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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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Stewart S, Cruz-Centeno N, Marlor DR, St Peter SD, Oyetunji TA. Bridging the Gap: Pediatric General Surgery for the Pediatrician. Pediatr Rev 2023; 44:632-643. [PMID: 37907417 DOI: 10.1542/pir.2022-005894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Håkanson CA, Fredriksson F, Lilja HE. Paediatric Adhesive Small Bowel Obstruction is Associated with a Substantial Economic Burden and High Frequency of Postoperative Complications. J Pediatr Surg 2023; 58:2249-2254. [PMID: 37355434 DOI: 10.1016/j.jpedsurg.2023.05.017] [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: 02/13/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Intra-abdominal adhesions can lead to adhesive small bowel obstruction (ASBO). The incidence of ASBO is higher in paediatric surgery than in adult surgery. However, ASBO related complications, economic burden and clear management guidelines in the treatment of ASBO are lacking. The aims of this study were to investigate underlying diagnoses, treatments, complications and costs in paediatric ASBO. METHOD An observational retrospective study in children 0-15 years, hospitalised for ASBO during 2000-2020. Data were extracted from the medical records. Complications were classified based on Clavien Dindo Classification of Surgical Complications. Descriptive statistics were presented as median, continuous variables and categorical variables summarised with frequencies. Time to ASBO was presented as a Kaplan-Meier estimate. RESULTS In total, 101 patients with 137 episodes of ASBO were included whereof 58.4% underwent first (index) surgery during the neonatal period. Median follow-up was 11.3 (0.6-19) years and median time to the first ASBO was 3.76 months (95%CI 2.23-12.02). The most common diagnoses at index surgery were necrotising enterocolitis, duodenal obstruction and primary ASBO. In 86.6% of the patients, first ASBO did not resolve with conservative treatment and a laparotomy was needed. Postoperative complications were found in 52%. Median cost for one episode of acute ASBO was 36 236 USD (1629-236 159). CONCLUSION Neonatal surgery was the dominating cause of ASBO and surgical intervention the most common treatment with a high frequency of postoperative complications and significant healthcare costs. Future studies are needed to develop safe management guidelines for the treatment of paediatric ASBO. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Cecilia Arana Håkanson
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Solna, Sweden.
| | - Fanny Fredriksson
- Detpartment of Women's and Children's health, Uppsala University, Sweden
| | - Helene Engstrand Lilja
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Solna, Sweden; Department of Pediatric Surgery, Astrid Lindgren Hospital, Eugeniavägen 23, 171 64, Solna, Sweden
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Zeineddin S, Hu A, Linton S, Zhang V, De Boer C, Raval MV, Abdullah F, Goldstein SD. Association between appendiceal stump closure method and post-operative bowel obstruction after laparoscopic appendectomy. J Pediatr Surg 2023; 58:643-647. [PMID: 36670005 DOI: 10.1016/j.jpedsurg.2022.12.015] [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: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is one of the most common urgent pediatric surgical operations. Endoscopic surgical staplers and pre-tied endoloop ligatures are both routinely used for closure of the appendiceal stump in children. Practice patterns vary for a number of reasons, including cost, size, and ease of use. While stapling is standard for some pediatric surgeons, others believe that staples can act as a nidus for small bowel obstruction (SBO). However, studies comparing closure methods have been conflicting in their results and limited in size. Therefore, we aim to determine if there is an association between appendiceal stump closure method and SBO using a national comparative pediatric database. METHODS We queried the Pediatric Health Information System (PHIS) for patients ages 3-18 years who underwent laparoscopic appendectomy for appendicitis between 1/1/2016 - 12/31/2020. We included hospitals that had greater than 50 patients with billing data and excluded patients with inflammatory bowel disease and simultaneous abdominal operations. We used billing data for the patient's appendectomy to determine if a stapler or a suture ligature was used during the case. Our primary outcome of interest was post-operative SBO or reoperation for lysis of adhesion or intestinal surgery within the first 30 post-operative days. Multivariable regression analyses were used to estimate the association between stump closure method and post-operative SBO or reoperation in addition to cost while adjusting for patient demographics and appendiceal perforation. RESULTS In total, 49,191 patients from 37 hospitals were included, of which, 29,733 (60.44%) were male, 21,403 (43.51%) were non-Hispanic white, and 18,291 (37.18%) had a diagnosis of complicated appendicitis. The median [IQR] age of the cohort was 11 [8-14] years. A surgical stapler was used during laparoscopic appendectomy in 35,788 (72.75%) patients, and early SBO or reoperation