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Diagnostic, Therapy and Complications in Acute Appendicitis of 19,749 Cases Based on Routine Data: A Retrospective Multicenter Observational Study. J Clin Med 2022; 11:jcm11154495. [PMID: 35956110 PMCID: PMC9369616 DOI: 10.3390/jcm11154495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 12/19/2022] Open
Abstract
Background: Acute appendicitis is one of the most common emergencies in general surgery. The gold standard treatment is surgery. Complications may occur during or after an appendectomy. In addition to age, clinically important factors for the outcome after appendicitis seems to be the comorbidities and the stage of the appendicitis at the time of the operation. Large observational data describing these facts are missing. Methods: In this retrospective multicenter observational study, all inpatients over the age of 17 years with a diagnosis of acute appendicitis in 47 hospitals of the Clinotel Hospital Group between 2010 and 2017 were included. Results: A total of 19,749 patients with acute appendicitis were operated on. The number of patients with more than five secondary diagnoses has increased from 8.4% (2010) to 14.5% (2017). The number of secondary diagnoses correlates with the ages of the patients and leads to a significantly longer hospital stay. Computer tomography (CT) has gained in importance in recent years in the diagnosis of acute appendicitis. A total of 19.9% of patients received a CT in 2017. Laparoscopic appendectomy increased from 88% in 2010 to 95% in 2017 (p < 0.001). The conversion rate did not change relevant in the study period (i.e., 2.3% in 2017). Appendicitis with perforation, abscess, or generalized peritonitis was observed in 24.8% of patients. Mortality was 0.6% during the observation period and was associated with age and the number of secondary diagnoses. The analysis is based on administrative data collected primarily for billing purposes, subject to the usual limitations of such data. This includes partially incomplete clinical data. Conclusions: Multimorbidity is increasingly present in patients with acute appendicitis. Mortality is still in an acceptably low range with no increase. A CT scan is necessary for a precise diagnosis in unclear clinical situations to avoid unnecessary operations and was performed more often at the end of the study than at the beginning.
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Alramadhan MM, Al Khatib HS, Murphy JR, Tsao K, Chang ML. Using Artificial Neural Networks to Predict Intra-Abdominal Abscess Risk Post-Appendectomy. ANNALS OF SURGERY OPEN 2022; 3:e168. [PMID: 37601615 PMCID: PMC10431380 DOI: 10.1097/as9.0000000000000168] [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: 09/27/2021] [Accepted: 04/18/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To determine if artificial neural networks (ANN) could predict the risk of intra-abdominal abscess (IAA) development post-appendectomy. Background IAA formation occurs in 13.6% to 14.6% of appendicitis cases with "complicated" appendicitis as the most common cause of IAA. There remains inconsistency in describing the severity of appendicitis with variation in treatment with respect to perforated appendicitis. Methods Two "reproducible" ANN with different architectures were developed on demographic, clinical, and surgical information from a retrospective surgical dataset of 1574 patients less than 19 years old classified as either negative (n = 1,328) or positive (n = 246) for IAA post-appendectomy for appendicitis. Of 34 independent variables initially, 12 variables with the highest influence on the outcome selected for the final dataset for ANN model training and testing. Results A total of 1574 patients were used for training and test sets (80%/20% split). Model 1 achieved accuracy of 89.84%, sensitivity of 70%, and specificity of 93.61% on the test set. Model 2 achieved accuracy of 84.13%, sensitivity of 81.63%, and specificity of 84.6%. Conclusions ANN applied to selected variables can accurately predict patients who will have IAA post-appendectomy. Our reproducible and explainable ANNs potentially represent a state-of-the-art method for optimizing post-appendectomy care.
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Affiliation(s)
- Morouge M. Alramadhan
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - Hassan S. Al Khatib
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - James R. Murphy
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
| | - KuoJen Tsao
- Division of General and Thoracic Pediatric Surgery, Department of Pediatric Surgery, UTHealth Houston McGovern Medical School, Houston, TX
| | - Michael L. Chang
- From the Division of Infectious Diseases, Department of Pediatrics, UTHealth Houston McGovern Medical School, Houston, TX
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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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Emergency Surgery in the Elderly: Could Laparoscopy Be Useful in Frailty? A Single-Center Prospective 2-Year Follow-Up in 120 Consecutive Patients. SURGERIES 2021. [DOI: 10.3390/surgeries2010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: the general population is aging across the world. Therefore, even surgical interventions in the elderly—in particular those involving emergency surgical admissions—are becoming more frequent. The elderly population is often frail (in multiple physiological systems, this is often defined as age-related cumulative decline). This study involved a 2-year follow-up evaluation of frail elderly patients treated with urgent surgical intervention at Santa Maria Regina della Misericordia Hospital, General Surgery Department, in Adria (Italy). Method: a prospective, single-center, 2-year follow-up study of 120 patients >65 years old, treated at our department for surgical abdominal emergencies. We considered co-morbidities (ASA—American Society of Anesthesiologists Physical Status Classification System—score), type of surgery (laparoscopy, laparotomy or converted), frailty score, mortality, and complications at 30 days and at 2 years. Conclusions: 70 (58.4%) patients had laparoscopy, 49 (40.8) had laparotomy, and in 1 (0.8%) case, surgery was converted from laparoscopy to laparotomy. Mortality strictly depends on the type of surgery (laparotomy vs. laparoscopy), complications during recovery, and a lower Fried frailty criteria score, on average. The long-term follow-up can be a useful tool to highlight a safer surgical approach, such as laparoscopy, in frail elderly patients. We consider the laparoscopic approach feasible in emergency situations, with similar or better outcomes than laparotomy, especially in frail elderly patients.
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Comparison of postoperative complications between open and laparoscopic appendectomy: An umbrella review of systematic reviews and meta-analyses. J Trauma Acute Care Surg 2020; 89:813-820. [PMID: 32649616 DOI: 10.1097/ta.0000000000002878] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) has been popular for decades because of shorter hospitalization and return to routine activity. However, complications (e.g., surgical site infection [SSI] and intra-abdominal abscess [IAA]) relative to open appendectomy (OA) are still debated. We therefore conducted an umbrella review to systematically appraise meta-analyses (MAs) comparing SSI and IAA between LA and OA. METHODS Meta-analyses that included only randomized controlled trials were identified from MEDLINE and Scopus databases from inception until July 2018. Their findings were described, the number of overlapping studies was assessed using corrected covered area, and excess significant tests were also assessed. Finally, effect sizes of SSI and IAA were repooled. RESULTS Ten MAs were eligible; SSI was reported in all MAs and IAA in 8 MAs. Surgical site infection rate was 48% to 70% lower in LA than OA, but conversely, IAA rate was 1.34 to 2.20 higher in LA than OA. Overlapping included studies for SSI and IAA were 61% and 54%, respectively, indicating that less information was added across MAs. However, there was no evidence of bias from excess significant tests when pooling SSI or IAA estimates. The risk ratios (95% confidence interval) comparing LA versus OA were repooled in adults and children yielding risk ratios of 0.56 (0.47-0.67) and 0.40 (0.25-0.65) for SSI, and 1.20 (0.88-1.63) and 1.05 (0.61-1.80) for IAA. CONCLUSION Evidence from this umbrella review indicates that LA carries a significantly lower risk of SSI but likely a higher risk of IAA than OA. LEVEL OF EVIDENCE Systematic review/meta-analysis, level I.
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Guaitoli E, Gallo G, Cardone E, Conti L, Famularo S, Formisano G, Galli F, Giuliani G, Martino A, Pasculli A, Patini R, Soriero D, Pappalardo V, Casoni Pattacini G, Sparavigna M, Meniconi R, Mazzari A, Barra F, Orsenigo E, Pertile D. Consensus Statement of the Italian Polispecialistic Society of Young Surgeons (SPIGC): Diagnosis and Treatment of Acute Appendicitis. J INVEST SURG 2020; 34:1089-1103. [PMID: 32167385 DOI: 10.1080/08941939.2020.1740360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients' morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, laboratory index and imaging should be part of the management of patients with suspicion of AA.Methods: This consensus statement was written in relation to the most recent evidence for diagnosis and treatment of AA, performing a literature review on the most largely adopted scientific sources. The members of the SPIGC (Italian Polispecialistic Society of Young Surgeons) worked jointly to draft it. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Chest Physicians (CHEST) for the strength of the recommendations.Results: Fever and migratory pain tend to be present in patients with suspicion of AA. Laboratory and radiological examinations are commonly employed in the clinical practice, but today also scoring systems based on clinical signs and laboratory data have slowly been adopted for diagnostic purpose. The clinical presentation of AA in children, pregnant and elderly patients can be unusual, leading to more difficult and delayed diagnosis. Surgery is the best option in case of complicated AA, whereas it is not mandatory in case of uncomplicated AA. Laparoscopic surgical treatment is feasible and recommended. Postoperative antibiotic treatment is recommended only in patients with complicated AA.
