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Currow C, Patel K, Askari A, Rabie M, Aly M, Aker M. Current technical surgical practice of emergency appendicectomy: a cross-sectional survey of surgical registrars in the UK. Ann R Coll Surg Engl 2020; 102:606-610. [PMID: 32501113 DOI: 10.1308/rcsann.2020.0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Appendicectomy remains one of the most commonly performed procedures in general surgery. The aim of this study was to explore variation in operative techniques of an appendicectomy among surgical registrars in England. MATERIALS AND METHODS An anonymised survey was sent out to surgical registrars in the UK via email and social media. Subgroup analyses were performed comparing respondents based on their level of seniority and subspecialty background. RESULTS A total of 168 respondents completed the survey, of whom 77.4% (130/168) were specialty trainees years 3-8 and 44.6% (75/168) were colorectal trainees. The majority (98.8%) preferred a laparoscopic approach to appendicectomy. Overall, 73.2% opted to use diathermy to divide an uninflamed mesoappendix. Half of the respondents (50%) preferentially used diathermy to control the appendicular artery, followed by 44% preferring use of metal or polymeric clips. The appendicular stump was most often secured with Endoloops (85.7%) when removing a macroscopically uninflamed appendix but less readily used in the visibly inflamed appendix (75.6%, p = 0.01). Colorectal and upper gastrointestinal registrars were more likely to use diathermy on the mucosa of the appendix stump compared with other subspecialties (p = 0.03). The majority (82.1%) of respondents extracted the appendix via a retrieval bag. Regarding skin closure, most respondents (69%) adopted absorbable subcuticular sutures. Preferential duration of postoperative antibiotic use following appendicectomy for complicated appendicitis varied among the respondents. CONCLUSION There are similarities and differences across surgical registrars in terms of technical practice in appendicectomy, partially attributed to prior experience and training.
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Affiliation(s)
- C Currow
- Luton and Dunstable Hospital, Luton, United Kingdom
| | - K Patel
- Luton and Dunstable Hospital, Luton, United Kingdom
| | - A Askari
- Luton and Dunstable Hospital, Luton, United Kingdom
| | - M Rabie
- Ain Shams University, Cairo, Egypt
| | - M Aly
- Lister Hospital, Stevenage, United Kingdom
| | - M Aker
- West Suffolk Hospital, Bury St Edmunds, United Kingdom
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Logie K, Robinson T, VanHouwelingen L. Management of the normal-appearing appendix during laparoscopy for clinically suspected acute appendicitis in the pediatric population. J Pediatr Surg 2020; 55:893-898. [PMID: 32081356 DOI: 10.1016/j.jpedsurg.2020.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE The widespread use of laparoscopy has brought forth the question of how to manage a macroscopically normal-appearing appendix in cases of clinically suspected appendicitis. This study aimed to determine the current practices of pediatric general surgeons in Canada regarding this matter. METHODS An online survey was created following the American Pediatric Surgical Association (APSA) guidelines and distributed via email to the Canadian Association of Pediatric Surgeons (CAPS) staff surgeons. The questions assessed clinician characteristics, standard practice, and rationale. Results were analyzed using descriptive statistics. RESULTS A total of 54/72 (75%) CAPS members practicing in Canada completed the survey. All (100%) agreed they would remove a normal-appearing appendix during laparoscopy for suspected acute appendicitis. The most common reasons were: possibility of microscopic appendicitis (39/54, 72.2%), avoiding future diagnostic confusion (28/54, 51.9%), and patient preference/consent discussion (21/54, 38.9%). Most (53/54, 98.1%) had performed a negative appendectomy and 49/54 (90.7%) agreed there were no sufficient guidelines. CONCLUSIONS The majority of pediatric surgeons agree sufficient guidelines do not exist to support decision making when a normal-appearing appendix is found during laparoscopy for suspected acute appendicitis. This survey shows that removal of the appendix in this case would be supported by the majority of Canadian pediatric surgeons. TYPE OF STUDY Survey LEVEL OF EVIDENCE: VII (Expert Opinion).