occurred in 653 (1.33%) patients. In adjusted analysis controlling for demographics and complicated appendicitis there was no statistically significant difference in the odds of SBO or reoperation between the two groups. (OR 1.17; 99% CI 0.86 - 1.6). Complicated appendicitis was the factor most associated with post-operative SBO or reoperation (OR 4.4; 99% CI 3.01 - 6.44). Median cumulative cost was slightly higher on unadjusted analysis in the stapler group ($10,329.3 vs $9,569.2). However, there was no significant difference on adjusted analysis. CONCLUSION SBO or reoperation following laparoscopic appendectomy for appendicitis is uncommon. Complicated appendicitis is the most predictive factor of this outcome. Adjusting for available patient, disease, and hospital characteristics, use of a surgical stapler does not appear to be meaningfully associated with the development of acute SBO or reoperation. Surgeon preference remains the mainstay for safe appendiceal stump closure method. LEVEL OF EVIDENCE Level III. STUDY TYPE Retrospective Comparative Study.
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Affiliation(s)
- Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Andrew Hu
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Samuel Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Veronica Zhang
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christopher De Boer
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis. J Pediatr Surg 2022; 57:394-405. [PMID: 34332757 DOI: 10.1016/j.jpedsurg.2021.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays. AIM To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA. METHODS The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. RESULTS Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. CONCLUSION This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.
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6
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Lascano D, Kelley-Quon LI. Management of Postoperative Complications Following Common Pediatric Operations. Surg Clin North Am 2021; 101:799-812. [PMID: 34537144 DOI: 10.1016/j.suc.2021.05.021] [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: 10/20/2022]
Abstract
This review discusses complications unique to pediatric surgical populations. Here the authors focus primarily on five of the most common procedures performed in children: appendectomy, central venous catheterization, pyloromyotomy, gastrostomy, and inguinal/umbilical hernia repair.
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Affiliation(s)
- Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #100, Los Angeles, CA 90027, USA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.
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Omling E, Salö M, Saluja S, Bergbrant S, Olsson L, Björk J, Hagander L. A Nationwide Cohort Study of Outcome after Pediatric Appendicitis. Eur J Pediatr Surg 2021; 31:191-198. [PMID: 32590867 PMCID: PMC10499502 DOI: 10.1055/s-0040-1712508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/16/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. MATERIALS AND METHODS A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. RESULTS Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18-3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08-5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61-5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62-0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11-0.63], p = 0.002). CONCLUSION Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.
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Affiliation(s)
- Erik Omling
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Saurabh Saluja
- Department of Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Sanna Bergbrant
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Louise Olsson
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Björk
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Skåne, Sweden
| | - Lars Hagander
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Ekdahl L, Wallin E, Alfonzo E, Reynisson P, Lönnerfors C, Dahm-Kähler P, Falconer H, Persson J. Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study. J Clin Med 2020; 9:jcm9113715. [PMID: 33228139 PMCID: PMC7699339 DOI: 10.3390/jcm9113715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (≤50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.
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Affiliation(s)
- Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Emelie Wallin
- Department of Women’s and Children’s Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, 14186 Stockholm, Sweden; (E.W.); (H.F.)
- Department of Pelvic Cancer, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Emilia Alfonzo
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.A.); (P.D.-K.)
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.A.); (P.D.-K.)
- Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Henrik Falconer
- Department of Women’s and Children’s Health, Division of Neonatology, Obstetrics and Gynecology, Karolinska Institutet, 14186 Stockholm, Sweden; (E.W.); (H.F.)
- Department of Pelvic Cancer, Karolinska University Hospital, 14186 Stockholm, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, 22185 Lund, Sweden; (L.E.); (P.R.); (C.L.)