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Affiliation(s)
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Eleonora Cardone
- Department of Surgery, Santa Maria del Popolo degli Incurabili Hospital, Napoli, Italy
| | - Luigi Conti
- Department of Surgery, G. Da Saliceto Hospital, Piacenza, Italy
| | - Simone Famularo
- Department of Medicine and Surgery University of Milan Bicocca HPB Unit, San Gerardo Hospital, Monza, Italy
| | - Giampaolo Formisano
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | | | - Giuseppe Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Antonio Martino
- Department of General Surgery, University of Genoa, Genova, Italy
| | | | - Romeo Patini
- Odontostomatology and Oral Surgery, Sacro Cuore Hospital, Rome, Italy
| | - Domenico Soriero
- Department of General Surgery, University of Genoa, Genova, Italy
| | | | | | - Marco Sparavigna
- Department of General Surgery, University of Genoa, Genova, Italy
| | - Roberto Meniconi
- Department of General Surgeon and Transplantations, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Mazzari
- Mini Invasive and General Surgery, Cristo Re Hospital, Rome, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Elena Orsenigo
- Department of General and Emergency Surgery, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Pertile
- Department of General Surgery, University of Genoa, Genova, Italy
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Fugazzola P, Ceresoli M, Agnoletti V, Agresta F, Amato B, Carcoforo P, Catena F, Chiara O, Chiarugi M, Cobianchi L, Coccolini F, De Troia A, Di Saverio S, Fabbri A, Feo C, Gabrielli F, Gurrado A, Guttadauro A, Leone L, Marrelli D, Petruzzelli L, Portolani N, Prete FP, Puzziello A, Sartelli M, Soliani G, Testini M, Tolone S, Tomasoni M, Tugnoli G, Viale P, Zese M, Ishay OB, Kluger Y, Kirkpatrick A, Ansaloni L. The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World J Emerg Surg 2020; 15:19. [PMID: 32156296 PMCID: PMC7063712 DOI: 10.1186/s13017-020-00298-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.
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Affiliation(s)
- Paola Fugazzola
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy.
| | - Marco Ceresoli
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | | | | | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Osvaldo Chiara
- Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Alessandro De Troia
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Carlo Feo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Francesco Gabrielli
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Angela Gurrado
- Department of Biochemical Sciences and Human Oncology, University of Medical School "A. Moro" of Bari, Bari, Italy
| | - Angelo Guttadauro
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Leonardo Leone
- General and Oncological Surgery, Filippo Neri Hospital, Rome, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Petruzzelli
- Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Francesco Paolo Prete
- Endocrine, Digestive and Emergency Surgery Department, University of Medical School of Bari, Bari, Italy
| | | | | | - Giorgio Soliani
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Mario Testini
- Endocrine, Digestive and Emergency Surgery Department, University of Medical School of Bari, Bari, Italy
| | - Salvatore Tolone
- General, Mininvasive and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Matteo Tomasoni
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Pierluigi Viale
- Operative Unit of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Monica Zese
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Offir Ben Ishay
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Andrew Kirkpatrick
- Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Luca Ansaloni
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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de Wijkerslooth EML, van den Boom AL, Wijnhoven BPL. Disease burden of appendectomy for appendicitis: a population-based cohort study. Surg Endosc 2019; 34:116-125. [PMID: 30919056 PMCID: PMC6946751 DOI: 10.1007/s00464-019-06738-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/06/2019] [Indexed: 01/07/2023]
Abstract
Background Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this study, the objective was to determine the burden of appendectomy for appendicitis in terms of incidence rates, length of hospital stay (LOS) and hospital costs on a national level. In addition, outcomes were compared for subgroups based on surgical treatment, age and hospital setting. Methods Observational retrospective population-based cohort study using the national Dutch healthcare reimbursement registry, which covers hospital registration and reimbursement for 17 million inhabitants. Patients with a diagnosis of appendicitis who underwent appendectomy between 2006 and 2016 were included. Primary outcomes were incidence rates, LOS and hospital costs. Results A total of 135,025 patients were included. Some 53% of patients was male, and 64% was treated in a general hospital. The overall incidence rate of appendectomy was 81 per 100,000 inhabitants and showed a significant decreasing trend across time and age. Mean ± SD LOS per patient was 3.66 ± 3.5 days. LOS showed a significant increase with age and was significantly longer for open versus minimally invasive appendectomy. Mean ± SD hospital costs per patient were €3700 ± 1284. Costs were initially lower for open compared to minimally invasive appendectomy, but were similar from 2012 onward. Compared to non-university hospitals, patients treated in university hospitals had a significantly longer LOS and higher costs. Conclusions Appendectomy for appendicitis represents a substantial clinical and economic burden in the Netherlands. A preference for minimally invasive technique seems justified.
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Affiliation(s)
| | - Anne Loes van den Boom
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Center, PO Box 2040, 3000CA, Rotterdam, The Netherlands
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Buitrago G, Junca E, Eslava-Schmalbach J, Caycedo R, Pinillos P, Leal LC. Clinical Outcomes and Healthcare Costs Associated with Laparoscopic Appendectomy in a Middle-Income Country with Universal Health Coverage. World J Surg 2019; 43:67-74. [PMID: 30145672 DOI: 10.1007/s00268-018-4777-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although many studies have compared outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA), some clinical and economic outcomes continue to be controversial, particularly in low-medium-income countries. We aimed at determining clinical and economic outcomes associated with LA versus OA in adult patients in Colombia. METHODS Retrospective, cohort study based on administrative healthcare records included all patients who underwent LA or OA in Colombia's contributory regime between July 1, 2013, and September 30, 2015. Outcomes were 30-day mortality rates, ICU admissions rates, length of stay (LOS), and hospital costs provided until discharge. Propensity score matching techniques were used to balance the baseline characteristics of patients (age, sex, comorbidities based on the Charlson index, insurer, and geographic location) and to estimate the average treatment effect (ATE) of LA as compared to OA over outcomes. RESULTS A total of 65,625 subjects were included, 92.9% underwent OA and 7.1% LA. For the entire population, 30-day mortality was 0.74 per 100 appendectomies (95% CI 0.67-0.81), the mean and median LOS were 3.83 days and 1 day, respectively, and the ICU admissions rate during the first 30 days was 7.92% (95% CI 7.71-8.12). The ATE shows an absolute difference in the mortality rate after 30 days of -0.35 per 100 appendectomies (p = 0.023), in favor of LA. No effects on ICU admissions or LOS were identified. LA was found to increase costs by 514.13 USD on average, with total costs of 772.78 USD for OA and 1286.91 USD for LA (p < 0.001). CONCLUSIONS In Colombia's contributory regime, LA is associated with lower 30-day mortality rate and higher hospital costs as compared to OA. No differences are found in ICU admissions or LOS.
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Affiliation(s)
- Giancarlo Buitrago
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia.
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
| | - Edgar Junca
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Javier Eslava-Schmalbach
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Ruben Caycedo
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Pilar Pinillos
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Luis Carlos Leal
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Carrera 45 N° 26-85, Edificio 471, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
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Jaschinski T, Mosch CG, Eikermann M, Neugebauer EAM, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2018; 11:CD001546. [PMID: 30484855 PMCID: PMC6517145 DOI: 10.1002/14651858.cd001546.pub4] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The removal of the acute appendix is one of the most frequently performed surgical procedures. Open surgery associated with therapeutic efficacy has been the treatment of choice for acute appendicitis. However, in consequence of the evolution of endoscopic surgery, the operation can also be performed with minimally invasive surgery. Due to smaller incisions, the laparoscopic approach may be associated with reduced postoperative pain, reduced wound infection rate, and shorter time until return to normal activity.This is an update of the review published in 2010. OBJECTIVES To compare the effects of laparoscopic appendectomy (LA) and open appendectomy (OA) with regard to benefits and harms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE and Embase (9 February 2018). We identified proposed and ongoing studies from World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and EU Clinical Trials Register (9 February 2018). We handsearched reference lists of identified studies and the congress proceedings of endoscopic surgical societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing LA versus OA in adults or children. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed the risk of bias, and extracted data. We performed the meta-analyses using Review Manager 5. We calculated the Peto odds ratio (OR) for very rare outcomes, and the mean difference (MD) for continuous outcomes (or standardised mean differences (SMD) if researchers used different scales such as quality of life) with 95% confidence intervals (CI). We used GRADE to rate the quality of the evidence. MAIN RESULTS We identified 85 studies involving 9765 participants. Seventy-five trials included 8520 adults and 10 trials included 1245 children. Most studies had risk of bias issues, with attrition bias being the largest source across studies due to incomplete outcome data.In adults, pain intensity on day one was reduced by 0.75 cm on a 10 cm VAS after LA (MD -0.75, 95% CI -1.04 to -0.45; 20 RCTs; 2421 participants; low-quality evidence). Wound infections were less likely after LA (Peto OR 0.42, 95% CI 0.35 to 0.51; 63 RCTs; 7612 participants; moderate-quality evidence), but the incidence of intra-abdominal abscesses was increased following LA (Peto OR 1.65, 95% CI 1.12 to 2.43; 53 RCTs; 6677 participants; moderate-quality evidence).The length of hospital stay was shortened by one day after LA (MD -0.96, 95% CI -1.23 to -0.70; 46 RCTs; 5127 participant; low-quality evidence). The time until return to normal activity occurred five days earlier after LA than after OA (MD -4.97, 95% CI -6.77 to -3.16; 17 RCTs; 1653 participants; low-quality evidence). Two studies showed better quality of life scores following LA, but used different scales, and therefore no pooled estimates were presented. One used the SF-36 questionnaire two weeks after surgery and the other used the Gastro-intestinal Quality of Life Index six weeks and six months after surgery (both low-quality evidence).In children, we found no differences in pain intensity on day one (MD -0.80, 95% CI -1.65 to 0.05; 1 RCT; 61 participants; low-quality evidence), intra-abdominal abscesses after LA (Peto OR 0.54, 95% CI 0.24 to 1.22; 9 RCTs; 1185 participants; low-quality evidence) or time until return to normal activity (MD -0.50, 95% CI -1.30 to 0.30; 1 RCT; 383 participants; moderate-quality evidence). However, wound infections were less likely after LA (Peto OR 0.25, 95% CI 0.15 to 0.42; 10 RCTs; 1245 participants; moderate-quality evidence) and the length of hospital stay was shortened by 0.8 days after LA (MD -0.81, 95% CI -1.01 to -0.62; 6 RCTs; 316 participants; low-quality evidence). Quality of life was not reported in any of the included studies. AUTHORS' CONCLUSIONS Except for a higher rate of intra-abdominal abscesses after LA in adults, LA showed advantages over OA in pain intensity on day one, wound infections, length of hospital stay and time until return to normal activity in adults. In contrast, LA showed advantages over OA in wound infections and length of hospital stay in children. Two studies reported better quality of life scores in adults. No study reported this outcome in children. However, the quality of evidence ranged from very low to moderate and some of the clinical effects of LA were small and of limited clinical relevance. Future studies with low risk of bias should investigate, in particular, the quality of life in children.
