1
|
Dohner E, Kierdorf FJ, Langer R, Zuber M, Fahrner R. Retrospective analysis of the incidence of appendiceal neoplasm and malignancy in patients treated for suspected acute appendicitis. BMC Surg 2024; 24:121. [PMID: 38658891 PMCID: PMC11040831 DOI: 10.1186/s12893-024-02412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Nonoperative management of uncomplicated appendicitis is currently being promoted as treatment option, albeit 0.7-2.5% of appendectomies performed due to suspected acute appendicitis show histologically malignant findings. The purpose of this study was to investigate the incidence of neoplasm and malignancy of the appendix in patients presenting with suspected acute appendicitis in real world setting. METHODS This is a retrospective single-centre investigation of 457 patients undergoing appendectomy between the years 2017-2020. The patients' demographics, symptoms and diagnosis, intraoperative findings, and histopathological results were analysed. RESULTS In 3.7% (n = 17) histological analysis revealed neoplasms or malignancies. Median age was 48 years (20-90 years), without sex predominance. Leukocytes (11.3 ± 3.7 G/l) and C-reactive protein (54.2 ± 69.0 mg/l) were elevated. Histological analysis revealed low-grade mucinous appendiceal neoplasia (n = 3), sessile serrated adenoma of the appendix (n = 3), neuroendocrine tumours (n = 7), appendiceal adenocarcinoma of intestinal type (n = 3), and goblet cell carcinoma (n = 1). Additional treatment varied between no treatment or follow-up due to early tumour stage (n = 4), follow-up care (n = 3), additional surgical treatment (n = 8), or best supportive care (n = 2). CONCLUSIONS Preoperative diagnosis of appendiceal tumours is difficult. Nonoperative management of patients with acute, uncomplicated appendicitis potentially prevents the correct diagnosis of malignant appendiceal pathologies. Therefore, close follow-up or surgical removal of the appendix is mandatory.
Collapse
Affiliation(s)
- Eliane Dohner
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | | | - Rupert Langer
- Institute of Pathology and Molecular Pathology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Markus Zuber
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland
- Clarunis University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital Basel and University Hospital, Basel, Switzerland
| | - René Fahrner
- Department of Surgery, Bürgerspital Solothurn, Solothurn, Switzerland.
- Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.
| |
Collapse
|
2
|
Gu Q, Hua Y. Perforated appendicitis treated with laparoscopic appendicectomy or open appendicectomy: A meta-analysis. J Minim Access Surg 2023; 19:348-354. [PMID: 37357489 PMCID: PMC10449044 DOI: 10.4103/jmas.jmas_158_22] [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: 06/01/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 06/27/2023] Open
Abstract
Aim This analysis compared the impact of laparoscopic appendicectomy (LA) and open appendicectomy (OA) on treating adult perforated appendicitis (PA). Methods Articles relating to LA and OA in treating PA were retrieved from databases including PubMed, Cochrane Library and Embase since their founding to January 2022. These articles were independently filtered based on the inclusion and exclusion criteria by two investigators. The quality of these articles was assessed and article data were extracted. Dichotomous data were presented in the form of odd's ratio (OR), whereas continuous data were in the form of weighted mean difference (WMD). The included articles reported at least one of the following outcomes: intra-abdominal abscess (IAA), wound infection, operative time, hospital stay and complications. Results Three randomised control trials (198 LA cases vs. 205 OA cases) and 12 case - control trials (914 LA cases vs. 2192 OA cases) were included. This analysis revealed that although the IAA formation rate was similar in the LA and OA groups (OR: 1.28, 95% confidence interval [CI]: 0.87-1.88), the wound infection rate was lower in the LA group (OR: 0.38, 95% CI: 0.28-0.51). Furthermore, LA was associated with shorter hospital stay (WMD: -1.43 days, 95% CI: -2.33--0.52) and fewer complications than OA (OR: 0.40, 95% CI: 0.28-0.57). Conclusion LA has significant benefits in treating PA and is associated with better post-operative outcomes such as shorter hospital stay, lower incidence of wound infection and other complications. However, more studies with randomised and large-sample populations are still required to determine the clinical benefit of LA in treating PA.