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Affiliation(s)
- Kathleen Logie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tessa Robinson
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada
| | - Lisa VanHouwelingen
- Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
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Tartaglia D, Bertolucci A, Galatioto C, Palmeri M, Di Franco G, Fantacci R, Furbetta N, Chiarugi M. Incidental appendectomy? Microscopy tells another story: A retrospective cohort study in patients presenting acute right lower quadrant abdominal pain. Int J Surg 2016; 28:149-52. [PMID: 26931338 DOI: 10.1016/j.ijsu.2016.02.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Optimal management of macroscopically normal appendix encountered during laparoscopy for acute abdominal pain is still unclear. METHODS 164 acute abdominal pain cases in which laparoscopy showed a normal appendix were reviewed. No other intra-peritoneal acute disease was present in 50 patients (Group 1) whereas a miscellanea of intra-peritoneal conditions was identified in the other 114 (Group 2). All the patients underwent appendectomy with specimen examination. RESULTS Following incidental appendectomy significant microscopical changes were seen in 125 specimens (76%). Among these, inflammation was found in 122 and neuroendocrine tumors in 3. Appendices harbored pathological changes in n = 45 patients (90%) of Group 1 and in n = 34 patients (70%) of Group 2 patients (p < 0.05). Morbidity for incidental appendectomy was 2%. CONCLUSION This study supports an appendectomy in patients who are undergoing laparoscopy for acute right lower quadrant abdominal pain even when the appendix appears normal on visual inspection.
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Affiliation(s)
| | | | | | | | | | - Rita Fantacci
- Emergency Surgery Unit, University of Pisa, Pisa, Italy
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Transition towards laparoscopic appendicectomy at a UK center over a 7-year period. Surg Laparosc Endosc Percutan Tech 2015; 25:59-63. [PMID: 24732741 DOI: 10.1097/sle.0000000000000017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute appendicitis remains the most common indication for emergency abdominal surgery in the United Kingdom. Although laparoscopic appendicectomy has demonstrable advantages over open appendicectomy, uptake has not been universal. The aims of this study were to describe trends in laparoscopic appendicectomy in a District General Hospital in Scotland. METHODS Retrospective review of appendix histopathology records within NHS Fife between 2003 and 2010. Note review of cases of acute appendicitis managed with laparoscopic appendicectomy was performed. Perioperative variables in perforated and nonperforated appendicitis were compared. A multivariate logistic regression analysis to determine factors associated with developing complications was performed. RESULTS Between 2003 and 2010, 237 laparoscopic appendicectomies were performed. The rate of laparoscopic appendicectomy increased from 2.5% in 2003 to 78% in 2010. In 50% of cases, the trainee surgeon was the primary operator. Complications occurred in 9.6% and the mortality rate was 0.4%. No factors on multivariate logistic regression predicted development of complications. CONCLUSIONS We describe a change in practice towards laparoscopic appendicectomy for the treatment of acute appendicitis over a 7-year period. Furthermore, laparoscopic appendicectomy is associated with acceptable morbidity rates.
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Jaunoo SS, Hale AL, Masters JPM, Jaunoo SR. An international survey of opinion regarding investigation of possible appendicitis and laparoscopic management of a macroscopically normal appendix. Ann R Coll Surg Engl 2012; 94:476-80. [PMID: 23031764 PMCID: PMC3954241 DOI: 10.1308/003588412x13373405385377] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The use of imaging and laparoscopy in patients with right iliac fossa pain as tools to make or exclude a diagnosis of appendicitis is at the discretion of the clinician. We sought to establish a consensus of opinion on this matter by surveying professional bodies for laparoscopic surgery in France, Italy and the US. METHODS A survey was sent to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), as well as the French Society for Endoscopic Surgery (SFCE) and the Italian Society for Endoscopic Surgery (SICE). The survey asked about management of both male and female patients presenting with right iliac fossa pain and what operative strategy the respondents would pursue should they find a macroscopically normal appendix at laparoscopy. RESULTS A total of 364 responses were returned from the three groups. The responses from SAGES showed computed tomography to be the preferred modality for investigating patients with right iliac fossa pain, irrespective of sex. Both SFCE and SICE preferred the use of diagnostic laparoscopy, especially in the female patient group. The majority of all respondents stated that they would remove a macroscopically normal appendix at laparoscopy. CONCLUSIONS Laparoscopy remains a potent tool in the management of appendicitis. However, the dilemma of when to remove a macroscopically normal appendix remains. Our study shows that removal of the appendix in this instance would be supported by an international consensus.