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Affiliation(s)
- Thomas Jaschinski
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Christoph G Mosch
- University Witten/HerdeckeInstitute for Research in Operative Medicine (IFOM) ‐ Department for Evidence‐based Health Services ResearchOstmerheimer Str. 200 (Building 38)CologneGermany51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS)Department of Evidence‐based medicineTheodor‐Althoff‐Straße 47EssenNorth Rhine WestphaliaGermany51109
| | - Edmund AM Neugebauer
- Brandenburg Medical School Theodor Fontane 3Fehrbelliner Str 38NeuruppinBrandenburgGermany16816
| | - Stefan Sauerland
- Institute for Quality and Efficiency in Health Care (IQWiG)Department of Non‐Drug InterventionsIm Mediapark 8CologneGermany50670
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[Appendectomy: open versus laparoscopic versus single port : Evidence for choice of surgical procedure]. Chirurg 2018; 90:186-193. [PMID: 30421067 DOI: 10.1007/s00104-018-0758-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The treatment of choice in acute appendicitis is still the surgical removal of an inflamed vermiform appendix. There is still some disagreement regarding the optimal access route, i.e. conventional open or minimally invasive. The best available evidence is used to answer the question of the current optimal choice of procedure. For laparoscopic appendectomy there are evidence-based benefits in terms of access trauma, postoperative pain, wound infection rates and convalescence. For the alternative minimally invasive procedure single port appendectomy, mini-laparoscopic appendectomy or NOTES appendectomy, there is still a lack of scientific evidence to advocate the broad clinical use of these procedures. It is recommended that whenever the infrastructure permits, laparoscopic appendectomy should be the treatment of choice.
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12
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Role of Laparoscopic Appendectomy Radix Ligation Techniques on the Formation of Inner Abdomen Abscess. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:164-168. [PMID: 32595392 PMCID: PMC7315095 DOI: 10.14744/semb.2017.92905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/20/2017] [Indexed: 11/23/2022]
Abstract
Objectives: Our aim was to study whether laparoscopic appendectomy radix ligation techniques were eutrophic in the development of intra-abdominal abscess. Methods: Between September 2009 and April 2017, all emergency cases admitted to our surgery polyclinic were reviewed, and the results of the patients who underwent laparoscopic appendectomy were collected. Appendectomy radix ligation techniques were reviewed from surgical notes on discharge reports. Postoperative controls were also reviewed, and any cases with abscess formation were reported. Results: A total of 350 patients were included in the study. Of these cases, 207 were males, and 143 were females. The mean age of the patients was 26.89±4.9 years. One hundred eighty-nine cases were found to have two endoloops placed on top of each other, whereas 161 cases had a 2 mm distance left in between the two endoloops and tied. None of the 189 cases who had endoloops placed on top of each other developed abscess formation. However, of the 161 cases who had endoloops with a 2 mm distance in between, 8 reported with abscess formation in the inner abdomen. Of these eight cases, seven had percutaneous abscess drainage by an interventional radiologist, whereas one was treated with relaparoscopy. Conclusion: In the present study, patients who had endoloops placed on top of each other developed no abscess formation, whereas in the literature’s gold standard procedure, those with a 2 mm distance left between two endoloops developed an inner abdominal abscess formation in 8 (4.9%) of the patients. We believe that this 2 mm dead space distance left between the two endoloops contributes to the formation of the abscess.
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13
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Risk factors for intraabdominal abscess formation after laparoscopic appendectomy - results from the Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Wideochir Inne Tech Maloinwazyjne 2018; 14:70-78. [PMID: 30766631 PMCID: PMC6372867 DOI: 10.5114/wiitm.2018.77272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/04/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction According to meta-analyses laparoscopic appendectomy is associated with many benefits. However, in comparison to open surgery an increased rate of intraabdominal abscesses (IAA) has been reported. Identification of predictive factors for this complication may help to identify patients with higher risk of IAA. Aim To identify potential risk factors for intraabdominal abscess after laparoscopic appendectomy (LA). Material and methods Eighteen surgical units in Poland and Germany submitted data of patients undergoing LA to the online web-based database created by the Polish Videosurgery Society of the Association of Polish Surgeons. It comprised 31 elements related to the pre-, intra- and postoperative period. Surgical outcomes were compared among the groups according to occurrence of IAA. Univariate and multivariate logistic regression models were used to identify potential risk factors for IAA. Results 4618 patients were included in the analysis. IAA were found in 51 (1.10%) cases. Although several risk factors were found in univariate analysis, in the multivariate model, only the presence of complicated appendicitis was statistically significant (OR = 2.98, 95% CI: 1.11–8.04). Moreover, IAA has a significant influence on postoperative reintervention rate (OR = 126.95, 95% CI: 67.98–237.06), prolonged length of stay > 8 days (OR = 41.32, 95% CI: 22.86–74.72) and readmission rate (OR = 33.89, 95% CI: 18.60–34.73). Conclusions Intraabdominal abscesses occurs relatively rarely after LA. It is strongly associated with complicated appendicitis. Occurrence of this complication has a great influence on the postoperative period and due to the nature of its treatment is associated with the need for reintervention, prolonged length of stay and by extension possible readmission.
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14
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Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, Coccolini F, Vijayan D, Abbas A, Abongwa HK, Agboola J, Ahmed A, Akhmeteli L, Akkapulu N, Akkucuk S, Altintoprak F, Andreiev AL, Anyfantakis D, Atanasov B, Bala M, Balalis D, Baraket O, Bellanova G, Beltran M, Melo RB, Bini R, Bouliaris K, Brunelli D, Castillo A, Catani M, Che Jusoh A, Chichom-Mefire A, Cocorullo G, Coimbra R, Colak E, Costa S, Das K, Delibegovic S, Demetrashvili Z, Di Carlo I, Kiseleva N, El Zalabany T, Faro M, Ferreira M, Fraga GP, Gachabayov M, Ghnnam WM, Giménez Maurel T, Gkiokas G, Gomes CA, Griffiths E, Guner A, Gupta S, Hecker A, Hirano ES, Hodonou A, Hutan M, Ioannidis O, Isik A, Ivakhov G, Jain S, Jokubauskas M, Karamarkovic A, Kauhanen S, Kaushik R, Kavalakat A, Kenig J, Khokha V, Khor D, Kim D, Kim JI, Kong V, Lasithiotakis K, Leão P, Leon M, Litvin A, Lohsiriwat V, López-Tomassetti Fernandez E, Lostoridis E, Maciel J, Major P, Dimova A, Manatakis D, Marinis A, Martinez-Perez A, Marwah S, McFarlane M, Mesina C, Pędziwiatr M, Michalopoulos N, Misiakos E, Mohamedahmed A, Moldovanu R, Montori G, Mysore Narayana R, Negoi I, Nikolopoulos I, Novelli G, Novikovs V, Olaoye I, Omari A, Ordoñez CA, Ouadii M, Ozkan Z, Pal A, Palini GM, Partecke LI, Pata F, Pędziwiatr M, Pereira Júnior GA, Pintar T, Pisarska M, Ploneda-Valencia CF, Pouggouras K, Prabhu V, Ramakrishnapillai P, Regimbeau JM, Reitz M, Rios-Cruz D, Saar S, Sakakushev B, Seretis C, Sazhin A, Shelat V, Skrovina M, Smirnov D, Spyropoulos C, Strzałka M, Talving P, Teixeira Gonsaga RA, Theobald G, Tomadze G, Torba M, Tranà C, Ulrych J, Uzunoğlu MY, Vasilescu A, Occhionorelli S, Venara A, Vereczkei A, Vettoretto N, Vlad N, Walędziak M, Yilmaz TU, Yuan KC, Yunfeng C, Zilinskas J, Grelpois G, Catena F. Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Surg 2018; 13:19. [PMID: 29686725 PMCID: PMC5902943 DOI: 10.1186/s13017-018-0179-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/04/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. METHODS This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. RESULTS A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%) patients underwent surgery; 1809 (42.2%) underwent open appendectomy and 2215 (51.7%) had laparoscopic appendectomy. One hundred eighty-five (4.3%) patients were managed conservatively. Major complications occurred in 199 patients (4.6%). The overall mortality rate was 0.28%. CONCLUSIONS The results of the present study confirm the clinical value of imaging techniques and prognostic scores. Appendectomy remains the most effective treatment of acute appendicitis. Mortality rate is low.