Collapse
Affiliation(s)
- Qianquan Gu
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Ye Hua
- Department of General Surgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| |
Collapse
|
3
|
Surabhi A, Behura A, Behera CR, Patra RK, Panda B, Mishra A, Karnati R, Mohanty S. Post-Operative Outcomes of Laparoscopic Appendectomy in Acute Complicated Appendicitis: A Single Center Study. Cureus 2023; 15:e38868. [PMID: 37303449 PMCID: PMC10257217 DOI: 10.7759/cureus.38868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is a surgical emergency because of inflammation in the appendix leading to swelling, whereas acute complicated appendicitis is characterized by a gangrenous or perforated appendix with or without periappendicular abscess, peritonitis, and an appendicular mass. The laparoscopic approach in complicated acute appendicitis is a viable alternative method but is not practiced in all cases because of technical difficulties and unpredictable complications. Thus, the present study aimed to evaluate the primary and secondary outcome predictors of laparoscopic appendectomy in complicated appendicitis. METHODS A single-center prospective observational study was carried out after the approval of the Institutional Ethics Committee (IEC). A total of 87 complicated acute appendicitis patients were included in the study. Clinico-demographic features such as age, gender, duration of surgery, post-operative pain, and hospital stay were monitored in different age groups of <20, 20-39, and >40 years, and the primary and secondary outcomes of laparoscopic surgery in acute complicated appendicitis were measured. RESULT Acute complicated appendicitis cases were observed mostly in people older than 42 years in the total study population. Laparoscopic appendectomy was conducted in all 87 acute complicated appendicitis patients, and the major surgical outcome predictors were monitored, such as mean operating time (87.9 minutes), post-operative pain (3.9 scores), and post-operative stay (6.7 days). Post-operative complications such as drain site infection (1.14%), enterocutaneous fistula (2%), and intra-abdominal abscess (7%) were observed. CONCLUSION Based on our observations, a laparoscopic appendectomy can be considered a viable alternative with an acceptable complication rate. Operative time varies from 84 to 94 minutes in different age groups and with the extent of the disease.
Collapse
Affiliation(s)
- Anurag Surabhi
- Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Aparna Behura
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Chinmay R Behera
- Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Rajat K Patra
- Department of Surgery, Kalinga Institute of Medical sciences, Bhubaneswar, IND
| | - Bandita Panda
- Department of Research and Development, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Amaresh Mishra
- Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Ranjit Karnati
- Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Subrat Mohanty
- Department of Surgery (Pediatric Surgery), Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| |
Collapse
|
4
|
Nikolovski A, Ulusoy C. Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:59-65. [PMID: 35843917 DOI: 10.2478/prilozi-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. Material and Methods: In this prospective interventional clinical study we compared the intraoperative data and the postoperative outcome of 77 patients presented with complicated appendicitis, operated with open and laparoscopic appendectomy within a period of 20 months. One surgeon performed all of the laparoscopic procedures and two other senior surgeons performed the open procedures. Results: Operative time was shorter in the laparoscopic group (p = 0.033). Conversion rate was 2.3%. Overall postoperative morbidity was 25.97%. There was one operative revision due to postoperative small bowel obstruction in the laparoscopic group. Appendicular stump leakage occurred in one patient in the open group. One intra-abdominal abscess occurred in the laparoscopic group (p = 0.38). Wound infection occurred only in the open group (p = 0.018). Length of stay was shorter in the laparoscopic group (p = 0.0052). One patient from the laparoscopic group was readmitted. Conclusions: Laparoscopy is a reliable method in the treatment of complicated appendicitis. It offers a shorter operative time, low conversion rate, an acceptable rate of major postoperative complications and a shorter length of stay.
