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Xiao Z, Wu L, Li J, He S, Chen J, Li L, Xu D, Kang Y. Application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents. BMC Pediatr 2024; 24:593. [PMID: 39294601 PMCID: PMC11409603 DOI: 10.1186/s12887-024-05076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 09/11/2024] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of transumbilical single-incision laparoscopic surgery in the treatment of complicated appendicitis in overweight/obese adolescents. METHODS A retrospective analysis was conducted on the clinical data of 226 adolescent patients with complicated appendicitis who were admitted to our hospital from January 2014 to June 2022. Among them, 102 cases underwent transumbilical single-incision laparoscopic appendectomy as the observation group, and another 124 cases underwent conventional three-port laparoscopic appendectomy as the control group. The surgical time, intraoperative blood loss, duration of incisional pain, postoperative flatus time, length of hospital stay, surgical site infection (SSI), satisfaction with cosmetic result, and occurrence of postoperative complications were compared between the two groups. RESULTS Both groups completed the surgery smoothly, and there were no statistically significant differences in gender, age, BMI, duration of illness, white blood cell count, and preoperative CRP value between the two groups (P > 0.05). There were no statistically significant differences in surgical time and intraoperative blood loss between the two groups (P > 0.05). However, the observation group had shorter hospital stays, shorter duration of incisional pain, shorter postoperative time to flatus, and lower overall postoperative complication rates compared to the control group, with statistically significant differences (P < 0.05). The observation group had higher satisfaction with cosmetic result compared to the control group, with statistically significant differences (P < 0.05). Both groups were followed up for one year postoperatively, and there were no occurrences of residual appendicitis or severe adhesive intestinal obstruction. CONCLUSION When proficiently mastered, the application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents offers advantages such as minimal trauma, rapid recovery, fewer complications, and improved aesthetic outcomes.
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Affiliation(s)
- Zhixiang Xiao
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Lijing Wu
- Fujian Maternity and Child Health Hospital, Fuzhou, China
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jun Li
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Shaohua He
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Jingyi Chen
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Lizhi Li
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Di Xu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Yingquan Kang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, 350001, China.
- Fuzhou University Affiliated Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, 350001, Fujian Province, China.
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Sanmoto Y, Goto Y, Shirane K, Kawami A, Masumoto K. Factors prolonging the operative time for transumbilical laparoscopic-assisted appendectomy in pediatric patients: a retrospective single-center study. Surg Today 2024:10.1007/s00595-024-02896-w. [PMID: 38963541 DOI: 10.1007/s00595-024-02896-w] [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: 05/08/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Transumbilical laparoscopic-assisted appendectomy (TULAA) is one of the first endoscopic surgeries performed by trainee pediatric surgeons. While the operative time is generally shorter than for conventional laparoscopic appendectomy, the indications for this procedure are unclear and many unknown factors can prolong the operative time. We conducted this study to identify the factors that may prolong the operative time for TULAA. METHODS This retrospective, single-center study was conducted between 2015 and 2023. We performed multivariate analysis to identify the factors associated with prolonged operative time by analyzing TULAA procedures performed by trainees. RESULTS The study included 243 patients. The median operative time was 84 min (interquartile range, 69-114 min). Multivariate analysis revealed that an increased body mass index, elevated C-reactive protein level, a history of conservative treatment for acute appendicitis, and appendix perforation, for the patient; < 6 years' experience since graduation for the operating surgeon; and lack of board certification as a supervisor from the Japanese Society of Pediatric Surgeons for the attending surgeon were independent risk factors for prolonging the operative time. CONCLUSION Having an attending surgeon with board certification as a supervisor by the Japanese Society of Pediatric Surgeons contributes to reducing the operative time required for TULAA.