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Affiliation(s)
| | - Gian L. Baiocchi
- 0000000417571846grid.7637.5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salomone Di Saverio
- 0000 0004 1759 7093grid.416290.8Emergency Surgery, Maggiore Hospital, Bologna, Italy
| | - Francesco Ferrara
- grid.414126.4General Surgery and Polytrauma, San Carlo Borromeo Hospital, Milan, Italy
| | - Francesco M. Labricciosa
- Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, UNIVPM, Ancona, Italy
| | - Luca Ansaloni
- 0000 0004 1758 8744grid.414682.dDepartment of Surgery, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- 0000 0004 1758 8744grid.414682.dDepartment of Surgery, Bufalini Hospital, Cesena, Italy
| | - Deepak Vijayan
- 0000 0004 0376 6589grid.412563.7General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ashraf Abbas
- grid.469958.fEmergency Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | - John Agboola
- Surgery, Kwara State General Hospital, Ilorin, Kwara Nigeria
| | - Adamu Ahmed
- 0000 0004 4688 7583grid.413221.7Surgery, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | | | - Nezih Akkapulu
- 0000 0001 1457 1144grid.411548.dGeneral Surgery, Baskent Universitesi Adana Eğitim ve Uygulama Hastanesi, Adana, Turkey
| | - Seckin Akkucuk
- 0000 0001 0680 7823grid.14352.31General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
| | - Fatih Altintoprak
- 0000 0001 0682 3030grid.49746.38General Surgery, Sakarya University School of Medicine, Sakarya, Turkey
| | - Aurelia L. Andreiev
- 0000 0004 0376 6589grid.412563.7General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Boiko Atanasov
- 0000 0001 0726 0380grid.35371.33Department of General Surgery, Medical University of Plovdiv, UMHAT Eurohospital, Plovdiv, Bulgaria
| | - Miklosh Bala
- 0000 0001 2221 2926grid.17788.31General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Dimitrios Balalis
- Surgical Department, Agios Savvas Anticaner Hospital, Athens, Greece
| | - Oussama Baraket
- General Surgery, Hospital Habib Bouguefa de Bizerte, Bizerte, Tunisia
| | | | - Marcelo Beltran
- Surgery, Hospital San Juan de Dios de La Serena, La Serena, Chile
| | - Renato Bessa Melo
- 0000 0000 9375 4688grid.414556.7General Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Roberto Bini
- 0000 0004 1760 7116grid.415044.0General and Emergency Surgery, San Giovanni Bosco Hospital, Turin, Italy
| | | | | | - Adrian Castillo
- 0000 0001 0157 6501grid.239844.0Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Marco Catani
- grid.7841.aDEA, La Sapienza Università di Roma, Policlinico Umberto I, Rome, Italy
| | - Asri Che Jusoh
- General Surgery, Kuala Krai Hospital, Kuala Krai, Kelantan Malaysia
| | | | - Gianfranco Cocorullo
- 0000 0004 1756 3088grid.412510.3Emergency Surgery, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Raul Coimbra
- 0000 0001 2107 4242grid.266100.3Trauma/Acute Care Surgery, University of California San Diego, San Diego, USA
| | - Elif Colak
- General Surgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Silvia Costa
- 0000 0000 8902 4519grid.418336.bSurgery, CHVNG/E, EPE, Vila Nova de Gaia, Portugal
| | - Koray Das
- 0000 0004 0642 7670grid.413791.9General Surgery, Numune Training and Research Hospital, Adana, Turkey
| | - Samir Delibegovic
- 0000 0001 0682 9061grid.412410.2Colorectal Surgery, Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | - Isidoro Di Carlo
- 0000 0004 0637 437Xgrid.413542.5Surgery, Hamad General Hospital, Doha, Qatar
| | - Nadezda Kiseleva
- 0000 0004 0375 2558grid.488518.8General and Emergency Surgery, Riga East University Hospital “Gailezers”, Riga, Latvia
| | | | - Mario Faro
- 0000 0004 0643 8839grid.412368.aDepartment of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo Andreì, SP Brazil
| | - Margarida Ferreira
- 0000 0000 8563 4416grid.414708.eGeneral Surgery, Hospital Garcia de Orta, Lisbon, Portugal
| | - Gustavo P. Fraga
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, University of Campinas (Unicamp), Campinas, Brazil
| | - Mahir Gachabayov
- Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia
| | - Wagih M. Ghnnam
- 0000000103426662grid.10251.37General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Teresa Giménez Maurel
- 0000 0000 9854 2756grid.411106.3Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Georgios Gkiokas
- 0000 0001 2155 0800grid.5216.0Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos A. Gomes
- Surgery, Therezinha de Jesus University Hospital, Juiz de Fora, Brazil
| | - Ewen Griffiths
- 0000 0004 0376 6589grid.412563.7Upper GI/General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ali Guner
- 0000 0001 2186 0630grid.31564.35Department of General Surgery, Karadeniz Technical University, Farabi Hospital, Trabzon, Turkey
| | - Sanjay Gupta
- 0000 0004 1767 2831grid.413220.6Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Andreas Hecker
- 0000 0000 8584 9230grid.411067.5Department of General and Thoracic Surgery, University Hospital, Giessen, Germany
| | - Elcio S. Hirano
- 0000 0001 0723 2494grid.411087.bDivision of Trauma Surgery, Hospital de Clinicas, University of Campinas (Unicamp), Campinas, Brazil
| | | | - Martin Hutan
- Surgical Department, Landesklinikum Hainburg, Hainburg An Der Donau, Austria
| | - Orestis Ioannidis
- 0000000109457005grid.4793.94th Surgical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- grid.414012.2General Hospital “George Papanikoalou”, Thessaloniki, Greece
| | - Arda Isik
- 0000 0001 1498 7262grid.412176.7General Surgery, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey
| | | | - Sumita Jain
- 0000 0004 1767 3615grid.416077.3Surgery, S M S Medical college, Jaipur, India
| | - Mantas Jokubauskas
- 0000 0004 0575 8750grid.48349.32Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Aleksandar Karamarkovic
- 0000 0001 2166 9385grid.7149.bClinic for Emergency Surgery, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Saila Kauhanen
- 0000 0004 0628 215Xgrid.410552.7Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Robin Kaushik
- 0000 0004 1767 2831grid.413220.6Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Alfie Kavalakat
- 0000 0004 1802 2603grid.464600.0General Surgery, Jubilee Mission Medical College & Research Institute, Thrissur, India
| | - Jakub Kenig
- 0000 0001 2162 9631grid.5522.03rd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Desmond Khor
- 0000 0001 0084 1895grid.411409.9Acute Care Surgery, LAC+USC Medical Center, California, USA
| | - Dennis Kim
- 0000 0001 0157 6501grid.239844.0Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Jae I. Kim
- 0000 0004 0371 8173grid.411633.2Department of Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Victor Kong
- 0000 0004 0576 7753grid.414386.cDepartment of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | | | - Pedro Leão
- General Surgery, Colorectal Unit, Hospital de Braga, Braga, Portugal
| | - Miguel Leon
- grid.419651.eGeneral and Digestive Surgery, Hospital Fundación Jimenez Diaz, Madrid, Spain
| | - Andrey Litvin
- Surgical Disciplines, Regional Clinical Hospital, Kaliningrad, Russia
| | - Varut Lohsiriwat
- grid.416009.aFaculty of Medicine, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - James Maciel
- 0000 0001 0157 6501grid.239844.0Department of Surgery, Harbor-UCLA Medical Center, Torrance, USA
| | - Piotr Major
- 0000 0001 2162 9631grid.5522.02nd Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Ana Dimova
- 0000 0004 0397 9648grid.412688.1Clinic of surgery, Department of Gastrointestinal Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Dimitrios Manatakis
- grid.414012.2Surgical Department, Konstantopouleio General Hospital, Athens, Greece
| | | | - Aleix Martinez-Perez
- 0000 0004 1770 9825grid.411289.7Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Sanjay Marwah
- 0000 0004 1771 1642grid.412572.7Department of General Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Michael McFarlane
- 0000 0001 2322 4996grid.12916.3dDepartment of Surgery, Radiology, Anaesthetics and Intensive Care, University of the West Indies, Kingston, Jamaica
- 0000 0004 0500 5353grid.412963.bUniversity Hospital of the West Indies, Kingston, Jamaica
| | - Cristian Mesina
- Department of Surgery Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Michał Pędziwiatr
- 0000 0001 1216 0093grid.412700.0Department of General Surgery and Emergency Medicine, University Hospital, Kraków, Poland
| | - Nickos Michalopoulos
- 0000 0004 0576 4544grid.411222.63rd Department of Surgery, Ahepa University Hospital, Thessaloniki, Greece