Collapse
Affiliation(s)
- Andrej Nikolovski
- Department of Visceral Surgery, University Surgical Clinic "Sv. Naum Ohridski", University "Sv. Kiril i Metodij", Skopje, RN Macedonia
| | - Cemal Ulusoy
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, Istanbul, Turkey
| |
Collapse
|
5
|
Rasuli SF, Naz J, Azizi N, Hussain N, Qureshi PNAA, Swarnakari KM, Dost W, Zafar S, Qadar LT, Talpur AS. Laparoscopic Versus Open Appendectomy for Patients With Perforated Appendicitis. Cureus 2022; 14:e26265. [PMID: 35911350 PMCID: PMC9312283 DOI: 10.7759/cureus.26265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute appendicitis can lead to perforation which can be lethal. The present study assessed the outcomes of laparoscopic appendectomy versus open appendectomy in patients with perforated appendicitis. Methodology A comparative study was conducted at the Department of Surgery, Liaquat University of Medical & Health Sciences (LUMHS), between March 2, 2019 and July 7, 2020. The inclusion criteria consisted of a diagnosis of perforated appendicitis. Exclusion criteria consisted of intellectual disability hindering the procurement of informed consent, pediatric patients < 15 years of age, patients with an appendicular mass or abscess unsuited for laparoscopic appendectomy, severe sepsis or septic shock on presentation, and pregnant women. Patients were allocated to either open appendectomy (Group A) or laparoscopic appendectomy (Group B). The data gathering proforma recorded demographics, surgical findings, operating room (OR) time, length of inpatient care, requirement of analgesic, and any adverse events following surgery. All of the surgeries were conducted by an experienced surgical consultant with an experience of at least five years. Results A total of 85 patients were included in the laparoscopic appendectomy group, while 101 cases were included in the open appendectomy group. The use of analgesics thrice a day to manage the postoperative pain was significantly associated with the open appendectomy (p < 0.0001). Moreover, the postoperative length of hospitalization was substantially greater in patients who underwent open appendectomy than those who underwent laparoscopic procedure (p < 0.0001). Wound-related complications were considerably lower in patients who had laparoscopic appendectomy as compared to those who had open appendectomy (23.53% versus 40.5%; p = 0.013). Conclusion The length of stay was significantly lower in patients who underwent laparoscopic appendectomy. Moreover, laparoscopic appendectomy was also associated with a lower rate of wound infection postoperatively, thus giving the former an edge over the latter. Despite the finding that the postoperative pain was not considerably different between the two groups, patients who underwent open appendectomy group required significantly more painkillers to manage the postoperative pain.
Collapse
|
6
|
Laparoscopic versus open approach for diffuse peritonitis from appendicitis ethiology: a subgroup analysis from the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study. Updates Surg 2020; 72:185-191. [PMID: 32077062 DOI: 10.1007/s13304-020-00711-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 12/29/2022]
Abstract
Diffuse peritonitis represents a life-threatening complication of acute appendicitis (AA). Whether laparoscopy is a safe procedure and presents similar results compared with laparotomy in case of complicated AA is still a matter of debate. The objective of this study is to compare laparoscopic (LA) and open appendectomy (OA) for the management of diffuse peritonitis caused by AA. This is a prospective multicenter cohort study, including 223 patients with diffuse peritonitis from perforated AA, enrolled in the Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) study from February to May 2018. Two groups were created: LA = 78 patients, mean age 42.51 ± 22.14 years and OA = 145 patients, mean age 38.44 ± 20.95 years. LA was employed in 34.98% of cases. There was no statically significant difference between LA and OA groups in terms of intra-abdominal abscess, postoperative peritonitis, rate of reoperation, and mortality. The wound infection rate was higher in the OA group (OR 21.63; 95% CI 3.46-895.47; P = 0.00). The mean postoperative hospital stay in the LA group was shorter than in the OA group (6.40 ± 4.29 days versus 7.8 ± 5.30 days; P = 0.032). Although LA was only used in one-third of cases, it is a safe procedure and should be considered in the management of patients with diffuse peritonitis caused by AA, respecting its indications.