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Affiliation(s)
- S S Jaunoo
- Warwickshire Surgical Research Group, University Hospitals Coventry & Warwickshire NHS Trust, UK.
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6
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Youatou Towo P, Ramadan ASE, Ngatchou W, Djiélé JN, Etienne A, Capelluto E, Mols PP. Predictors of early outcome after acute appendicitis: is delaying surgery for acute appendicitis an option? A retrospective study. Eur J Trauma Emerg Surg 2012; 38:641-6. [PMID: 26814550 DOI: 10.1007/s00068-012-0208-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 06/23/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE This study analysed the clinical and para-clinical criteria that may allow surgeons and emergency physicians to take a decision regarding the surgery of acute appendicitis. METHODS A retrospective analysis was conducted on 284 acute appendicitis patients who underwent surgery between January 2007 and December 2009 in our institution. The registered data were extracted from patient files and statistically analysed. These data included past medical history, clinical, laboratory and imaging data, duration of hospital stay and post-operative complications. Patient delay (time between the appearance of symptoms and patient arrival at the emergency department) and hospital delay (time between hospital arrival and operation) were correctly investigated. Statistical analysis was done by using SPSS software. RESULTS The patient delay is significantly increased in relation to the severity of appendicitis: 24 h (10.8-30.8 h) versus 37.4 h (36.8-38 h) (P < 0.05), unlike hospital delay, which remains constant (between simple and severe appendicitis): 7.5 h (5-14.8 h) versus 8 h (5-13 h). In severe appendicitis, the proportion of guarding, rebound tenderness, tachycardia (P < 0.05) and fever (P < 0.005) were significantly high, and leucocytosis (P < 0.05), C-reactive protein (CRP) (P < 0.001) and eosinopaenia [37.0 vs. 72.8 (P < 0.001)] were significantly different. Concerning computed tomography (CT) and echography, perforation, abscess formation (P < 0.05), phlegmon (P < 0.005) and peritonitis (P < 0.05) were significant signs of complicated cases. The length of hospital stay (P < 0.001) and duration of antibiotic therapy (P < 0.001) were statistically significant in cases of complicated appendicitis. CONCLUSION Patient delay is a determining factor for the grade of appendicitis. It has an influence on the complications, length of hospital stay and duration of antibiotic treatment, unlike hospital delay.
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Affiliation(s)
- P Youatou Towo
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
| | - A S E Ramadan
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium.
| | - W Ngatchou
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
| | - J N Djiélé
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
| | - A Etienne
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
| | - E Capelluto
- Department of General Surgery, Saint Pierre University Hospital, Brussels, Belgium
| | - Pr P Mols
- Department of Emergency, Saint Pierre University Hospital, Rue Haute 322, 1000, Brussels, Belgium
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Shen Z, Ye Y, Yin M, Wang S. Laparoscopic appendectomy for acute appendicitis versus chronic appendicitis. J INVEST SURG 2012; 25:209-13. [PMID: 22571593 DOI: 10.3109/08941939.2011.619248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The advantage or disadvantage of laparoscopic appendectomy for acute appendicitis remains unclear. PATIENTS AND METHODS Data were collected prospectively from 129 consecutive patients with appendicitis between June 2008 and December 2009. The clinical outcomes of acute appendicitis after laparoscopic and open operation were compared. Furthermore, the outcomes of laparoscopic procedure for acute and chronic appendicitis were compared. RESULTS The length of hospitalization and incidence of intra-abdominal abscess were significantly decreased in patients with laparoscopic group after operation as compared to open operation. The mean operation time, the time of first anal exsufflation, and oral intake after operation were longer for acute appendicitis patients than for chronic appendicitis in laparoscopic group. The incidence of postoperative intestinal obstruction in patients with acute appendicitis was higher after laparoscopic surgery than after open procedure. CONCLUSIONS Laparoscopic appendectomy for acute appendicitis is feasible and safe. However, laparoscopic appendectomy for acute appendicitis might cause more postoperative complications including intra-abdominal abscess and small intestinal obstruction compared to laparoscopic appendectomy for chronic appendicitis. These complications could potentially be avoided by improving techniques in operation.
