Late caecal fistula after laparoscopic appendectomy managed mini-invasively - case report

Is laparoscopic appendectomy going to be standard procedure for acute appendicitis; a 5-year single center experience with 1,788 patients

PURPOSE

To evaluate whether laparoscopic appendectomy can be the gold standard for acute appendicitis regarding the applicability and cost effectivity.

MATERIALS AND METHODS

The study included patients who were operated by laparoscopically for acute appendicitis between January 2008 and September 2012. Patients' sex, ages, hospitalization time, the type for closure of the appendiceal stump, complication rate, surgery time and other parameters were recorded.

RESULTS

1,788 patients with acute appendicitis on laparoscopic evaluation constituted the study population. Average age of the patient group was 30.1 ± 2.3 years old. Average hospitalization time was 1.2 ± 1.1 days. Metal clips were used in 1,100 (61.5%) patients, intracorporeal knotting was performed in the remaining. Total complication rate was 3.8%.

CONCLUSION

By the using of metal clips and increased experience; laparoscopy may be gold standard for acute appendicitis.

The need for culture swabs in laparoscopically treated appendicitis

INTRODUCTION

Appendicitis remains the most common cause of an acute abdomen. Obtaining intra-abdominal cultures is routine surgical practice. There are studies showing no efficacy of such procedures in cases where open appendectomies are performed.

AIM

The goal of this study was to assess the need for obtaining intra-abdominal cultures during laparoscopic appendectomies.

MATERIAL AND METHODS

Between 2007 and 2012, 369 patients were operated on with the diagnosis of histopathologically proven acute appendicitis. Sixty-two percent of them were operated on using laparoscopic techniques. The microbiological assessment was routinely done for the open procedures and in 42% of cases that underwent a laparoscopic operation.

RESULTS

In 57% (134) the swabbing results were negative. Among 43% (102) of the patients with a positive result, Escherichia coli was isolated in 76.5% (78), Proteus mirabilis in 13.7% (14), Pseudomonas aeruginosa in 4.9% (5) and Citrobacter freundii in 4.9% (5). Five cases had bacteria resistant to the antibiotic given preoperatively (that is 4.9% of all positive cultures and 1.4% of all operated patients). However, these cases did not affect the incidence of postoperative complications. Consideration of the postoperative morbidity showed that there was no statistically significant difference between the laparoscopic group with and without intra-operative swabbing (p > 0.05).

CONCLUSIONS

The postoperative patient outcome was more dependent on the pathology of the appendix than on the results of the microbiological assessment at the time of surgery. Hence, routine intra-operative cultures during laparoscopic appendectomies appear to have little value in patient management. Swabbing during laparoscopic procedures should be limited to only selected high-risk groups.

Analysis of intracorporeal knotting with invaginating suture versus endoloops in appendiceal stump closure

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.