- Department of Clinical Sciences, Obstetrics and Gynaecology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Correspondence: ; Tel.: +46-733522080; Fax: +46-46157868
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Adhesive small bowel obstruction after appendectomy in children - Laparoscopic versus open approach. J Pediatr Surg 2020; 55:2419-2424. [PMID: 32192735 DOI: 10.1016/j.jpedsurg.2020.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/11/2020] [Accepted: 02/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aims of this study were to compare the incidence of small bowel obstruction (SBO) requiring laparotomy after laparoscopic appendectomy (LA) and open appendectomy (OA) in children and to identify risk factors for SBO. METHODS Medical records of patients who underwent appendectomy from 2000 to 2014 at our department of Pediatric Surgery were reviewed. Risk factors were analyzed using Cox proportional hazard regression. RESULTS Totally 619 out of 840 patients were included. OA was performed in 474 (76.6%), LA in 130 patients (21%), and 15 (2.4%) were converted from LA to OA. Age, sex and proportion of perforated appendicitis were comparable in the LA and OA groups. Median follow-up time was 11.4 years (2.6-18.4). The incidence of SBO after LA was 1.5%, after OA 1.9% and in the converted group 6.7% (p = 0.3650). There were no significant differences in the incidence of postoperative intraabdominal abscess, wound infection or length of stay between LA and OA. Perforation and postoperative intra-abdominal abscess were identified as risk factors with 9.03 (p < 0.001) and 6.98 (p = 0.004) times higher risk of SBO, respectively. CONCLUSIONS The risk for SBO after appendectomy in children was significantly related to perforated appendicitis and postoperative intra-abdominal abscess and not to the surgical approach. LEVEL OF EVIDENCE Level III.
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10
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Madenci AL, Dieffenbach BV, Liu Q, Yoneoka D, Knell J, Gibson TM, Yasui Y, Leisenring WM, Howell RM, Diller LR, Krull KR, Armstrong GT, Oeffinger KC, Murphy AJ, Weil BR, Weldon CB. Late-onset anorectal disease and psychosocial impact in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2019; 125:3873-3881. [PMID: 31322729 DOI: 10.1002/cncr.32395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/08/2019] [Accepted: 06/13/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The prevalence and associated psychosocial morbidity of late-onset anorectal disease after surgery and radiotherapy for the treatment of childhood cancer are not known. METHODS A total of 25,530 survivors diagnosed between 1970 and 1999 (median age at cancer diagnosis, 6.1 years; age at survey, 30.2 years) and 5036 siblings were evaluated for late-onset anorectal disease, which was defined as a self-reported fistula-in-ano, self-reported anorectal stricture, or pathology- or medical record-confirmed anorectal subsequent malignant neoplasm (SMN) 5 or more years after the primary cancer diagnosis. Piecewise exponential models compared the survivors and siblings and examined associations between cancer treatments and late-onset anorectal disease. Multiple logistic regression with generalized estimating equations was used to evaluate associations between late-onset anorectal disease and emotional distress, as defined by the Brief Symptom Inventory 18 (BSI-18), and health-related quality of life, as defined by the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS By 45 years after the diagnosis, 394 survivors (fistula, n = 291; stricture, n = 116; anorectal SMN, n = 26) and 84 siblings (fistula, n = 73; stricture, n = 23; anorectal neoplasm, n = 1) had developed late-onset anorectal disease (adjusted rate ratio [RR] for survivors vs siblings, 1.2; 95% confidence interval [CI], 1.0-1.5). Among survivors, pelvic radiotherapy with ≥30 Gy within 5 years of the cancer diagnosis was associated with late-onset anorectal disease (adjusted RR for 30-49.9 Gy vs none, 1.6; 95% CI, 1.1-2.3; adjusted RR for ≥50 Gy vs none, 5.4; 95% CI, 3.1-9.2). Late-onset anorectal disease was associated with psychosocial impairment in all BSI-18 and SF-36 domains. CONCLUSIONS Late-onset anorectal disease was more common among childhood cancer survivors who received higher doses of pelvic radiotherapy and was associated with substantial psychosocial morbidity.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bryan V Dieffenbach
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Qi Liu