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Affiliation(s)
- Yohei Sanmoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan.
| | - Yudai Goto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Kazuki Shirane
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Akio Kawami
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba-shi, 305-8576, Japan
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Nishida N, Kawano T, Sugita K, Yano K, Kedoin C, Nagano A, Matsui M, Murakami M, Baba T, Onishi S, Harumatsu T, Yamada K, Yamada W, Torikai M, Ieiri S. Comparison of Transumbilical Laparoscopy-Assisted Appendectomy with Conventional Three-Port Laparoscopic Appendectomy Performed by Pediatric Surgeons in Training for Appendicitis in Children. J Laparoendosc Adv Surg Tech A 2024; 34:380-385. [PMID: 38573162 DOI: 10.1089/lap.2023.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Transumbilical laparoscopy-assisted appendectomy (TULAA) is the technique of choice for all types of appendicitis. However, the technique is challenging for trainees to learn in comparison with performing conventional three-port laparoscopic appendectomy (CTPLA) in children. We aimed to compare the surgical outcomes of children with appendicitis treated by TULAA versus CTPLA performed by pediatric surgeons in training (PSITs). Materials and Methods: This retrospective study analyzed pediatric patients with acute appendicitis treated with CTPLA or TULAA between April 2016 and December 2022. Operative time (OT: minutes), pneumoperitoneum time (PT: minutes), blood loss (milliliter), length of hospital stay (days), and surgical site infection rate were compared between the two groups. Operative outcomes were also analyzed according to type of appendicitis such as uncomplicated and complicated cases. Results: Two hundred twenty-five laparoscopic appendectomies were performed by CTPLA (n = 94) or TULAA (n = 131). All cases were performed by PSITs and there was no open conversion cases. TULAA had a shorter OT (67.0 ± 28.4 versus 78.3 ± 21.7; P < .01) and PT (26.1 ± 17.4 versus 52.5 ± 22.1 min; P < .01). The surgical site infection rate was slightly higher in the TULAA group, but the difference was not statistically significant. In uncomplicated appendicitis (n = 164), significant differences between the CTPLA and TULAA groups were observed in OT (CTPLA versus TULAA: 70.7 ± 14.9 versus 59.1 ± 21.6, P < .01) and PT (CTPLA versus TULAA: 43.6 ± 13.1 versus 20.4 ± 13.6, P < .01). With regard to postoperative complications, only surgical site infection was significantly different between the CTPLA and TULAA groups (CTPLA: 0.0% versus TULAA: 8.2%, P < .05). In complicated cases (n = 61), there were significant differences between the groups in PT (CTPLA versus TULAA: 73.4 ± 24.9 versus 42.3 ± 17.2, P < .01) and length of hospital stay (CTPLA versus TULAA: 7.0 ± 1.3 versus 8.9 ± 4.7, P < .05). Conclusions: TULAA had a shorter OT and PT than CTPLA. TULAA for PSITs shows similar safety and feasibility to CTPLA for not only uncomplicated cases but also complicated cases.
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Affiliation(s)
- Nanako Nishida
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Ayaka Nagano
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Mayu Matsui
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Tokuro Baba
- Department of Digestive and General Surgery, University of the Ryukyus, Okinawa, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Motofumi Torikai
- Department of Pediatric Surgery, Kagoshima City Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
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Chen Y, Fan Z, Zhang X, Fu X, Li J, Yuan J, Guo S. A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go. J Int Med Res 2023; 51:3000605231183781. [PMID: 37466195 PMCID: PMC10363874 DOI: 10.1177/03000605231183781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Single-port laparoscopic appendectomy (SPLA) has become a good alternative to the traditional surgical treatment of acute appendicitis, due to its advantages of small incision, mild postoperative pain, short hospital stay, and good cosmetic effect. However, the further application of SPLA has been restricted by its relatively long operating time, high level of operating difficulty, and increased equipment and technical requirements. Clinical teams worldwide have attempted to improve and optimize SPLA technical protocols and equipment to maintain stable intraoperative pneumoperitoneal pressure, improve the 'triangle relationship' of operating angles, and develop new surgical procedures with less trauma and higher cost-effectiveness. Here, new SPLA techniques reported over the past decade are reviewed and compared, with the aim of providing new insights into technical improvements, equipment upgrades and clinical studies in the coming years.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Zongqi Fan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiaoxin Zhang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xinao Fu
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jushang Li
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
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Zampieri N, Vestri E, Bianchi F, Peretti M, Patanè S, Cecchetto M, Mantovani A, Giambanco A, Farina F, Scirè G, Camoglio FS. Single port surgery in pediatric age: report of first 300 cases. Minerva Surg 2023; 78:23-29. [PMID: 35230038 DOI: 10.23736/s2724-5691.22.09315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In recent years, evolution of surgery has led to laparoscopy and then to single port surgery. In pediatric age, few papers have been published about single port procedures; in particular, no one has described the use of the Octoport device (Frankenman International Ltd., Suzhou, China). We present our experience using a new device. METHODS A retrospective analysis of first 300 cases was performed collecting the data of all patients treated with Octoport device from October 2017 to September 2021. Epidemiological data, diagnosis, operative times, and complications were analyzed. Postoperative pain was compared with standard laparoscopy. RESULTS A total of 300 procedures were performed during the study period. The age range was 1-17 years. The conversion rate was 3.6% (11 patients) including both conversion to traditional laparoscopy and to laparotomy. Pain management was comparable to traditional laparoscopy. The complication rate was 3.6%, in one case leading to re-do surgery. All the cases in our Unit were successfully completed, with complications mainly related to the original pathology rather than to the technique itself. CONCLUSIONS The learning curve for Octoport use proved to be functional as for standard laparoscopy. In this study, surgical indications for the use of single port laparoscopy were defined, discerning favorable and unfavorable procedures. A proven superiority of this technique over traditional laparoscopy is yet to be defined, but Octoport has proved to be a safe and easy tool to reduce invasiveness of procedures in pediatric surgery with better cosmetic results.