Collapse
|
7
|
Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surg Endosc 2019; 34:907-914. [PMID: 31139982 DOI: 10.1007/s00464-019-06847-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The advantages of laparoscopic appendectomy did not meet the same acceptance in the setting of perforated appendicitis as in uncomplicated appendicitis in the general surgical community. The aim of this study was to compare the clinical outcome of laparoscopic and open appendectomy in perforating appendicitis. METHODS A randomized controlled study was conducted on 126 patients presenting with perforated appendicitis. Sixty patients were subjected to laparoscopic appendectomy (LA) and 66 patients underwent traditional open appendectomy (OA). RESULTS 65 (51.6%) patients were female, and 61 (48.4%) patients were male in whom the mean age was 37.6 + 8.5 years. A significant difference was calculated in the domains of postoperative pain, less need for analgesics, hospital stay, and return to daily activities. The mean operative time was shorter in OA 94 ± 10.4 min than LA 120.6 ± 17.7 min. No statistically significant difference between both groups was detected as regard occurrence of intra-abdominal collection. CONCLUSION In view of its clinical outcomes, laparoscopy should be considered in the context of perforated appendicitis. The possibility of intra-abdominal collection should not be a barrier against the widespread practice of this surgical procedure amidst laparoscopic surgeons if adequate precautions are employed.
Collapse
|
8
|
Quah GS, Eslick GD, Cox MR. Laparoscopic appendicectomy is superior to open surgery for complicated appendicitis. Surg Endosc 2019; 33:2072-2082. [PMID: 30868324 DOI: 10.1007/s00464-019-06746-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the last three decades, laparoscopic appendicectomy (LA) has become the routine treatment for uncomplicated acute appendicitis. The role of laparoscopic surgery for complicated appendicitis (gangrenous and/or perforated) remains controversial due to concerns of an increased incidence of post-operative intra-abdominal abscesses (IAA) in LA compared to open appendicectomy (OA). The aim of this study was to compare the outcomes of LA versus OA for complicated appendicitis. METHODS A systematic literature search following PRISMA guidelines was conducted using MEDLINE, EMBASE, PubMed and Cochrane Database for randomised controlled trials (RCT) and case-control studies (CCS) that compared LA with OA for complicated appendicitis. RESULTS Data from three RCT and 30 CCS on 6428 patients (OA 3,254, LA 3,174) were analysed. There was no significant difference in the rate of IAA (LA = 6.1% vs. OA = 4.6%; OR = 1.02, 95% CI = 0.71-1.47, p = 0.91). LA for complicated appendicitis has decreased overall post-operative morbidity (LA = 15.5% vs. OA = 22.7%; OR = 0.43, 95% CI: 0.31-0.59, p < 0.0001), wound infection, (LA = 4.7% vs. OA = 12.8%; OR = 0.26, 95% CI: 0.19-0.36, p < 0.001), respiratory complications (LA = 1.8% vs. OA = 6.4%; OR = 0.25, 95% CI: 0.13-0.49, p < 0.001), post-operative ileus/small bowel obstruction (LA = 3.1% vs. OA = 3.6%; OR = 0.65, 95% CI: 0.42-1.0, p = 0.048) and mortality rate (LA = 0% vs. OA = 0.4%; OR = 0.15, 95% CI: 0.04-0.61, p = 0.008). LA has a significantly shorter hospital stay (6.4 days vs. 8.9 days, p = 0.02) and earlier resumption of solid food (2.7 days vs. 3.7 days, p = 0.03). CONCLUSION These results clearly demonstrate that LA for complicated appendicitis has the same incidence of IAA but a significantly reduced morbidity, mortality and length of hospital stay compared with OA. The finding of complicated appendicitis at laparoscopy is not an indication for conversion to open surgery. LA should be the preferred treatment for patients with complicated appendicitis.