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daisuke Yoneoka
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jamie Knell
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy M Leisenring
- Clinical Research and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lisa R Diller
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Pediatric Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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11
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Castro BA, Novillo IC, Vázquez AG, Garcia PY, Herrero EF, Fraile AG. IMPACT OF THE APPENDICEAL POSITION ON THE DIAGNOSIS AND TREATMENT OF PEDIATRIC APPENDICITIS. REVISTA PAULISTA DE PEDIATRIA 2019; 37:161-165. [PMID: 30892542 PMCID: PMC6651307 DOI: 10.1590/1984-0462/;2019;37;2;00012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
Objective: To investigate how symptoms vary according to the appendiceal position in pediatric patients and to demonstrate that the laparoscopic approach is safe and effective in any appendiceal location by comparing each location to another. Methods: The medical records of 1,736 children aged 14 or younger who underwent laparoscopic appendectomy over a period of 14 years were analyzed retrospectively. Patients were divided according to the position of the appendiceal tip into four groups: anterior, pelvic, retrocecal and subhepatic. The Kruskal-Wallis and chi-square tests were used with the Bonferroni correction, with a significant p<0.05. Results: The appendiceal location was anterior in 1,366 cases, retrocecal in 248 cases, pelvic in 66 cases and subhepatic in 56 cases. There were no significant differences between the groups in terms of patient age and gender. Abdominal pain was the only symptom with statistically significant differences between the groups. The rate of perforated appendicitis was higher in the subhepatic and pelvic positions. Intraoperative complications and conversions were not statistically significant. Technical difficulties and operative time were higher in subhepatic position. The rate of postoperative complications was similar between the different locations, except for bowel obstruction, which was higher in pelvic appendicitis. Conclusions: The clinical symptoms of appendicitis hardly ever change with the position of the appendix. The laparoscopic approach is safe and effective, regardless the appendiceal location.
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Laparoscopic versus open appendectomy in pediatric patients with complicated appendicitis: a meta-analysis. Surg Endosc 2019; 33:4066-4077. [PMID: 30805783 DOI: 10.1007/s00464-019-06709-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/19/2019] [Indexed: 01/07/2023]
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13
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Postoperative Small Bowel Obstruction Following Laparoscopic or Open Fundoplication in Children: A Retrospective Analysis Using a Nationwide Database. World J Surg 2019; 42:4112-4117. [PMID: 30014291 DOI: 10.1007/s00268-018-4735-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Postoperative small bowel obstruction (SBO) is one of the most serious adverse events resulting in deteriorated quality of life in children. Numerous studies have shown that laparoscopic surgery significantly reduces the occurrence of SBO compared with open surgery in adults. However, evidence of the advantages of laparoscopic surgery over open surgery in terms of reducing SBO is lacking in children. Fundoplication is a common abdominal procedure in children. This study was performed to compare the occurrence of SBO after laparoscopic fundoplication (LF) versus open fundoplication (OF). METHODS Using the Diagnosis Procedure Combination database, a national inpatient database in Japan, we retrospectively identified patients aged 0-18 years who underwent LF or OF from July 2010 to March 2016. Propensity score adjustment was used to compare the occurrence of SBO between the groups. RESULTS We identified 1838 eligible patients who underwent LF (n = 1362) or OF (n = 476). The median age at surgery was 4.0 and 1.5 years in the LF and OF group, respectively (P < 0.001). The median weight at admission was 11.4 and 7.5 kg, respectively (P < 0.001). Nineteen (1.4%) patients in the LF group and 13 (2.7%) in the OF group had at least one episode of SBO (P = 0.11, log-rank test). In the propensity score-adjusted Cox regression analysis, SBO was significantly less likely to occur in the LF than OF group (hazard ratio, 0.36; 95% confidence interval 0.16-0.82; P = 0.01). CONCLUSIONS In this retrospective nationwide study, LF was significantly associated with a reduction in SBO compared with OF in children.