| | - Evangelos Misiakos
- 0000 0001 2155 0800grid.5216.03rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Radu Moldovanu
- Department of Visceral, Digestive and Oncologic Surgery, Clinique Sainte Marie, Cambrai, France
| | - Giulia Montori
- 0000 0004 1758 8744grid.414682.dDepartment of Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Ionut Negoi
- General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Giuseppe Novelli
- grid.414614.2General, Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - Viktors Novikovs
- 0000 0004 0375 2558grid.488518.8General and Emergency Surgery, Riga East University Hospital “Gailezers”, Riga, Latvia
| | - Iyiade Olaoye
- 0000 0000 8878 5287grid.412975.cSurgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Abdelkarim Omari
- 0000 0004 0411 3985grid.460946.9General Surgery, King Abdullah University Hospital, Irbid, Jordan
| | - Carlos A. Ordoñez
- grid.477264.4Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili and Universidad del Valle, Cali, Colombia
| | - Mouaqit Ouadii
- Surgery Departement, Medical School of Fezm, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Zeynep Ozkan
- General Surgery, Elazig Training and Research Hospital, Elazig, Turkey
| | - Ajay Pal
- 0000 0004 0645 6578grid.411275.4General Surgery, King George’s Medical University, Lucknow, India
| | - Gian M. Palini
- grid.414614.2General, Emergency Surgery, Infermi Hospital, Rimini, Italy
| | | | - Francesco Pata
- Department of General Surgery, Sant’Antonio Abate Hospital, Gallarate, Italy
| | - Michał Pędziwiatr
- 0000 0001 1216 0093grid.412700.0Department of Emergency Surgery and Trauma Centre, University Hospital, Kraków, Poland
| | | | - Tadeja Pintar
- 0000 0004 0571 7705grid.29524.38Abdominal surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Magdalena Pisarska
- 0000 0001 1216 0093grid.412700.0Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, The University Hospital in Krakow, Kraków, Poland
| | - Cesar F. Ploneda-Valencia
- 0000 0001 0432 668Xgrid.459608.6General Surgery, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | | | - Vinod Prabhu
- 0000 0004 0503 0903grid.411681.bSurgery, Bharati Vidyapeeth Deemed University Medical College & Hospital, Sangli, Maharashtra India
| | | | - Jean-Marc Regimbeau
- 0000 0004 0593 702Xgrid.134996.0Digestive Surgery, CHU Amiens-Picardie, Amiens, France
| | - Marianne Reitz
- General Surgery, Hospital Municipal Dr. Jose de Carvalho Florence, Sao Jose Dos Campos, Brazil
| | - Daniel Rios-Cruz
- General Surgery, Hospital General Regional # 1 I.M.S.S, Cuernavaca, Mexico
| | - Sten Saar
- Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | - Boris Sakakushev
- General Surgery, University Hospital St George, Plovdiv, Bulgaria
| | - Charalampos Seretis
- 0000 0004 0399 9948grid.416281.8General Surgery, Russells Hall Hospital, Birmingham, UK
| | | | - Vishal Shelat
- grid.240988.fGeneral Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Matej Skrovina
- Surgery, Hospital & Oncological Centre Novy Jicin, Novy Jicin, Czech Republic
| | - Dmitry Smirnov
- General Surgery, Clinical Hospital at Chelyabinsk Station OJSC “Russian Railways”, Chelyabinsk, Russian Federation
| | | | - Marcin Strzałka
- 0000 0001 2162 9631grid.5522.0General Surgery and Polytrauma, University Hospital, Medical College, Jagiellonian University, Kraków, Poland
| | - Peep Talving
- Acute Care Surgery, North Estonia Medical Center, Tallinn, Estonia
| | | | - George Theobald
- 0000 0004 0376 6589grid.412563.7General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gia Tomadze
- 0000 0004 0428 8304grid.412274.6Surgery Department #2, Tbilisi State Medical University, Tbilisi, Georgia
| | - Myftar Torba
- General Surgery, Trauma University Hospital, Tirana, Albania
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Jan Ulrych
- 0000 0000 9100 9940grid.411798.21st Department of Surgery—Department of Abdominal Thoracic Surgery and Traumatology, General University Hospital, Prague, Czech Republic
| | - Mustafa Y. Uzunoğlu
- 0000 0001 0680 7823grid.14352.31General Surgery, Training and Research Hospital of Mustafa Kemal University, Hatay, Turkey
| | - Alin Vasilescu
- First Surgical Clinic, St. Spiridon University Hospital, Iasi, Romania
| | | | - Aurélien Venara
- 0000 0004 0472 0283grid.411147.6Digestive and Endocrinal Surgery, University Hospital, Angers, France
| | - Andras Vereczkei
- 0000 0001 0663 9479grid.9679.1Department of Surgery, Medical School University of Pécs, Pécs, Hungary
| | | | - Nutu Vlad
- First Surgical Clinic, St. Spiridon University Hospital, Iasi, Romania
| | - Maciej Walędziak
- 0000 0004 0620 0839grid.415641.3Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Tonguç U. Yilmaz
- 0000 0001 0691 9040grid.411105.0Department of General Surgery, Kocaeli University, Kocaeli, Turkey
| | - Kuo-Ching Yuan
- Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cui Yunfeng
- grid.417036.7Department of Surgery, Tianjin Nankai Hospital, Tianjin, China
| | - Justas Zilinskas
- 0000 0004 0575 8750grid.48349.32Department of Surgery, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Gérard Grelpois
- 0000 0004 0593 702Xgrid.134996.0Digestive Surgery, CHU Amiens-Picardie, Amiens, France
| | - Fausto Catena
- grid.469958.fEmergency Surgery, Mansoura University Hospital, Mansoura, Egypt
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15
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Spille J, Wenners A, von Hehn U, Maass N, Pecks U, Mettler L, Alkatout I. 2D Versus 3D in Laparoscopic Surgery by Beginners and Experts: A Randomized Controlled Trial on a Pelvitrainer in Objectively Graded Surgical Steps. JOURNAL OF SURGICAL EDUCATION 2017; 74:867-877. [PMID: 28215494 DOI: 10.1016/j.jsurg.2017.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/30/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Progress in endoscopic surgery in the past few decades has led to the application of 3-dimensional (3D) procedures in operating rooms. This permits patient- and surgeon-friendly operations and also maximizes the superiority of laparoscopy over laparotomy. In this study, we compare 2-dimensional (2D) and 3D endoscopy techniques with regard to time, efficiency, optics, and handling by users with different degrees of experience at 4 difficulty levels. DESIGN A randomized controlled trial on a pelvitrainer in objectively graded surgical steps for students and postgraduates. SETTING The trials took place at the Kiel School of Gynaecological Endoscopy, a training unit of the Kiel University Department of Obstetrics and Gynecology, a tertiary academic medical center. PARTICIPANTS The 277 study participants, divided into students, residents, and specialists, worked on pelvitrainers with 2 different optical systems, the 2D full HD and the 3D mode. The following 4 exercises were performed with each optical system: (1) grasping and transferring of pins, (2) cutting predetermined marks, (3) vaginal closure with prevention of prolapse, and (4) sacrocolpopexy. The duration and success of the tasks were measured and compared. A self-assessment questionnaire was completed by the participants. RESULTS Overall, the 3D-system permitted a greater improvement in working speed, superior optical visualization, and better endoscopic handling in all groups, independent of surgical experience. All students improved in speed (exercises: 1-3) and made significantly fewer mistakes (exercise 2) on 3D compared with 2D. Residents made progress in time (exercises: 1-4) and task performance (exercise 3). Specialists improved significantly in the more challenging tasks 3 and 4. Subjectively, 68.8% of participants preferred 3D for performing laparoscopy. CONCLUSION Systematic training programs on pelvitrainers can improve endoscopic skills not only in beginners but also in experienced surgeons. The 3D system offered distinct advantages over 2D imaging and was well accepted by surgeons.
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Affiliation(s)
- Johannes Spille
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Antonia Wenners
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany; Department of Reproductive Medicine, Fertility Center Kiel, Park Clinic, Kiel, Germany
| | - Ulrike von Hehn
- Institute of Medical Informatics and Statistics, Medistat, Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Pecks
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein Campus Kiel, Kiel, Germany.