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Affiliation(s)
- Zhanlong Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing P. R. China
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Vettoretto N, Gobbi S, Corradi A, Belli F, Piccolo D, Pernazza G, Mannino L. Consensus conference on laparoscopic appendectomy: development of guidelines. Colorectal Dis 2011; 13:748-54. [PMID: 21651696 DOI: 10.1111/j.1463-1318.2011.02557.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic appendectomy (LA) is not yet unanimously considered the gold standard treatment for appendicitis, despite the increasing use of advanced laparoscopic operations and the high incidence of the disease. METHOD Due to the results of an audit which classified LA as widespread in Italy, a Consensus Conference was organized, in order to give evidence-based answers to the most debated problems regarding the operation. After researching the literature, a panel of 20 experts were selected and interviewed on hot topics; a subsequent discussion using the Delphi methodology was utilized in the course of the consensus conference and submitted to the evaluation of an audience of surgeons. RESULTS Checkpoint statements were formulated whenever an agreement was reached. A level of evidence was then assigned to single statements and the process revised by two external reviewers. CONCLUSION Consensus development guidelines are herein reported and regard diagnostic pathway, diagnostic laparoscopy, indications, behaviour in case of innocent appendix, technical aspects, learning curve; however, some questions remain unsolved due to the lack of evidence.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgery Unit, M Mellini Hospital, Chiari, Italy.
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9
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Yu J, Wang YN, Hu YF, Cheng X, Zhen L, Li GX. Single-incision laparoscopic appendectomy performed above the pubic symphysis - a new scarless approach. MINIM INVASIV THER 2011; 20:18-21. [PMID: 21222504 DOI: 10.3109/13645706.2010.518672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The three-port method is commonly used for laparoscopic appendectomy. To obtain a better cosmetic result, we have selected the single-incision laparoscopic appendectomy to be performed above the pubic symphysis. We performed six single-incision laparoscopic appendectomies above the pubic symphysis. During each operation, a 2 cm transverse incision was made in the pubic hair area 3-4 cm above the pubic symphysis. A 5 mm trocar was then placed as an observation port with another two 5 mm trocars as main- and side-operating ports. The laparoscopic appendectomy was performed using this single-incision method. Six patients (five male and one female; body mass indexes of 18.07, 19.27, 21.67, 18.34, 26.83 and 22.46 kg/m(2), respectively) underwent successful single-incision laparoscopic appendectomy above the pubic symphysis. Operating times were recorded at 55, 58, 47, 51, 42 and 33 minutes, the corresponding post-operative anal ventilation times were 25, 24, 22, 18, 7 and 10 hours, while post-operative hospitalization periods stand at 3, 5, 2, 1, 3 and 2 days, respectively. No complications occurred during or post-operation. Our initial work shows that a single-incision laparoscopic appendectomy performed above the pubic symphysis is feasible and safe and yields excellent post-operative cosmetic results.
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Affiliation(s)
- J Yu
- Department of General Surgery, Nanfang Hospital Southern Medical University, Guangzhou, China
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10
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Pérez RC, González LRA, Reyes ED, Fernández JCD, Arias LER, Estrada MO. [The transvaginal approach in acute appendicitis]. Cir Esp 2011; 89:517-23. [PMID: 21514578 DOI: 10.1016/j.ciresp.2011.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 01/17/2011] [Accepted: 02/14/2011] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this work is to present 8 minilaparoscopic-assisted transvaginal appendectomies using rigid instruments in patients with acute appendicitis. MATERIAL AND METHODS Eight minilaparoscopic-assisted transvaginal appendectomies were performed from the 10th of August 2009 to the 30th of June 2010. The inclusion criteria were women between 18 and 65 years of age with a diagnosis of acute appendicitis. The exclusion criteria were palpable masses, appendicular abscesses, ASA III and IV; morbid obesity (BMI > 35); gynaecological infections; virgin patients and pregnant women. The surgical intervention was performed with rigid instruments. Surgical time, the need for post-operative analgesics, and post-surgical complications. RESULTS The age range varied between 18 and 42 years, with a mean of 29.6 years. The mean surgical time was 48.3 minutes (37-75). Analgesics were given to 2 patients after surgery (1 parenteral and 1 oral). Five patients were discharged before 24 hours and 3 at 48 hours. There were no post-operative complications. CONCLUSIONS Minilaparoscopic-assisted transvaginal appendectomy with rigid instruments, in selected women is a feasible and safe method, and with better aesthetic results than laparoscopic appendectomy, but future studies will be required that can demonstrate its advantages.