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Rasmussen T, Fonnes S, Rosenberg J. Long-Term Complications of Appendectomy: A Systematic Review. Scand J Surg 2018; 107:189-196. [PMID: 29764306 DOI: 10.1177/1457496918772379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Appendectomy is a common surgical procedure, but no overview of the long-term consequences exists. Our aim was to systematically review the long-term complications of appendectomy for acute appendicitis. MATERIALS AND METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42017064662). The databases PubMed and EMBASE were searched for original reports on appendectomy with n ≥ 500 and follow-up >30 days. The surgical outcomes were ileus and incisional hernia; other outcomes were inflammatory bowel disease, cancer, fertility, and mortality. RESULTS We included 37 studies. The pooled estimate of the ileus prevalence was 1.0% over a follow-up period of 4.6 (range, 0.5-15) years. Regarding incisional hernia, we found a pooled estimate of 0.7% prevalence within a follow-up period of 6.5 (range, 1.9-10) years. Ulcerative colitis had a pooled estimate of 0.15% prevalence in the appendectomy group and 0.19% in controls. The opposite pattern was found regarding Crohn's disease with a pooled estimate of 0.20% prevalence in the appendectomy group and 0.12% in controls. No clear pattern was found regarding most of the examined cancers in appendectomy groups compared with background populations. Pregnancy rates increased after appendicitis compared with controls in most studies. Mortality was low after appendectomy. CONCLUSION Appendectomy had a low prevalence of long-term surgical complications. We did not find any significant other long-term complications, though the prevalence of Crohn's disease was higher and the prevalence of ulcerative colitis was lower after appendectomy than in controls. Appendectomy did not impair fertility.
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Affiliation(s)
- T Rasmussen
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - S Fonnes
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Abstract
Complications related to general pediatric surgery procedures are a major concern for pediatric surgeons and their patients. Although infrequent, when they occur the consequences can lead to significant morbidity and psychosocial stress. The purpose of this article is to discuss the common complications encountered during several common pediatric general surgery procedures including inguinal hernia repair (open and laparoscopic), umbilical hernia repair, laparoscopic pyloromyotomy, and laparoscopic appendectomy.
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Affiliation(s)
- Maria E Linnaus
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, Arizona 85016.
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Does age affect the outcomes and management of pediatric appendicitis in Taiwan? FORMOSAN JOURNAL OF SURGERY 2016. [DOI: 10.1016/j.fjs.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Swaid F, Kirshon M, Hebron D, Kessel B. Surgical drains: what is still unlearned in everyday practice? ANZ J Surg 2016; 88:E471-E472. [PMID: 26748573 DOI: 10.1111/ans.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Forat Swaid
- General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Mark Kirshon
- Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dan Hebron
- Radiology Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
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Mahida JB, Asti L, Deans KJ, Minneci PC, Nwomeh BC. Laparoscopic bowel resection for pediatric inflammatory bowel disease. J Surg Res 2015; 199:130-6. [DOI: 10.1016/j.jss.2015.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/24/2015] [Accepted: 04/02/2015] [Indexed: 12/14/2022]
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Madenci AL, Fisher S, Diller LR, Goldsby RE, Leisenring WM, Oeffinger KC, Robison LL, Sklar CA, Stovall M, Weathers RE, Armstrong GT, Yasui Y, Weldon CB. Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2015; 33:2893-900. [PMID: 26261256 DOI: 10.1200/jco.2015.61.5070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE For adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited. METHODS Intestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS. RESULTS Late IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors. CONCLUSION The long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.