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16
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Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016; 30:4668-4690. [PMID: 27660247 PMCID: PMC5082605 DOI: 10.1007/s00464-016-5245-7] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023]
Abstract
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
- Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Gabor S A Abis
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Amish Acharya
- Department of Surgery, St Mary's Hospital, London, UK
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stavros A Antoniou
- Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany
- Department of Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Simone Arolfo
- Department of Surgery, University of Torino, Torino, Italy
| | - Benjamin Babic
- Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luigi Boni
- Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Marlieke Bruntink
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Barbara Defoort
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - Charlotte L Deijen
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Borja DeLacy
- Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Peter Mnyh Go
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Florin Iordache
- Department of Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Filip E Muysoms
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - M Mahir Ozmen
- Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Michail Papoulas
- Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Michael Rhodes
- Department of Surgery, Stepping Hill Hospital, Stockport, UK
| | - Jennifer Straatman
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Victor Turrado
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pecs, Hungary
| | - Ramon Vilallonga
- Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain
| | - Jort D Deelder
- Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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17
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Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016; 11:34. [PMID: 27437029 PMCID: PMC4949879 DOI: 10.1186/s13017-016-0090-5] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
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Affiliation(s)
| | - Arianna Birindelli
- S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy
| | - Micheal D Kelly
- Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Dieter G Weber
- Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | | | | | - Mark De Moya
- Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Carlos Augusto Gomes
- Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | - Aneel Bhangu
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | | | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Ewen Griffiths
- University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Birmingham, UK
| | | | - Jeffry Kashuk
- Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- Abdominal Center, University of Helsinki, Helsinki, Finland
| | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Manne Andersson
- Department of Surgery, Linkoping University, Linkoping, Sweden
| | | | - Raul Coimbra
- UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA
| | | | | | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI USA
| | | | | | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | | | - Ronald V Maier
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | | | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Roberto Cirocchi
- Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy
| | - Valeria Tonini
- S. Orsola Malpighi University Hospital - University of Bologna, Bologna, Italy
| | - Alice Piccinini
- Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy
| | | | - Elio Jovine
- Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy
| | - Roberto Persiani
- Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Antonio Biondi
- Department of Surgery, University of Catania, Catania, Italy
| | | | - Philip Stahel
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA USA
| | - George Velmahos
- Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
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18
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Nickerson TP, Aho JM, Bingener J. Single-incision laparoscopic resection of small bowel tumours: Making it easier for patient and surgeon. J Minim Access Surg 2016; 12:235-9. [PMID: 27279394 PMCID: PMC4916749 DOI: 10.4103/0972-9941.158958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Patients with small bowel tumours frequently require surgical intervention. Minimally invasive techniques require advanced skills and may not be offered to many patients. We present a laparoscopic single-incision technique that is minimally invasive without requiring intracorporeal anastomosis. MATERIALS AND METHODS: The cases of all patients with laparoscopic small bowel resections performed by one surgeon from 2008 to 2012 were reviewed. A single-port technique was introduced after it became available at our institution in 2009. Before that, conventional laparoscopy (LAP) was performed with extension of the periumbilical incision to allow externalisation of the bowel. RESULTS: Totally, 10 patients were identified who underwent laparoscopic resection of small bowel tumours: 9 in the small bowel and 1 in the terminal ileum near the cecum. Three tumours were resected before 2009 using LAP, and 7 were resected using the single-port technique. Median length of stay was 3 days, median follow-up was 16.5 months, and no patients had a recurrence. Operative time, post-operative complications, hospital length of stay, and narcotic utilisation were similar between the single-port and traditional laparoscopic groups. CONCLUSION: Laparoscopic removal of small bowel tumours with a small, periumbilical trocar incision is both effective and feasible without advanced technical skill.
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Affiliation(s)
| | - Johnathon M Aho
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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19
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Tashiro J, Einstein SA, Perez EA, Bronson SN, Lasko DS, Sola JE. Hospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendicitis. J Pediatr Surg 2016; 51:804-9. [PMID: 26944182 DOI: 10.1016/j.jpedsurg.2016.02.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/07/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We hypothesize that laparoscopic (LA) or open appendectomy (OA) outcomes are associated with hospital procedure preference. METHODS We queried Kids' Inpatient Database (1997-2009) for simple (ICD-9-CM 540.9) and complicated (540.0, 540.1) appendicitis. RESULTS On PS-matched analysis of simple appendicitis (91,118 LA vs. 97,496 OA), LA had increased transfusion (1.7) rates, but lower wound infection (0.6) and perforation/laceration (0.3) rates. LA had shorter length of stay (LOS; 1.7 vs. 2.1days), but higher total charges (TC; 19,501 vs. 13,089 USD) and cost (7121 vs. 5968) vs. OA. For complicated appendicitis (28,793 LA vs. 30,782 OA), LA had increased nausea/vomiting rates (1.9), but lower wound infection (0.5) and transfusion (0.6) rates. LA had shorter LOS (5.1 vs. 5.9), but higher TC (32,251 vs. 28,209). MVA demonstrated shorter LOS (0.9) for LA at laparoscopic-preferring hospitals vs. open-preferring hospitals for simple appendicitis. For complicated appendicitis, higher complication rates (1.1) were associated with OA at laparoscopic-preferring hospitals. Laparoscopic-preferring hospitals had higher TC in all categories. CONCLUSION Complications and resource utilization for appendicitis are associated with surgical technique and hospital procedure preference. Laparoscopic-preferring hospitals had higher complication rates with OA for complicated appendicitis and higher charges regardless of appendectomy technique or appendicitis type. LEVEL OF EVIDENCE 2c, Outcomes Research.
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Affiliation(s)
- Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Stephanie A Einstein
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - Steven N Bronson
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL
| | - David S Lasko
- South Florida Pediatric Surgeons, P.A., Plantation, FL
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
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20
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Cho J, Park I, Lee D, Sung K, Baek J, Lee J. Antimicrobial treatment after laparoscopic appendectomy for preventing a post-operative intraabdominal abscess: A Prospective Cohort Study of 1817 patients. Int J Surg 2016; 27:142-146. [PMID: 26808321 DOI: 10.1016/j.ijsu.2016.01.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Post-operative antimicrobial treatment is usually administered to prevent a post-operative intraabdominal abscess (IAA) after laparoscopic appendectomy (LA). The aim of this study was to identify the role of post-operative antibiotic treatment and the optimal length for the antibiotic course to prevent post-operative IAA after LA. METHODS Between January 2010 and December 2013, 1817 patients who underwent three-port LA were enrolled in this study. Patients were classified into four groups according to the type of appendicitis and infectious source control. The characteristics of antimicrobial treatment and the incidence of IAA were analyzed and compared among the four groups. RESULTS The incidence of IAA after three-port LA was 1.5% (27/1817). The mean durations of post-operative antibiotic use were 3.1 days for the non-IAA group and 3.3 days for the IAA group, with no significant difference between the groups (p = 0.510). DISCUSSION The length of post-operative antibiotic treatment and antimicrobial combination therapy did not affect the development of IAA, and prolonged antibiotic treatment did not prevent IAA. However, when source control was not completely achieved, an IAA was frequently observed in the patient group that received a short course of antibiotic treatment. CONCLUSION The role of antibiotic treatment for preventing post-appendectomy IAA seems to be related with achieving intraperitoneal infectious source control. In the setting of incomplete source control, we recommend a 5-day course of antimicrobial combination therapy and consecutive source control such as peritoneal drainage.
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Affiliation(s)
- Jinbeom Cho
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
| | - Ilyoung Park
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
| | - Dosang Lee
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
| | - Kiyoung Sung
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
| | - Jongmin Baek
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
| | - Junhyun Lee
- Department of Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Sosa-dong, Wonmi-gu, Bucheon-si, Gyunggi-do 420-717, South Korea.
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21
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Kuroyanagi H, Inomata M, Saida Y, Hasegawa S, Funayama Y, Yamamoto S, Sakai Y, Watanabe M. Gastroenterological Surgery: Large intestine. Asian J Endosc Surg 2015; 8:246-62. [PMID: 26303730 DOI: 10.1111/ases.12222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 01/16/2023]
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22
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Jaschinski T, Mosch C, Eikermann M, Neugebauer EAM. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015; 15:48. [PMID: 25884671 PMCID: PMC4399217 DOI: 10.1186/s12876-015-0277-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/30/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Several systematic reviews (SRs) of randomised controlled trials (RCTs) comparing laparoscopic versus open appendectomy have been published, but there has been no overview of SRs of these two interventions. This overview (review of review) aims to summarise the results of such SRs in order to provide the most up to date evidence, and to highlight discordant results. METHODS Medline, Embase, Cinahl, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for SRs published up to August 2014. Study selection and quality assessment using the AMSTAR tool were carried out independently by two reviewers. We used standardised forms to extract data that were analysed descriptively. RESULTS Nine SRs met the inclusion criteria. All were of moderate to high quality. The number of randomized controlled trials (RCTs) they included ranged from eight to 67. The duration of surgery pooled by eight reviews was 7.6 to 18.3 minutes shorter using the open approach. Pain scores on the first postoperative day were lower after laparoscopic appendectomy in two out of three reviews. The risk of abdominal abscesses was higher for laparoscopic surgery in half of six meta-analyses. The occurrence of wound infections pooled by all reviews was lower after laparoscopic appendectomy. One review showed no difference in mortality. The laparoscopic approach shortened hospital stay from 0.16 to 1.13 days in seven out of eight meta-analyses, though the strength of the evidence was affected by strong heterogeneity. CONCLUSION Laparoscopic and open appendectomy are both safe and effective procedures for the treatment of acute appendicitis. This overview shows discordant results with respect to the magnitude of the effect but not to the direction of the effect. The evidence from this overview may prove useful for the development of clinical guidelines and protocols.