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Affiliation(s)
- Nicola Zampieri
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy -
| | - Elettra Vestri
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Federica Bianchi
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Marta Peretti
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Simone Patanè
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Mariangela Cecchetto
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Alberto Mantovani
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Annamaria Giambanco
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Fabiana Farina
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Gabriella Scirè
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Francesco S Camoglio
- Unit of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, Woman and Child Hospital, University of Verona, Verona, Italy
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Zhong A, Short C, Sundin A, Austin C, Gao L, Tabarsi E, Chen S, Wang K, Pelayo JC. Postoperative narcotic utilization in single incision laparoscopic-assisted extracorporeal appendectomy (SILEA): a single-institution retrospective review. Pediatr Surg Int 2022; 38:1997-2003. [PMID: 36138321 DOI: 10.1007/s00383-022-05252-6] [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] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Laparoscopic appendectomy for pediatric acute appendicitis is commonly performed by pediatric surgeons. A single incision approach has been investigated, but the lack of technical uniformity has resulted in conflicting data. We hypothesized that an initial single incision laparoscopic-assisted extracorporeal appendectomy (SILEA) approach is associated with similar complication rates as compared to the standard three-incision laparoscopic appendectomy (TILA). METHODS Approximately 1300 laparoscopic appendectomies were retrospectively reviewed for acute appendicitis over a 5 year period. Patients were split into TILA or SILEA cohorts. Propensity score matching identified 102 matched cases in both cohorts. Case and control cohort comparisons were then analyzed. RESULTS Successful SILEA was associated with no difference in post-operative complication rate. SILEA was associated with decreased postoperative narcotic dosage and shorter operative time than TILA. CONCLUSIONS An initial SILEA approach is safe and associated with similar complication rates as TILA. Based on this data, the authors advocate adoption of the an initial SILEA approach for uncomplicated, freely mobile, acute appendicitis with seamless conversion to TILA if the appendix is not amendable to SILEA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Allen Zhong
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Celia Short
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Andrew Sundin
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Charlotte Austin
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Leland Gao
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Emiliano Tabarsi
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Stephanie Chen
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Kasper Wang
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Juan Carlos Pelayo
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
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Wczysla K. [Appendix somewhat different-Excerpts from the history, controversies of the present and view to the future]. Chirurg 2022; 93:610-621. [PMID: 34994807 DOI: 10.1007/s00104-021-01556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/24/2022]
Abstract
If one could talk about a superstar in abdominal surgery, the appendix would definitely be qualified for this name. Much has already been said about the vermiform appendix. The potential to talk about the appendix is, however, by no means exhausted. In this article already published articles are selected and subsumed. Less known details on the discovery and research of the appendix as well as the diagnostics of appendicitis and establishment of appendectomy are also included.
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Affiliation(s)
- Karolina Wczysla
- Klinik für Allgemein‑, Viszeral‑, Endokrin- und Transplantationschirurgie, Kantonspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Schweiz.