Collapse
Affiliation(s)
- Gaik S Quah
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - Michael R Cox
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
- Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, P.O. Box 63, Penrith, NSW, 2751, Australia.
| |
Collapse
|
9
|
Shimoda M, Maruyama T, Nishida K, Suzuki K, Tago T, Shimazaki J, Suzuki S. Comparison of clinical outcome of laparoscopic versus open appendectomy, single center experience. Heliyon 2018; 4:e00635. [PMID: 29872767 PMCID: PMC5986549 DOI: 10.1016/j.heliyon.2018.e00635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/26/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Laparoscopic appendectomy (LA) is now a treatment of choice in patients with appendicitis. This study compares the treatment outcomes of LA and open appendectomies (OA) in our department. Patients and Methods From January 2006 to April 2016 a total of 185 patients underwent appendectomy at our institution. We divided the patients into two groups; LA group (LAG) and OA group (OAG). Following parameters were analyzed: age, gender, preoperative clinicolaboratory characteristics, operative factors, interval appendectomy, length of hospital stay (LHS), and surgical site infections (SSI). Results There were 93 patients in LA G and 92 in OAG. According to the Univariate analysis, there were statistically significant differences among age (p = 0.037), LHS (p = 0.0001), duration till resuming oral intake (p = 0.016), blood loss (p = 0.038), SSI ratio (p = 0.044) and CRP level (p = 0.038) between the LAG and the OAG. According to the Multivariate analysis, blood loss (p = 0.038) and LHS (p = 0.023) were significantly different between both groups. Conclusion LA was decreasing blood loss and LHS.
Collapse
Affiliation(s)
- Mitsugi Shimoda
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Tsunehiko Maruyama
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Kazuomi Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Tomoya Tago
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| | - Shuji Suzuki
- Department of Gastroenterological Surgery, Tokyo Medical University, Ibaraki Medical Center, Japan
| |
Collapse
|
10
|
Systematic Review and Meta-Analysis of Laparoscopic Versus Open Appendicectomy in Adults with Complicated Appendicitis: an Update of the Literature. World J Surg 2018; 41:3083-3099. [PMID: 28717908 DOI: 10.1007/s00268-017-4123-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS To review and compare the outcomes of laparoscopic (LA) versus open appendicectomy (OA) in complicated appendicitis in adult patients, eight years after the last literature review. METHODS The PRISMA guidelines were adhered to. Pre-defined inclusion and exclusion criteria were used to search the PubMed, Scopus and Cochrane databases and extract relevant data. Methodological and quality assessment was undertaken with outcome meta-analysis and subgroup analyses of methodological quality, type of study and year of study. Assessment of clinical and statistical heterogeneity and publication bias was conducted. RESULTS Three randomised control trials (RCTs) (154LA vs 155OA) and 23 case-control trials were included (2034LA vs 2096OA). Methodological quality was low to average but with low statistical heterogeneity. Risk of publication bias was low, and meta-regression indicated shorter length of hospital stay (LOS) in more recent studies, Q = 7.1, P = 0.007. In the combined analysis LA had significantly less surgical site infections [OR = 0.30 (0.22,0.40); p < 0.00001] with reduced time to oral intake [WMD = -0.98 (-1.09,-0.86); P < 0.00001] and LOS [WMD = -3.49(-3.70,-3.29); p < 0.00001]. There was no significant difference in intra-abdominal abscess rates [OR = 1.11(0.85,1.45); p = 0.43]. Operative time was longer during LA [WMD = 10.51 (5.14,15.87); p = 0.0001] but did not reach statistical significance (p = 0.13) in the RCT subgroup analysis. CONCLUSIONS LA appears to have significant benefits with improved morbidity compared to OA in complicated appendicitis (level of evidence II).