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Affiliation(s)
- Thomas Jaschinski
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Christoph Mosch
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Michaela Eikermann
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
| | - Edmund A M Neugebauer
- Department for Evidence-based health services research, Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (building 38), 51109, Cologne, Germany.
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van den Boom AL, Gorter RR, van Haard PMM, Doornebosch PG, Heij HA, Dawson I. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int 2015; 31:339-45. [PMID: 25687156 DOI: 10.1007/s00383-015-3677-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Although a national guideline has been implemented, the optimal approach for appendectomy in children remains subject of debate in the Netherlands. Opponents of laparoscopy raise their concerns regarding its use in complex appendicitis as it is reported to be associated with an increased incidence of intra-abdominal abscesses. The aim of this study was to evaluate the outcome of surgical approaches in both simple and complex appendicitis in paediatric patients. METHODS A 10-year retrospective cohort study was performed (2001-2010) in paediatric patients treated for suspected acute appendicitis. Patients were divided into either simple or complex appendicitis and into different age groups. Primary outcome parameters were complication rate (intra-abdominal abscess (IAA), superficial surgical site infection (SSI) and readmission) and hospital stay. RESULTS In total, 878 patients have been treated (median age 12, range 0-17 years). Two-thirds of the patients younger than 6 years had complex appendicitis, compared to one quarter in the group aged 13-18. In the complex appendicitis group, LA was associated with more IAA and early readmissions. In the simple appendicitis group, the complication rate was comparable between the two approaches. Significantly more IAAs were seen after LA in the youngest age group. CONCLUSION This study demonstrates the unfavourable outcome of LA in the youngest age group and in patients with complex appendicitis. Therefore, we advise to treat these patients with an open approach.
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Affiliation(s)
- A L van den Boom
- Surgery, IJsselland ziekenhuis, Pr Constantijnweg 2, 2906 ZC, Capelle aan den ijssel, The Netherlands,
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Long KL, Spears C, Kenady DE, Roth JS. Implementation of a low-cost laparoscopic skills curriculum in a third-world setting. JOURNAL OF SURGICAL EDUCATION 2014; 71:860-864. [PMID: 24931413 DOI: 10.1016/j.jsurg.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/12/2014] [Accepted: 05/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Training outside the operating room has become a mainstay of surgical education. Laparoscopic training often takes place in a simulation setting. Advanced laparoscopic procedures are now commonplace, even in third-world countries with minimal hospital resources. We sought to implement a low-cost laparoscopic skills curriculum in a general surgery residency program in East Africa. STUDY DESIGN The laparoscopic skills curriculum created and validated at the University of Kentucky was presented to the 10 general surgery residents at Tenwek Hospital. The curriculum and all materials were purchased for approximately $50 (USD). The residents in Kenya had access to laparoscopic trainer boxes and personal laptops to perform the simulations. Residents were timed on their performance at the initiation of the project and after 3 weeks of practice. RESULTS Residents were tested on 3 separate tasks (cannulation drill, peg board, and rope pass). At the initiation of the project, residents were unable to complete the 3 tasks chosen for timing without a critical error (i.e., dropping a peg out of view). After 3 weeks of independent practice, residents were able to successfully complete the tasks, nearing the time limits established in the curriculum manual. Additional practice and testing sessions are scheduled for the remainder of the year. CONCLUSIONS Implementation of a low-cost laparoscopic skills curriculum in a third-world setting is feasible. This approach offers much-needed exposure and opportunities for residents with extremely limited resources and promises to be a vital aspect of the growing surgical residency training in third-world settings.
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Affiliation(s)
- Kristin L Long
- Department of General Surgery, University of Kentucky, Lexington, Kentucky.
| | - Carol Spears
- Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - Daniel E Kenady
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
| | - John Scott Roth
- Department of General Surgery, University of Kentucky, Lexington, Kentucky
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Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, Li ZZ, Wang H, Zhang H, Lin ZF, Lu JH, Yang T. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc 2014; 29:1384-93. [PMID: 25303904 DOI: 10.1007/s00464-014-3809-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
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Impact of examinees' stereopsis and near visual acuity on laparoscopic virtual reality performance. Surg Today 2014; 45:1280-90. [PMID: 25304827 DOI: 10.1007/s00595-014-1046-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Laparoscopic surgery represents specific challenges, such as the reduction of a three-dimensional anatomic environment to two dimensions. The aim of this study was to investigate the impact of the loss of the third dimension on laparoscopic virtual reality (VR) performance. METHODS We compared a group of examinees with impaired stereopsis (group 1, n = 28) to a group with accurate stereopsis (group 2, n = 29). The primary outcome was the difference between the mean total score (MTS) of all tasks taken together and the performance in task 3 (eye-hand coordination), which was a priori considered to be the most dependent on intact stereopsis. RESULTS The MTS and performance in task 3 tended to be slightly, but not significantly, better in group 2 than in group 1 [MTS: -0.12 (95 % CI -0.32, 0.08; p = 0.234); task 3: -0.09 (95 % CI -0.29, 0.11; p = 0.385)]. The difference of MTS between simulated impaired stereopsis between group 2 (by attaching an eye patch on the adominant eye in the 2nd run) and the first run of group 1 was not significant (MTS: p = 0.981; task 3: p = 0.527). CONCLUSION We were unable to demonstrate an impact of impaired examinees' stereopsis on laparoscopic VR performance. Individuals with accurate stereopsis seem to be able to compensate for the loss of the third dimension in laparoscopic VR simulations.
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No advantages of laparoscopy for left-sided malignant colonic obstruction compared with open colorectal resection in both short-term and long-term outcomes. Med Oncol 2014; 31:213. [DOI: 10.1007/s12032-014-0213-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
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Bozkurt MA, Ünsal MG, Kapan S, Kankaya B, Kalaycı MU, Alış H. Two Different Methods for Appendiceal Stump Closure: Metal Clip and Hem-o-lok Clip. J Laparoendosc Adv Surg Tech A 2014; 24:571-3. [PMID: 25007288 DOI: 10.1089/lap.2013.0543] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Mustafa Gökhan Ünsal
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Selin Kapan
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Burak Kankaya
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Uygar Kalaycı
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Halil Alış
- Department of General Surgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
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Gorter RR, Heij HA, Eker HH, Kazemier G. Laparoscopic appendectomy: State of the art. Tailored approach to the application of laparoscopic appendectomy? Best Pract Res Clin Gastroenterol 2014; 28:211-24. [PMID: 24485267 DOI: 10.1016/j.bpg.2013.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/23/2013] [Indexed: 02/07/2023]
Abstract
Acute appendicitis is the most common surgical emergency in developed countries. The treatment of acute appendicitis is either open or laparoscopic appendectomy. The latter has gained wide acceptance in the past years, although the debate on the true merits of laparoscopic appendectomy is still on going. Some authors prefer this approach as the gold standard for all patients, but in our opinion a tailored approach is warranted for specific patient groups. In addition, a standardised guideline on the technical aspects is still lacking. In the current article, open versus laparoscopic appendectomy and several technical aspects, such as stump closure, appendix extraction and single incision are discussed laparoscopic appendectomy are being addressed. In the future perspectives we will briefly discuss the third 'newly' introduced antibiotic treatment.
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Affiliation(s)
- Ramon R Gorter
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands; Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands.
| | - Hugo A Heij
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC & VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, Red Cross Hospital, Vondellaan13, 1942 LE Beverwijk, The Netherlands; Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
| | - Geert Kazemier
- Department of Surgery, VU University Medical Centre, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands.
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Gravante G, Yahia S, Sorge R, Mathew G, Kelkar A. Back to basics: A meta-analysis of stump management during open appendicectomy for uncomplicated acute appendicitis. World J Surg Proced 2013; 3:47-53. [DOI: 10.5412/wjsp.v3.i3.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 09/02/2013] [Accepted: 09/17/2013] [Indexed: 02/07/2023] Open
Abstract
AIM: To compare simple ligation vs stump invagination during open appendicectomy for uncomplicated acute appendicitis on the risk of postoperative complications.
METHODS: A meta-analysis was conducted on randomised controlled trials comparing the two stump closure methods in open appendicectomy. Databases searched were PubMed, EMBASE and Cochrane Library databases. Included were those studies focusing on inflamed and suppurative appendicitis while perforated and gangrenous appendix was excluded. We also excluded retrospective case-control studies, commentaries, historical technical articles, or trials involving laparoscopic appendicectomies. The outcome of the meta-analysis was to find eventual differences in the incidence of postoperative ileus and wound infections between the two techniques of stump invagination.
RESULTS: Seven studies were included corresponding to 1468 patients. Postoperative complications consisted in wound infections (7%), ileus (4%), pyrexia (2%), vomiting (1%), obstructions from adhesions (0.1%). No cases of peritonitis, fecal fistulas (stump leaks), abdominal abscesses or wound dehiscences were reported. Postoperative ileus within the first 72 h was four times more frequent with stump invagination compared to simple ligation (OR: 4.06; 95%CI: 2.14-7.70; P < 0.0001). No significant differences were noted for wound infections (OR: 1.24; 95%CI: 0.83-1.87; P = 0.30) while for the remaining complications the incidence was extremely low in both groups. There was a high homogeneity on results (Q value for heterogeneity of postoperative ileus P = 0.17; Q value for heterogeneity of wound infections P = 0.98).