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Affiliation(s)
- Arin L Madenci
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stacey Fisher
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lisa R Diller
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert E Goldsby
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wendy M Leisenring
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kevin C Oeffinger
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leslie L Robison
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles A Sklar
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marilyn Stovall
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rita E Weathers
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gregory T Armstrong
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yutaka Yasui
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher B Weldon
- Arin L. Madenci and Christopher B. Weldon, Boston Children's Hospital and Harvard Medical School; Arin L. Madenci, Brigham and Women's Hospital and Harvard Medical School; Lisa R. Diller and Christopher B. Weldon, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA; Stacey Fisher and Yutaka Yasui, University of Alberta, Edmonton, Alberta, Canada; Robert E. Goldsby, School of Medicine, University of California, San Francisco, San Francisco, CA; Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA; Kevin C. Oeffinger and Charles A. Sklar, Memorial Sloan-Kettering Cancer Center, New York, NY; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; and Marilyn Stovall and Rita E. Weathers, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Luo CC, Chien WK, Huang CS, Huang HC, Lam C, Hsu CW, Chen RJ, Cheng KF. National trends in therapeutic approaches and outcomes for pediatric appendicitis: a Taiwanese nationwide cohort study. Pediatr Surg Int 2015; 31:647-51. [PMID: 25985878 DOI: 10.1007/s00383-015-3718-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To define the pattern of therapeutic approaches for pediatric appendicitis and compare their benefits in Taiwan, we analyzed a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA) to document the impact of the rise of laparoscopic treatment on outcomes. METHODS We identified 22,161 patients under 18 years who had been hospitalized with a diagnosis of acute appendicitis between 2007 and 2012 in the CCHIA. Statistical comparisons between the Laparoscopic appendectomy (LA) and open appendectomy (OA, control) groups were computed using a Chi squared test. The odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for intra-abdominal abscess (IAA) and postoperative bowel obstruction (PBO) were derived from multivariate logistic regression models. RESULTS In each respective year, the incidence of LA increased from 29.17% in 2007 to 57.4% in 2012, while that of OA decreased from 70.83% in 2007 to 42.60% in 2012; incidences of non-perforated appendicitis and perforated appendicitis with LA or OA seemed similar. The length of hospitalization between an LA and OA for non-perforated appendicitis was the same, but that with an LA was shorter for perforated appendicitis. The adjusted ORs for IAA and PBO for those patients with perforated and non-perforated appendicitis were 6.30 (95% CI = 5.09-7.78; p < 0.001) and 6.49 (95% CI = 4.45-9.48; p < 0.001); while for those cases undergoing an LA and OA, they were 0.50 (95 % CI = 0.40-0.62; p < 0.001) and 2.07 (95% CI = 1.45-2.95; p < 0.001), respectively. The ORs of IAA and PBO for those patients ≤6 and 7-12 years of age were 1.67 (95% CI = 1.23-2.25; p = 0.001) and 1.20 (95% CI = 0.97-1.49; p = 0.095), and 1.88 (95% CI = 1.08-3.24; p = 0.025) and 1.47 (95% CI = 1.01-2.14; p = 0.043), respectively, compared to those aged 13-18 years. CONCLUSIONS Our study demonstrated that young age and perforated appendicitis can affect postoperative IAA and PBO. LA appeared beneficial in reducing the length of hospitalization and postoperative IAA, but had an increasing risk of PBO. Although laparoscopic approach for pediatric appendectomy is increasing in our country, the different hospital levels and pediatric surgeon's laparoscopic experience must be evaluated in further study.
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Affiliation(s)
- Chih-Cheng Luo
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, No 111, Sec 3, Xinglong RD, Taipei, 11696, Taiwan,
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Anderson SA, Beierle EA, Chen MK. Role of laparoscopy in the prevention and in the treatment of adhesions. Semin Pediatr Surg 2014; 23:353-6. [PMID: 25459441 DOI: 10.1053/j.sempedsurg.2014.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The formation of adhesions after abdominal surgery can lead to increased morbidity in children, increases the incidence of readmission, and may pose a significant challenge to subsequent surgical care over their lifetime. As the pathophysiology of peritoneal adhesion formation has been better understood, preventive strategies that minimize surgical trauma and contamination have been sought. Laparoscopy, over the past few decades, has become an increasingly utilized approach for many pediatric surgical problems and intuitively should have an advantage over open surgery in reducing adhesion formation. In this review, we examine the utility of laparoscopy in both the prevention and the treatment of intraabdominal adhesive disease in children.
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Affiliation(s)
- Scott A Anderson
- Division of Pediatric Surgery, University of Alabama at Birmingham, 1600 7th Ave South, JFL 300, Birmingham, Alabama 35233-1711
| | - Elizabeth A Beierle
- Division of Pediatric Surgery, University of Alabama at Birmingham, 1600 7th Ave South, JFL 300, Birmingham, Alabama 35233-1711
| | - Mike K Chen
- Division of Pediatric Surgery, University of Alabama at Birmingham, 1600 7th Ave South, JFL 300, Birmingham, Alabama 35233-1711.