Collapse
|
11
|
Yu MC, Feng YJ, Wang W, Fan W, Cheng HT, Xu J. Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis. Int J Surg 2017; 40:187-197. [PMID: 28302449 DOI: 10.1016/j.ijsu.2017.03.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND laparoscopic appendectomy(LA) has proved to be a safe alternative to open appendectomy(OA) in uncomplicated appendicitis; however, the feasibility of LA for complicated appendicitis(CA) has not been conclusively determined. OBJECTIVES To assess the feasibility and safety of LA for CA through a systematic review and meta-analysis. METHODS A literature search in PubMed, Embase, Cochrane Library, and web of Science was performed for eligible studies published from the inception of the databases to January 2016. All studies comparing LA and OA for CA were reviewed. After literature selection, data extraction and quality assessment were performed by two reviewers independently, and meta-analysis was conducted using Revman software, vision 5.2. RESULTS Two randomized controlled trials (RCTs) and 14 retrospective cohort studies(RCSs) were finally identified. Our meta-analysis showed that LA for CA could reduce the rate of surgical site infections (SSIs) (OR = 0.28; 95% CI: 0.25 to0.31, P < 0.00001), but LA did not increase the rate of postoperative intra-abdominal abscess(IAA) (OR = 0.79; 95% CI: 0.45 to 1.34, P = 0.40). The results showed that the operating time in the LA groups was much longer than that in the OA groups (WMD = 13.78, 95% CI: 8.99 to 18.57, P < 0.00001). However, the length of hospital stays in the LA groups were significantly shorter than those in the OA groups (WMD = -2.47, 95%CI: -3.75 to -1.19, P < 0.0002), and the time until oral intake(TTOI) was much earlier in the LA groups than in the OA groups (WMD = -0.88, 95% CI: -1.20 to -0.55, P < 0.00001). No significant difference was observed in the times of postoperative analgesia between the two groups(P > 0.05). CONCLUSION LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.
Collapse
Affiliation(s)
- Man-Cheng Yu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
| | - Yao-Jun Feng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Wang
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Fan
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Hong-Tao Cheng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Juan Xu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| |
Collapse
|
12
|
Kim KH, Lee SC, Lee SK, Choi BJ, Jeong W, Kim SJ. Does Korea's current diagnosis-related group-based reimbursement system appropriately classify appendectomy patients? Ann Surg Treat Res 2016; 91:66-73. [PMID: 27478811 PMCID: PMC4961888 DOI: 10.4174/astr.2016.91.2.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose As several years have passed since the implementation of the Korean diagnosis-related group (DRG) payment system for appendicitis, its early outcomes should be assessed to determine if further improvements are warranted. Methods We retrospectively analyzed clinical data from Korean patients who underwent appendectomy, dividing the sample into 2 groups of those who received services before and after implementation of the DRG system. Based on the DRG code classification, patient data were collected including the amount of DRG reimbursement and the total in-patient costs. We subsequently performed univariate and multivariate analyses to identify independent factors contributing to higher total in-patient cost. Results Although implementation of the DRG system for appendicitis significantly reduced postoperative length of stay (2.8 ± 1.0 days vs. 3.4 ± 1.9 days, P < 0.001), it did not reduce total in-hospital cost. The independent factors related to total inhospital cost included patient age of 70 years or more (odds ratio [OR], 3.214; 95% confidence interval [CI], 1.769–5.840; P < 0.001) and operation time longer than 100 minutes (OR, 3.690; 95% CI, 2.007–6.599, P < 0.001). In addition, older patients (≥70 years) showed a nearly 10 times greater relative risk for having a comorbid condition (95% CI, 5.141–20.214; P < 0.001) and a 3.255 times greater relative risk for having higher total in-hospital cost (95% CI, 1.731–6.119, P < 0.001). Conclusion It appears that older patients (>70 years) have greater comorbidities, which contribute to higher inpatient costs. Thus, our study suggests that patient age be considered as a DRG classification variable.