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Affiliation(s)
- Raúl Castro Pérez
- Servicio de Cirugía General, Hospital Provincial Docente Abel Santamaría Cuadrado, Ciudad de Pinar del Río, Provincia de Pinar del Río, Cuba.
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Sesia SB, Haecker FM, Kubiak R, Mayr J. Laparoscopy-Assisted Single-Port Appendectomy in Children: Is the Postoperative Infectious Complication Rate Different? J Laparoendosc Adv Surg Tech A 2010; 20:867-71. [PMID: 20879873 DOI: 10.1089/lap.2010.0180] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sergio B Sesia
- Department of Paediatric Surgery, University Children's Hospital Basle (UKBB), Basle, Switzerland.
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Kanbour A, Al Alawia A, Al Den A, Bener A, Khallid M. Does Delay in Diagnosing Acute Appendicitis Affect the Outcome? Qatar Med J 2010. [DOI: 10.5339/qmj.2010.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute appendicitis is the most common surgical case met in an emergency department. Immediate surgery results in the confirmation of diagnosis and control of sepsis. To determine whether the delay in operating upon patients with acute appendicitis will affect the outcome or the stage of the disease, and if the clinical parameters give an indication of the severity of the disease medical records were reviewed retrospectively of 373 appendectomized patients above 14 years of age who were diagnosed with appendicitis in the emergency department of Hamad General Hospital, State of Qatar, between June and September 2007; 341 were diagnosed as acute appendicitis. Patients were classified according to the pre-operative and histopathological findings into four grades; A1: inflamed appendix, A2: gangrenous appendix, A3: perforated appendix, A4: pus +/- mass formation. Complications increased with the duration of the pre-hospital delay. The length of stay in hospital correlated significantly with the grade of diagnosis. The presence of fever, no change in bowel habit, and rigidity correlated well with advanced pathology, the complications increasing with greater delay. We conclude that delayed appendectomy is unsafe since it is associated with an increase in pathological grading as well as increasing the morbidity and the length of stay in hospital.
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Affiliation(s)
- A. Kanbour
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A. Al Alawia
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A.S. Al Den
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - A. Bener
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M. Khallid
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Park HC, Yang DH, Lee BH. The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J Laparoendosc Adv Surg Tech A 2010; 19:727-30. [PMID: 19792868 DOI: 10.1089/lap.2009.0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the laparoscopic approach for perforated appendicitis is commonly performed, there is some controversy over its use because of postoperative complications. These may be associated with various types of disease entities, from gangrenous change to diffuse peritonitis with abscess formation. The aim of the present study was to evaluate the safety and benefits of the laparoscopic approach for perforated appendicitis, including cases complicated by abscess, compared to open. MATERIALS AND METHODS A total of 1747 patients underwent treatment for appendicitis over a period of 3 years. The diagnosis of perforated appendicitis was made by radiology, operative finding, and pathology. Of our five attending surgeons, three performed open surgery for perforated appendicitis, while two performed laparoscopy. RESULTS There were 474 patients (27%) with perforated appendicitis without abscess (156 underwent laparoscopy, 318 underwent open) and 113 patients (6.4%) with perforated appendicitis and abscess (44 underwent laparoscopy, 69 underwent open). The duration for resumption of diet and hospital stay was shorter in the laparoscopy group than in the open group. There were no significant differences in postoperative complications between patients who had no abscess with laparoscopy and those with open: 5 intra-abdominal abscesses and 10 wound infections versus 11 intra-abdominal abscesses and 25 wound infections (P = 0.88, 0.12), and between patients who had abscesses with laparoscopy and those with open: 4 intra-abdominal abscesses and 3 wound infections versus 6 intra-abdominal abscesses and 6 wound infections (P = 0.94, 0.72). CONCLUSIONS The laparoscopic approach may be a safe, effective treatment for perforated appendicitis, even in the presence of an abscess.