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Feng W, Du XB, Zhao XF, Li MM, Cui HL. Risk factors of postoperative adhesive bowel obstruction in children with complicated appendicitis. Pediatr Surg Int 2021; 37:745-754. [PMID: 33538868 DOI: 10.1007/s00383-021-04862-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative adhesive bowel obstruction (ABO) is a common complication especially in complicated appendicitis. This study aimed to analyze the risk factors for ABO following appendectomy in children with complicated appendicitis, and establish a scoring model for predicting postoperative ABO and treatment option to relieve the obstruction. METHODS From December 2014 to January 2020, all files of consecutive patients with complicated appendicitis underwent appendectomy were reviewed. Univariate and multivariate analyses were used to screen out the risk factors of postoperative ABO, and establish a scoring model for predicting postoperative ABO and surgical relief to relieve the obstruction. RESULTS Of the 780 patients, 87 (11.2%) had ABO following appendectomy, including 27 who underwent surgical relief. Age ≤ 6 years, overweight and obesity, duration of symptoms ≥ 36 h, C-reactive protein ≥ 99 mg/L, duration of operation ≥ 60 min, intraoperative peritoneal lavage, and postoperative flatus time ≥ 20 h were independent risk factors for postoperative ABO. The final scoring model for postoperative ABO included factors above, and exhibited a high degree of discrimination (area under the curve [AUC]: 0.937; 95% confidence interval [CI] 0.913-0.960) corresponding to an optimal cut-off value of 6: 82.8% sensitivity, 92.6% specificity. Furthermore, the scoring model showed a sensitivity of 74.1% and a specificity of 91.7% for patients wo underwent surgical relief to relieve obstruction with the optimal cut-off value of 9. CONCLUSION Risk factors for postoperative ABO should be taken seriously in children with complicated appendicitis. The scoring model is a novel but promising method to predict postoperative ABO and provide reference for clinical decision-making to relieve the obstruction.
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Affiliation(s)
- Wei Feng
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Xiao-Bing Du
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Xu-Feng Zhao
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Miao-Miao Li
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Hua-Lei Cui
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, 300134, China.
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Chen Y, Yuan JQ, Guo SG, Yang ZJ. Single-port laparoscopic appendectomy using a needle-type grasping forceps for acute uncomplicated appendicitis in children: Case series. Int J Surg Case Rep 2020; 70:216-220. [PMID: 32422581 PMCID: PMC7229346 DOI: 10.1016/j.ijscr.2020.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022] Open
Abstract
Acute appendicitis is the most common between the ages of 10 and 20 years. Our centre performed a new technology of single-port laparoscopic appendectomy using a needle-type grasping forceps (SLAN). SLAN has advantages of favourable cosmetic results, minimal trauma, and enhanced postoperative recovery.
Introduction Single-port laparoscopy has been used in any areas of surgery, including appendectomy, to reduce the operative stress and enhance postoperative recovery procedure. This paper introduces our attempt to perform single-port laparoscopic appendectomy using conventional laparoscoopic instruments and a needle-type grasping forceps (SLAN), which has dominant advantage in cosmetic appearance. Methods We report six pediatric patients who underwent SLAN for uncomplicated appendicitis from April to November 2019. SLAN was performed transumbilically, while conventional laparoscopic instruments and needle-type grasping forceps were both used. After routine intracorporeal appendectomy was completed, the pathological appendix was extracted through the single-port site, while a 10 mm trocar was used to avoid incision infectious. Clinical data and postoperative follow-up data were collected and analyzed to evaluate the feasibility, safety, and clinical outcomes of this novel technique. Results SLAN was successfully performed in all six pediatric patients. The median operative time, first exhaust time after surgery, pain score of postoperative day 1, and postoperative hospital stay were 69 (range, 50−85) min, 1.33 (range, 1–2) d, 0.83 (range, 0–3) score, 1.5 (range, 1–2) d, respectively. Neither intraoperative nor postoperative complications were noted, while no incision infectious, adhesive intestinal obstruction, and abdominal abscess were observed with 2–9 months follow up. Discussion Though there are many methods to perform single-port laparoscopic appendectomy, the use of needle grasping forceps in laparoscopic appendectomy has been confirmed a new choice for uncomplicated appendicitis in children. Conclusion SLAN is a feasible and safe technique to treat acute uncomplicated appendicitis in children. To be emphasized, surgeons must strictly grasp the indications for this surgery.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, China.
| | - Jie-Qing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, China.
| | - Shi-Gang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, China.
| | - Zhen-Jiang Yang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, China.
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