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Retrospective analysis of operated cases of post appendectomy small bowel obstruction in a tertiary care centre. Indian J Gastroenterol 2014; 33:568-9. [PMID: 24852310 DOI: 10.1007/s12664-014-0471-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Laparoscopic approach to appendectomy reduces the incidence of short- and long-term post-operative bowel obstruction: systematic review and pooled analysis. J Gastrointest Surg 2014; 18:1683-92. [PMID: 24950775 DOI: 10.1007/s11605-014-2572-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 06/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this meta-analysis was to determine the effect of laparoscopic appendectomy (LA) compared to open appendectomy (OA) on short-term and long-term post-operative bowel obstruction. METHODS Medline, Embase, trial registries, conference proceedings and reference lists were searched. Subset analysis was performed for paediatric patients, patients who presented with perforated appendicitis and studies with long-term follow-up and surveillance for bowel obstruction and with surgery for bowel obstruction. RESULTS Overall, 29 studies comprising 159,729 patients (60,875 LA versus 98,854 OA) were included. LA was associated with a significant reduction in the incidence of post-operative bowel obstruction in the general population (pooled odds ratio (POR) = 0.43 [95 %C.I. 0.3-0.63]). Subset analysis demonstrated that LA significantly reduced the incidence of post-operative bowel obstruction in paediatric patients (POR = 0.48 [95 %C.I. 0.3-0.78]) and patients with perforated appendicitis (POR = 0.44 [95 %C.I. 0.26-0.74]). Furthermore, LA was associated with a significantly reduced incidence of long-term bowel obstruction (POR = 0.33 [95 %C.I. 0.19-0.56]) and bowel obstruction requiring surgery (POR = 0.31 [95 %C.I. 0.2-0.48]). DISCUSSIONS This present meta-analysis provides evidence to clearly demonstrate the benefits of a laparoscopic approach to appendectomy as reflected by a reduction in short- and long-term adhesive bowel obstruction. Important future areas for assessment include the influence of surgical approach on long-term quality of life following appendectomy.
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Long-term follow-up for adhesive small bowel obstruction after open versus laparoscopic surgery for suspected appendicitis. Ann Surg 2014; 259:1173-7. [PMID: 24374517 DOI: 10.1097/sla.0000000000000322] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the frequency of readmissions due to small bowel obstruction (SBO) after open versus laparoscopic surgery performed for suspected acute appendicitis. BACKGROUND Appendicitis is a common disease, with a lifetime risk of approximately 7%. Appendectomy is the treatment of choice for most patients. Postoperative adhesions are common after abdominal surgery, including appendectomy. MATERIALS AND METHODS Consecutive patients, 16 years or older, operated on because of suspected appendicitis at 2 university hospitals between 1992 and 2007 were included. The prime approach was open at one hospital and laparoscopic at the other hospital. Open and laparoscopic procedures were compared retrospectively, reviewing the patients' charts until the middle of 2012. Hospitalization for SBO after index surgery was registered. RESULTS A total of 2333 patients in the open group and 2372 patients in the laparoscopic group were included. The frequency of hospitalization for SBO was low in both groups, although a difference between the groups was identified (1.0% in the open group and 0.4% in the laparoscopic group) (P = 0.015). CONCLUSIONS Hospitalization due to SBO, between open and laparoscopic procedures, in patients operated on because of suspected appendicitis demonstrated a significant difference, favoring the laparoscopic approach. The frequency of SBO after the index surgery was, though, low in both groups.