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Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea.
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14
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Chouillard E, Dache A, Torcivia A, Helmy N, Ruseykin I, Gumbs A. Single-incision laparoscopic appendectomy for acute appendicitis: a preliminary experience. Surg Endosc 2010; 24:1861-5. [PMID: 20108149 DOI: 10.1007/s00464-009-0860-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 08/15/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is a major conceptual change in the field of modern surgery. However, corresponding technological refinements are not yet available to fill the gap separating the current laparoscopy from the NOTES of the future. Meanwhile, "hybrid" NOTES techniques, including single-port procedures, have been increasingly reported. This report describes a technique of single-incision laparoscopic appendectomy (SILA) for selected patients with acute appendicitis. METHODS Patients with noncomplicated acute appendicitis, excluding those with abscess, perforation, peritonitis, previous surgery, or obesity, underwent SILA. The procedure was performed using a single 15-mm-diameter umbilical incision with two 5-mm-diameter port sites. RESULTS The study enrolled 36 women and 19 men with a mean age of 28 years (range, 18-78 years). The procedure was achieved for 41 patients (74.5%). The mean operative time was 39 min (range, 14-111 min). There was no mortality. The postoperative complication rate was 5.4% (3 complications in 3 patients), and the median hospital stay was 39 h (range, 8-240 h). CONCLUSION The SILA technique is safe and feasible for selected patients with noncomplicated acute appendicitis. Compared with other transumbilical techniques of appendectomy, SILA has the advantages of feasibility without endoscopic skills and an acceptable operative time. Technical refinements and accomplished learning probably will enable its wider use for more patients with acute appendicitis.
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Affiliation(s)
- Elie Chouillard
- Department of General and Minimally Invasive Surgery, Centre Hospitalier, 10 rue du Champ Gaillard, 78300 Poissy, France.
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15
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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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The effects of LigaSure on the laparoscopic management of acute appendicitis: "LigaSure assisted laparoscopic appendectomy". Surg Laparosc Endosc Percutan Tech 2009; 19:333-5. [PMID: 19692885 DOI: 10.1097/sle.0b013e3181a99288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A very important step in laparoscopic appendectomy is dissection of the appendiceal mesenteric pedicle. The aim of this study was to investigate the effect of LigaSure in laparoscopic appendectomy. Between August 2007 and June 2008, a total of 32 patients were included in the study. Patients were randomized into 2 groups. The first group's dissection of the mesoappendix was performed with LigaSure (5 to 10 mm), whereas the second group's with endodissector and endoclip. The surgical time, postoperative complications, additional analgesics use and hospital stay were compared. There were no significant differences in complication rates, use of analgesics and hospital stay between the groups. The operation time (49.06+/-14.73 min vs. 59.69+/-12.54 min, P=0.036) was significantly lower in the LigaSure group. This study demonstrates that dissection of the mesoappendix with LigaSure reduces the operation time and could be used safely. However, more experiences are needed to attain reliable scientific results.
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Lázár G. [Abdominal catastrophe]. Magy Seb 2009; 62:265-273. [PMID: 19679538 DOI: 10.1556/maseb.62.2009.4.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- György Lázár
- Szegedi Tudományegyetem Szent-Györgyi Albert Klinikai Központ Sebészeti Klinika Szeged
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Hong TH, Kim HL, Lee YS, Kim JJ, Lee KH, You YK, Oh SJ, Park SM. Transumbilical Single-Port Laparoscopic Appendectomy (TUSPLA): Scarless Intracorporeal Appendectomy. J Laparoendosc Adv Surg Tech A 2009; 19:75-8. [PMID: 19196084 DOI: 10.1089/lap.2008.0338] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tae Ho Hong
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyung Lan Kim
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yoon Suk Lee
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jin Jo Kim
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Keun Ho Lee
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Young Kyoung You
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung Man Park
- Department of Surgery, Incheon St. Mary Hospital College of Medicine, The Catholic University of Korea, Incheon, Korea
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