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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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Acker SN, Staulcup S, Partrick DA, Sømme S. Evolution of Minimally Invasive Techniques Within an Academic Surgical Practice at a Single Institution. J Laparoendosc Adv Surg Tech A 2014; 24:806-10. [DOI: 10.1089/lap.2014.0239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shannon N. Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Susan Staulcup
- Children's Outcome Research, University of Colorado School of Medicine, Aurora, Colorado
| | - David A. Partrick
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
| | - Stig Sømme
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado
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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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Costa-Navarro D, Jiménez-Fuertes M, Illán-Riquelme A. Laparoscopic appendectomy: quality care and cost-effectiveness for today's economy. World J Emerg Surg 2013; 8:45. [PMID: 24180475 PMCID: PMC3842793 DOI: 10.1186/1749-7922-8-45] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/21/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Open appendectomy (OA) has traditionally been the treatment for acute appendicitis (AA). Beneficial effects of laparoscopic appendectomy (LA) for the treatment of AA are still controversial. AIM To present our technique for LA and to determine whether LA should be the technique of choice of any case of AA instead of OA. MATERIAL AND METHODS All cases operated for AA (February 2011 through February 2012) by means of LA or OA were prospectively evaluated. Data regarding length of stay, complications, emergency department consultation after discharge or readmission were collected. Patients were classified into four groups depending on the severity of the appendicitis. Economic data were obtained based on the cost of the disposable material. Cost of hospital stay was calculated based on the Ley de Tasas of the Generalitat Valenciana according to the DRG and the length of stay. RESULTS One hundred and forty-two cases were included. Ninety-nine patients underwent OA and 43 LA. Average length of stay for LA group was 2,6 days and 3,8 for OA. Average cost of the stay for OA was 1.799 euros and 1.081 euros for LA. Global morbidity rate was 16%, 5% for LA and 20% for OA. CONCLUSIONS LA is nowadays the technique of choice for the treatment of AA.
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Affiliation(s)
- David Costa-Navarro
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
| | - Montiel Jiménez-Fuertes
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
| | - Azahara Illán-Riquelme
- Department of Surgery, Marina Baixa Medical Center, 7 Alcalde Jaume Botella Mayor street, Villajoyosa, Alicante, Spain
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Nataraja RM, Loukogeorgakis SP, Sherwood WJ, Clarke SA, Haddad MJ. The Incidence of Intraabdominal Abscess Formation Following Laparoscopic Appendicectomy in Children: A Systematic Review and Meta-analysis. J Laparoendosc Adv Surg Tech A 2013; 23:795-802. [DOI: 10.1089/lap.2012.0522] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ramesh M. Nataraja
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Stavros P. Loukogeorgakis
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - William J. Sherwood
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Simon A. Clarke
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
| | - Munther J. Haddad
- Department of Paediatric Surgery, Chelsea and Westminster Hospital Foundation Trust, London, United Kingdom
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National trends in approach and outcomes with appendicitis in children. J Pediatr Surg 2012; 47:2264-7. [PMID: 23217886 DOI: 10.1016/j.jpedsurg.2012.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/01/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Appendicitis is one of the most common surgical conditions in children. Laparoscopy has become the standard approach to appendectomy over the past decade. Some critics cite a lack of evidence documenting clear advantages to laparoscopy. To define the pattern of approach compared to outcomes in the United States, we analyzed the Pediatric Health Information System (PHIS) database to document the impact on outcomes with the rise in laparoscopy. METHODS After IRB approval, we queried the PHIS database for all patients over 12 years. The percentages of cases performed open (OA) and laparoscopically (LA) were established for each year. Annual complication percentages were identified for wound infection, intra-abdominal abscess, subsequent laparotomy, and obstruction. For each complication, trend comparisons between LA and OA were made with generalized linear models. RESULTS There were 111,194 appendectomies with a positive trend in percentage of laparoscopy from 1999 (22.2%) to 2010 (90.8%), P<0.0001. Over 12 years, there were significant differential trends between LA and OA in rates of wound infection, abscesses, bowel obstructions, and laparotomies within 30 days (P<0.0001 for each). There was no trend in wound infection rates within OA over time (P=0.31), while there was a decrease in infection rates within LA over time (P<0.0001). CONCLUSIONS On the basis of a national database analysis, laparoscopy has increased for appendectomy in children over the past 12 years and is associated with a significant decrease in post-operative complications.