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Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score: a pilot study. Surg Endosc 2012; 27:1594-600. [PMID: 23073690 DOI: 10.1007/s00464-012-2634-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/25/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Diagnostic laparoscopy is the ultimate diagnostic tool to evaluate the appendix. Still, according to the literature, this strategy results in a negative appendectomy rate of approximately 12-18 % and associated morbidity. Laparoscopic criteria for determining appendicitis are lacking. The goal of this study is to define clear and reliable criteria for appendicitis during diagnostic laparoscopy that eventually may safely reduce the negative appendectomy rate. METHODS From December 2009 through April 2011, 134 patients were included and analysed in a single-centre prospective pilot study. Intraoperatively, the appendix was evaluated by the surgeon according to nine criteria for appendicitis. The operating surgeon decided whether it should be removed or not. Immediately after the operation the surgeon had to complete a questionnaire on nine criteria for appendicitis. All removed appendices were examined by a pathologist. In case the appendix was not removed, the clinical postoperative course was decisive for the (missed) presence of appendicitis. RESULTS In 109 cases an inflamed appendix was removed; in 25 patients the appendix was normal, 3 of which had been removed. After univariate analysis and clinical judgement six variables were included in the Laparoscopic APPendicitis score (LAPP score). In this study, use of the LAPP score would have led to a positive predictive value of 99 % and a negative predictive value of 100 %. CONCLUSIONS This study presents the LAPP score. The LAPP score is an easily applicable score that can be used by surgeons to evaluate the appendix during diagnostic laparoscopy. The score has high positive and negative predictive value. The LAPP score needs to be validated in a multicentre validation study.
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Abstract
PURPOSE OF REVIEW Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. RECENT FINDINGS Intussusception and intestinal malrotation are potentially serious causes of intestinal obstruction, which are best evaluated by ultrasound and upper gastrointestinal series, respectively. Ultrasound has diagnostic importance in the evaluation of multiple diseases, including appendicitis, by potentially decreasing the need for inpatient observation, cholecystitis and complications of gall stones such as pancreatitis, and ovarian diseases. Pelvic inflammatory disease should be considered in evaluation of a teenage girl with lower abdominal pain. Less common causes of acute abdominal pain include ingested foreign bodies, infected congenital anomalies, and perforated peptic ulcer disease. SUMMARY Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.
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[Pediatric appendicitis : Open or laparoscopic appendicectomy in a specialized visceral surgical clinic?]. Chirurg 2011; 82:1008-13. [PMID: 21431962 DOI: 10.1007/s00104-011-2087-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Following the first description of open appendicectomy using a lateral incision in the right lower abdomen by McBurney in 1894, this intervention was considered to be the standard method for treatment of appendicitis for nearly 100 years. In 1983 the gynecologist Semm presented a new option for the surgical therapy of appendicitis with the implementation of laparoscopic appendicectomy. Since then the indications for laparoscopic therapy have developed from young adults through elderly patients to children, pregnant women and finally to infants and newborns.
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Bowel Obstruction Following Appendectomy: A Protective Role Implied for Laparoscopy? Ann Surg 2010; 251:1190-1; author reply 1191. [DOI: 10.1097/sla.0b013e3181e01534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schimpl G. Appendizitis. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hsieh CS, Chen YL, Lee MH, Chang HC, Chen ST, Kuo SJ. A lower costly laparoscopic appendectomy: our experience of more than 2000 cases. Int J Surg 2009; 8:140-3. [PMID: 20005313 DOI: 10.1016/j.ijsu.2009.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 11/26/2009] [Indexed: 11/18/2022]
Abstract
Many authors emphasize the advantages of laparoscopic techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, lower incidence of adhesions, wound infections and believe that laparoscopic appendectomy is a reliable operation for treating acute appendicitis. Laparoscopic appendectomy has become a standard procedure in the treatment of acute appendicitis in our department since it was introduced in 2003. There are 414 patients underwent laparoscopic appendectomy and 37 patients underwent open appendectomy in our department in 2008. More than 2000 laparoscopic appendectomies were performed in our department during 2003-2009. However, open appendectomy is still the standard procedure in many Taiwan and worldwide hospitals. One of the reasons is that the operating costs incurred for laparoscopic appendectomy are higher than that of open appendectomy. We describe, herein, an access technique utilizing existing instrumentation that is reliable and easy.
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Affiliation(s)
- Ching-Shui Hsieh
- Department of General Surgery, Changhua Christian Hospital, Taiwan
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