RCT subgroup analysis. CONCLUSIONS LA appears to have significant benefits with improved morbidity compared to OA in complicated appendicitis (level of evidence II).
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Li P, Han Y, Yang Y, Guo H, Hao F, Tang Y, Guo C. Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients: Laparoscopic versus open surgery for appendiceal abscess. Medicine (Baltimore) 2017; 96:e7514. [PMID: 28746196 PMCID: PMC5627822 DOI: 10.1097/md.0000000000007514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Laparoscopic appendectomy (LA) has become well accepted, but the role of LA for appendicitis upon presentation with an abscess remains undefined. This study was to assess the postoperative recovery and complications following LA in pediatric patients with appendiceal abscess in comparison with open appendectomy (OA).We conducted a retrospective review of patients presented with appendiceal abscess between 2005 and 2016. Propensity score matching (PSM) was conducted to adjust for any potential selection bias for the surgical approaches. In 108 matched patients, operative outcomes and surgical complications were evaluated based on LA or OA.The patients with LA experienced prompt postoperative gastrointestinal function recovery, like first bowel movement (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.44-0.69; P < .001), so spend the lower mean length of hospitalization (RR, 0.53; 95% CI, 0.41-0.76; P < .001) in comparison with patients with OA. Furthermore, the immunologic and inflammatory variable white blood cell (WBC) (RR, 0.56; 95% CI, 0.46-0.73; P < .001) and C-reactive protein (CRP) (RR, 0.58; 95% CI, 0.43-0.86; P = .011) on postoperative days (POD) 5 was reduced in patients undergone LA compared with that of OA. A lower overall postoperative complication rate, including surgical wound infection (odds ratio [OR], 0.38; 95% CI, 0.18-0.81; P = .008) and incision dehiscence (OR, 0.06; 95% CI, 0.01-0.45; P < .001) was noted in patients with LA compared with OA.LA was feasible and effective for appendicitis upon presentation with an abscess and associated with beneficial clinical effects, such as postoperative gastrointestinal function recovery and reduced postoperative complications. LA should be seriously considered as the first line procedure of choice.
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Affiliation(s)
- Ping Li
- Department of Ultrasound, The Affiliated Hospital of Medical College, Qingdao University, Qingdao
| | | | - Yang Yang
- Department of Pediatric General Surgery and Liver Transplantation
| | - Hongjie Guo
- Department of Pediatric General Surgery and Liver Transplantation
| | - Fabao Hao
- Department of Pediatric General Surgery and Liver Transplantation
| | - Yan Tang
- Department of Pediatric General Surgery and Liver Transplantation
| | - Chunbao Guo
- Department of Pediatric General Surgery and Liver Transplantation
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
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Sallinen V, Tikkinen KAO. Antibiotics or Appendectomy for Acute Non-Perforated Appendicitis--How to Interpret the Evidence? Scand J Surg 2016; 105:3-4. [PMID: 26976819 DOI: 10.1177/1457496916632188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ville Sallinen
- Departments of Abdominal, Liver and Transplantation Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016; 30:4668-4690. [PMID: 27660247 PMCID: PMC5082605 DOI: 10.1007/s00464-016-5245-7] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023]
Abstract
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
- Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Gabor S A Abis
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Amish Acharya
- Department of Surgery, St Mary's Hospital, London, UK
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stavros A Antoniou
- Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany
- Department of Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Simone Arolfo
- Department of Surgery, University of Torino, Torino, Italy
| | - Benjamin Babic
- Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luigi Boni
- Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Marlieke Bruntink
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Barbara Defoort
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - Charlotte L Deijen
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Borja DeLacy
- Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Peter Mnyh Go
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Florin Iordache
- Department of Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Filip E Muysoms
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - M Mahir Ozmen
- Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Michail Papoulas
- Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Michael Rhodes
- Department of Surgery, Stepping Hill Hospital, Stockport, UK
| | - Jennifer Straatman
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Victor Turrado
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pecs, Hungary
| | - Ramon Vilallonga
- Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain
| | - Jort D Deelder
- Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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Ceresoli M, Zucchi A, Allievi N, Harbi A, Pisano M, Montori G, Heyer A, Nita GE, Ansaloni L, Coccolini F. Acute appendicitis: Epidemiology, treatment and outcomes- analysis of 16544 consecutive cases. World J Gastrointest Surg 2016; 8:693-699. [PMID: 27830041 PMCID: PMC5081551 DOI: 10.4240/wjgs.v8.i10.693] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/04/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the epidemiology, treatment and outcomes of acute appendicitis (AA) in a large population study.
METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system (more than 1 million inhabitants) from 1997 to 2013. Data about treatment, surgery, length of stay were collected. Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.
RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA, with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17, 54.7% were male and the mean Charlson’s comorbidity index was 0.32 ± 0.92. Mortality was < 0.0001%. Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion. Laparoscopic appendectomy was performed in 48% of cases. Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.
CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing, with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option, but rich of promising results.
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Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol 2015; 5:238-254. [PMID: 26713285 PMCID: PMC4686422 DOI: 10.5662/wjm.v5.i4.238] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.
METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.
RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.
CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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Antoniou SA, Antoniou GA, Granderath FA. Risk for bowel obstruction following laparoscopic and open appendectomy. J Gastrointest Surg 2015; 19:795-6. [PMID: 25691112 DOI: 10.1007/s11605-015-2768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/30/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Stavros A Antoniou
- Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany,
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