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Lin YM, Hsieh CH, Cheng CI, Tan BL, Liu HT. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 2012; 35:113-6. [PMID: 22884268 DOI: 10.1016/j.asjsur.2012.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/14/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/OBJECTIVES Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate the results of LA in both complicated and uncomplicated cases of acute appendicitis. METHODS From January to December 2009, 94 patients with acute appendicitis underwent LA by the same surgeon using the three-port technique. Data were accumulated and compared between complicated and uncomplicated acute appendicitis. RESULTS Of the 94 patients (45 women and 49 men), 19 had complicated and 75 uncomplicated acute appendicitis. The group with complicated acute appendicitis, as compared to the uncomplicated group, was significantly older (55.7 ± 20.5 years vs. 41.0 ± 18.0 years), and had a significantly increased operation time (117.6 ± 45.5 minutes vs. 78.2 ± 39.4 minutes), longer length of hospital stay (9.0 ± 3.3 days vs. 5.2 ± 6.0 days) and higher conversion rate (21.1% vs. 2.7%). No increase in surgical complications was noted in patients with complicated acute appendicitis, as compared to those with uncomplicated acute appendicitis. CONCLUSION This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.
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Affiliation(s)
- Yueh-Ming Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Suh YJ, Jeong SY, Park KJ, Park JG, Kang SB, Kim DW, Oh HK, Shin R, Kim JS. Comparison of surgical-site infection between open and laparoscopic appendectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 82:35-9. [PMID: 22324044 PMCID: PMC3268141 DOI: 10.4174/jkss.2012.82.1.35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 09/13/2011] [Accepted: 10/05/2011] [Indexed: 01/14/2023]
Abstract
Purpose An inflamed appendix can be removed either openly (open appendectomy [OA]) or laparoscopically (laparoscopic appendectomy [LA]). Surgical-site infection (SSI) is a representative healthcare-associated infection and can impose serious economic burdens on patients as well as affect morbidity and mortality rates. The aim of this study was to compare LA with OA in terms of SSI. Methods The medical records of 749 patients (420 males; mean age, 33 years) who underwent appendectomy (OA, 431; LA, 318) between September 1, 2008 and April 29, 2010 were retrospectively reviewed for demographic and pathologic characteristics, recovery of bowel movement, length of hospital stay, and postoperative complications. Results The frequency of purulent/gangrenous or perforated appendicitis was not significantly different between LA and OA groups (83% [263/318 cases] vs. 83% [359/431 cases], P = 0.183). The time to first flatus after surgery was not significantly different between the two groups (1.38 ± 1.07 days for LA, 1.33 ± 0.90 days for OA, P = 0.444), but the length of hospital stay was significantly shorter in LA group than in OA group (3.37 ± 0.12 days vs. 3.83 ± 0.12 days, P = 0.006). The frequency of overall SSI was not significantly different between the two groups (2.8% for LA, 4.6% for OA, P = 0.204), but that of superficial incisional SSI was significantly lower in LA group (0.6% vs. 3.9%, P = 0.016). Conclusion The results of this study suggest that LA may lead to a shorter length of hospital stay and may have a lower risk of superficial incisional SSI than OA.
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Affiliation(s)
- Yong Joon Suh
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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Adibe OO, Muensterer OJ, Georgeson KE, Harmon CM. Severity of appendicitis correlates with the pediatric appendicitis score. Pediatr Surg Int 2011; 27:655-8. [PMID: 20936475 DOI: 10.1007/s00383-010-2744-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE The pediatric appendicitis score (PAS) has been used as a diagnostic tool for the assessment of acute abdominal pain. Our institution has utilized this scoring system as part of a clinical pathway for acute appendicitis. We sought to discover if the PAS could also serve as a prognostic indicator. METHODS Patients treated within the clinical pathway were divided into three groups (A, B, and C) based on the PAS assigned on admission. Data pertaining to intraoperative findings and length of hospital stay were collected prospectively. RESULTS In 4 months, 112 patients were enrolled in the study (median age 10.5, range 1-18). 69 of these patients underwent early laparoscopic appendectomy. For group A, 75% had simple appendicitis and 5% were complex. For group B, 68.4% patients had simple appendicitis and 26.3% were complex. For group C, 27.3% were simple and 63.6% were complex. Mean length of hospital stay increased from 1.63 ± 0.34 for patients in group A to 5.9 ± 1.37 for patients in group C. CONCLUSION Our observational data suggests that the PAS may be a prognostic tool for acute appendicitis. It thereby may impact on preoperative management and postoperative clinical pathways. A larger cohort is necessary to validate our findings.
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Affiliation(s)
- Obinna O Adibe
- Division of Pediatric Surgery, The Children's Hospital of Alabama, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
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