CONCLUSION: Stump invagination does not seem to prevent infective complications but is associated with an increased risk of postoperative ileus in uncomplicated cases. Appropriate studies on complicated appendicitis should now evaluate the influence of the two techniques in this higher-risk subgroup.
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Lima GJDS, Silva ALD, Leite RFG, Abras GM, Castro EG, Pires LJS. Transumbilical laparoscopic assisted appendectomy compared with laparoscopic and laparotomic approaches in acute appendicitis. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:2-8. [PMID: 22569970 DOI: 10.1590/s0102-67202012000100002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Acute appendicitis is the most common cause of acute abdominal surgery. Despite nearly three decades comparing laparoscopic with laparotomic appendectomy, the available scientific evidence does not show consensus of opinion about the best access for the treatment of acute appendicitis. The transumbilical laparoscopic assisted appendectomy combines the advantages of laparoscopic access to the simplicity of the laparotomic technique. AIM To compare the three technical advantages showing possible tendency to transumbilical laparoscopic assisted appendectomy. METHODS This is a retrospective study comparing three series with 1232 patients. Variables were: operative time, hospital stay, early and late postoperative complications, postoperative pain and earlier return to daily activities. RESULTS The averaged surgical time was 59.8 min in laparotomic appendectomy, 75.5 min in laparoscopic appendectomy and 51,7 min in transumbilical laparoscopic assisted appendectomy with significant difference. The incidence of postoperative pain, general complications and wound infection were greater in the group submitted to laparotomic appendectomy. The earlier return to daily activities and short hospital stay were observed in groups laparoscopic appendectomy and transumbilical laparoscopic assisted appendectomy. CONCLUSION The effectiveness and safety of transumbilical laparoscopic assisted appendectomy can make this technique the preferred choice in the initial management of patients with acute appendicitis.
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Hughes MJ, Harrison E, Paterson-Brown S. Post-Operative Antibiotics after Appendectomy and Post-Operative Abscess Development: A Retrospective Analysis. Surg Infect (Larchmt) 2013; 14:56-61. [PMID: 23427791 DOI: 10.1089/sur.2011.100] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Michael J. Hughes
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ewen Harrison
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Simon Paterson-Brown
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Risk of perforation increases with delay in recognition and surgery for acute appendicitis. THE JOURNAL OF SURGICAL RESEARCH 2013. [PMID: 23290595 DOI: 10.1016/j.jss.2012.12.008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Appendicitis remains a common indication for urgent surgical intervention in the United States, and early appendectomy has long been advocated to mitigate the risk of appendiceal perforation. To better quantify the risk of perforation associated with delayed operative timing, this study examines the impact of length of inpatient stay preceding surgery on rates of perforated appendicitis in both adults and children. METHODS This study was a cross-sectional analysis using the National Inpatient Sample and Kids' Inpatient Database from 1988-2008. We selected patients with a discharge diagnosis of acute appendicitis (perforated or nonperforated) and receiving appendectomy within 7 d after admission. Patients electively admitted or receiving drainage procedures before appendectomy were excluded. We analyzed perforation rates as a function of both age and length of inpatient hospitalization before appendectomy. RESULTS Of 683,590 patients with a discharge diagnosis of appendicitis, 30.3% were recorded as perforated. Over 80% of patients underwent appendectomy on the day of admission, approximately 18% of operations were performed on hospital days 2-4, and later operations accounted for <1% of cases. During appendectomy on the day of admission, the perforation rate was 28.8%; this increased to 33.3% for surgeries on hospital day 2 and 78.8% by hospital day 8 (P<0.001). Adjusted for patient, procedure, and hospital characteristics, odds of perforation increased from 1.20 for adults and 1.08 for children on hospital day 2 to 4.76 for adults and 15.42 for children by hospital day 8 (P<0.001). CONCLUSIONS Greater inpatient delay before appendectomy is associated with increased perforation rates for children and adults within this population-based study. These findings align with previous studies and with the conventional progressive pathophysiologic appendicitis model. Randomized prospective studies are needed to determine which patients benefit from nonoperative versus surgically aggressive management strategies for acute appendicitis.
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Papandria D, Goldstein SD, Rhee D, Salazar JH, Arlikar J, Gorgy A, Ortega G, Zhang Y, Abdullah F. Risk of perforation increases with delay in recognition and surgery for acute appendicitis. J Surg Res 2012; 184:723-9. [PMID: 23290595 DOI: 10.1016/j.jss.2012.12.008] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/19/2012] [Accepted: 12/06/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Appendicitis remains a common indication for urgent surgical intervention in the United States, and early appendectomy has long been advocated to mitigate the risk of appendiceal perforation. To better quantify the risk of perforation associated with delayed operative timing, this study examines the impact of length of inpatient stay preceding surgery on rates of perforated appendicitis in both adults and children. METHODS This study was a cross-sectional analysis using the National Inpatient Sample and Kids' Inpatient Database from 1988-2008. We selected patients with a discharge diagnosis of acute appendicitis (perforated or nonperforated) and receiving appendectomy within 7 d after admission. Patients electively admitted or receiving drainage procedures before appendectomy were excluded. We analyzed perforation rates as a function of both age and length of inpatient hospitalization before appendectomy. RESULTS Of 683,590 patients with a discharge diagnosis of appendicitis, 30.3% were recorded as perforated. Over 80% of patients underwent appendectomy on the day of admission, approximately 18% of operations were performed on hospital days 2-4, and later operations accounted for <1% of cases. During appendectomy on the day of admission, the perforation rate was 28.8%; this increased to 33.3% for surgeries on hospital day 2 and 78.8% by hospital day 8 (P<0.001). Adjusted for patient, procedure, and hospital characteristics, odds of perforation increased from 1.20 for adults and 1.08 for children on hospital day 2 to 4.76 for adults and 15.42 for children by hospital day 8 (P<0.001). CONCLUSIONS Greater inpatient delay before appendectomy is associated with increased perforation rates for children and adults within this population-based study. These findings align with previous studies and with the conventional progressive pathophysiologic appendicitis model. Randomized prospective studies are needed to determine which patients benefit from nonoperative versus surgically aggressive management strategies for acute appendicitis.
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Affiliation(s)
- Dominic Papandria
- Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Analysis of intracorporeal knotting with invaginating suture versus endoloops in appendiceal stump closure. Wideochir Inne Tech Maloinwazyjne 2012; 8:69-73. [PMID: 23630557 PMCID: PMC3627155 DOI: 10.5114/wiitm.2011.31535] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/08/2012] [Accepted: 09/24/2012] [Indexed: 11/24/2022] Open
Abstract
Introduction Laparoscopic appendectomy is a well-described surgical technique and has gained wide clinical acceptance. Laparoscopic appendectomy offers fewer wound infections, faster recovery and an earlier return to work in comparison to open surgery. However, concerns still exist regarding the appendiceal stump closure. Aim The aim of this study was to compare the overall incidence and specific intraoperative and postoperative complications after application of intracorporeal knotting with invaginating suture versus endoloops for stump closure in laparoscopic appendectomy. Material and methods One hundred fifty two consecutive patients according to the following inclusion criteria were included in the study: 1. Laparoscopic appendectomy was performed during the study period; 2. Acute phlegmonous or gangrenous appendicitis without perforation was diagnosed during operation. Exclusion criteria - patients with acute perforated appendicitis and local or diffuse peritonitis. Data was grouped according to the appendiceal stump closure technique, with either endoloops – 112 patients (73.7 percent) or intracorporeal knotting with invaginating suture – 40 patients (26.3 per cent). The primary outcome measure was the rate of intraabdominal surgical-site infection, defined as post-operative intra-abdominal abscess. Secondary outcome variables were intraoperative and postoperative complications, duration of operation, hospital stay. Results There were no significant differences between the two groups in overall intraoperative and postoperative complications rate and in hospital stay. The median duration of operation was significantly shorter when the endoloop was used. The use of intracorporeal knotting with invaginating suture instead of endoloop to close the appendiceal stump decreased the total cost of laparoscopic appendectomy. Conclusions According our study results, intracorporeal knotting with invaginating suture appendiceal stump closure technique is acceptable laparoscopic procedure, which intraoperative and postoperative results do not differ from endoloops technique. The total cost of this procedure is 80 € cheaper then endoloops technique.
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Lee HJ, Park YH, Kim JI, Choi PW, Park JH, Heo TG, Lee MS, Kim CN, Chang SH. Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:321-5. [PMID: 22148124 PMCID: PMC3229000 DOI: 10.4174/jkss.2011.81.5.321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/03/2011] [Accepted: 08/19/2011] [Indexed: 01/06/2023]
Abstract
PURPOSE Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
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Affiliation(s)
- Ho Jun Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Lee HJ, Park YH, Kim JI, Choi PW, Park JH, Heo TG, Lee MS, Kim CN, Chang SH. Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [PMID: 22148124 DOI: 10.4174/jkss.2011.81.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.
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Affiliation(s)
- Ho Jun Lee
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea
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