New strategy during complicated open appendectomy: Convert open operation to laparoscopy

Comparative Analysis of Laparoscopic Versus Open Procedures in Specific General Surgical Interventions

Laparoscopic and open surgeries are two distinct surgical approaches with significantly different procedures and outcomes. Minimally invasive surgery, also known as laparoscopic surgery, utilizes small incisions and specialized instruments like the laparoscope to perform procedures. This contrasts with open surgery, which requires larger incisions to directly access the surgical site. Open surgery was the preferred approach for any invasive procedure until the introduction of new technological advances in the form of laparoscopy. While laparoscopy is still evolving, preliminary results demonstrate promise for various operations. Open surgery provides the healthcare professional with more liberty in the form of increased visualization, but it also increases tissue damage and hospital stays. Laparoscopic and open procedures are both valuable surgical methods with advantages and disadvantages. While open surgery is favored for difficult patients, laparoscopic surgery offers a quicker recovery and fewer scars. The choice between the two approaches depends on the patient's condition, surgical demands, and the surgeon's skills. As these methods develop, they become increasingly important for offering safe and efficient surgical treatments across a range of medical specialties.

Mucosa-Coring Salvage (MU-CO-SAL) Appendicectomy: A Useful Technique in the Management of Neglected Appendicular Mass

In the presence of an appendicular mass, surgery is generally limited to the drainage of abscess. Scientific literature is sparse and controversial as to how the ongoing sepsis despite the drainage of appendicular abscess should be managed. Deliberate appendicectomy in the presence of mass formation is often not recommended as it may cause collateral damage to the adherent bowel loops. The authors describe a useful technique of doing appendicectomy by stripping the mucosa alone, leaving behind the adherent muscular cuff undisturbed. This technique is given an acronym “mucosa-coring salvage (MU-CO-SAL) appendicectomy.” This article is intended to draw the attention of pediatric surgeons to this useful technique, which remains underutilized despite being described almost a decade ago.

Variations and morphometric features of the vermiform appendix: A systematic review and meta-analysis of 114,080 subjects with clinical implications

Determining the true and indisputable data regarding the vermiform appendix (VA) morphology is of a great clinical interest. The aim of this study was to provide the best evidence-based anatomical overview of the variations in location and size of VA using a systematic and meta-analytical approach. A systematic review with meta-analysis was performed of studies reporting variants of the location and morphometric data regarding the VA. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science databases were thoroughly searched throughout June 2018. The reported locations of the body of the VA were re-classified into a new, standardized classification system divided into nine categories. The AQUA tool was used to assess the quality of included studies. The research was conducted following PRISMA guidelines and registered at PROPSERO database. Our meta-analysis included 242 studies (n = 114,080). Overall, the VA was most commonly found in the retrocecal location (32.1%, 95%CI: 29.2-35.1), followed by the pelvic (28.5%, 95%CI: 26.7-30.4) and ileal (14.5%, 95%CI: 11.8-17.7) locations. Subjects without known appendiceal pathologies had significantly smaller VA outer diameters (5.84 mm, 95%CI: 5.68-5.99) than patients diagnosed with acute appendicitis (10.64 mm, 95%CI: 10.14-11.15). The overall pooled mean length of the VA was 80.29 mm (95%CI: 76.68-83.89). Significant differences were found in size of the VA between imaging modalities. The results obtained from this evidence-based anatomy study will improve the clinical understanding of the VA anatomy, which in turn will have major implications for clinical practice. Clin. Anat. 32:85-98, 2019. © 2019 Wiley Periodicals, Inc.

A study on evaluation of laparoscopic surgical approach for pediatric appendix abscess

BACKGROUND

The main objective of this study was to investigate and compare chosen time laparoscopic surgery to traditional open surgery and to analyze whether laparoscopic surgery is safe and feasible for pediatric appendix abscess in emergency.

METHODS

This retrospective study consisted of three groups of patients designated as group A, group B, group C and the preoperative and postoperative clinical characteristics were analyzed and compared. Group A comprised of 63 patients of appendix abscess which has been treated by laparoscopic surgery from January 2011 to December 2014. Group B comprised of 60 patients who had undergone pediatric appendix abscess laparotomy and group C comprised of 35 cases who had undergone time-selective laparoscopic appendix ablation surgery after receiving anti-inflammatory treatment.

RESULTS

The average operation time during which all the appendix ablated successfully between group A and group B patients was not significantly different (P>0.05), meanwhile, operation time was significantly less for group C patients in comparison with group A patients (P<0.05). The incidence of postoperative complications among patients of group A was significantly lower than that of group B (P<0.05), while, these complications were similarly distributed between group A and group C (P>0.05). The duration of hospitalization among patients of group B (P<0.05) and group C (P<0.05) was significantly higher in comparison with group A patients.

CONCLUSIONS

As long as preoperative and perioperative periods are appropriately dealt with, laparoscopic surgery is safe and feasible to pediatric appendix abscess in emergency.