Collapse
Affiliation(s)
- Kee-Hwan Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Kuon Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonjun Jeong
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
13
|
Horvath P, Lange J, Bachmann R, Struller F, Königsrainer A, Zdichavsky M. Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis. Surg Endosc 2016; 31:199-205. [PMID: 27194260 DOI: 10.1007/s00464-016-4957-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is now the treatment of choice in uncomplicated appendicitis. To date its importance in the treatment of complicated appendicitis is not clearly defined. METHODS From January 2005 to June 2013 a total of 1762 patients underwent appendectomy for the suspected diagnosis of appendicitis at our institution. Of these patients 1516 suffered from complicated appendicitis and were enrolled. In total 926 (61 %) underwent open appendectomy (OA) and 590 (39 %) underwent laparoscopic appendectomy (LA). The following parameters were retrospectively analyzed: age, sex, operative times, histology, length of hospital stay, 30-day morbidity focusing on occurrence of surgical site infections, intraabdominal abscess formation, postoperative ileus and appendiceal stump insufficiency, conversion rate, use of endoloops and endostapler. RESULTS A statistically significant difference in operative time was observed between the laparoscopic and the open group (64.5 vs. 60 min; p = 0.002). Median length of hospitalization was significantly shorter in the laparoscopic group (p < 0.000). Surgical site infections occurred exclusively after OA (38 vs. 0 patients). Intraabdominal abscess formation occurred statistically significantly more often after LA (2 vs. 10 patients; p = 0.002). There were no statistical significances concerning the occurrence of postoperative ileus (p = 0.261) or appendiceal stump insufficiencies (p = 0.076). CONCLUSIONS The laparoscopic approach for complicated appendicitis is a safe and feasible procedure. Surgeons should be aware of a potentially higher incidence of intraabdominal abscess formation following LA. Use of endobags , inversion of the appendiceal stump and carefully conducted local irrigation of the abdomen in a supine position may reduce the incidence of abscess formation.
Collapse
Affiliation(s)
- P Horvath
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
| | - J Lange
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - R Bachmann
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - F Struller
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - M Zdichavsky
- Department of General, Visceral and Transplant Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| |
Collapse
|
14
|
Popa D, Soltes M, Uranues S, Fingerhut A. Are There Specific Indications for Laparoscopic Appendectomy? A Review and Critical Appraisal of the Literature. J Laparoendosc Adv Surg Tech A 2015; 25:897-902. [PMID: 26575247 DOI: 10.1089/lap.2014.0624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dorin Popa
- University of Medicine and Pharmacy “Carol Davila” Bucharest, University Emergency Hospital, Bucharest, Romania
| | - Marek Soltes
- I. Chirurgicka Klinika, University of Pavol Jozef Safarik, Kosice, Slovak Republic
| | - Selman Uranues
- Section of Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abe Fingerhut
- Section of Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
- First Department of Surgery, University of Athens, Hippokration University Hospital, Athens, Greece
| |
Collapse
|
15
|
Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H. Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 2015; 30:1705-12. [PMID: 26275544 DOI: 10.1007/s00464-015-4453-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to assess whether laparoscopic appendectomy (LA) for complicated appendicitis (CA) effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with open appendectomy (OA). METHODS This single-center, randomized controlled trial was performed in the Nagoya Daini Red Cross Hospital. Patients diagnosed as having CA with peritonitis or abscess formation were eligible to participate and were randomly assigned to an LA group or an OA group. The primary study outcome was development of infectious complications, especially surgical site infection (SSI), within 30 days of surgery. RESULTS Between October 2008 and August 2014, 81 patients were enrolled and randomly assigned with a 1:1 allocation ratio (42, LA; 39, OA). All were eligible for study of the primary endpoint. Groups were well balanced in terms of patient characteristics and preoperative levels of C-reactive protein. SSI occurred in 14 LA group patients (33.3 %) and in 10 OA group patients (25.6 %) (OR 1.450, 95 % CI 0.553-3.800; p = 0.476). Overall, the rate of postoperative complications, including incisional or organ/space SSI and stump leakage, did not differ significantly between groups. No significant differences between groups were found in hospital stay, duration of drainage, analgesic use, or parameters for postoperative recovery except days to walking. CONCLUSION These results suggested that LA for CA is safe and feasible, while the distinguishing benefit of LA was not validated in this clinical trial.
Collapse
Affiliation(s)
- Yoshiro Taguchi
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
| | - Shunichiro Komatsu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.,Department of Gastroenterological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Eiji Sakamoto
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Shinji Norimizu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yuji Shingu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Hiroshi Hasegawa
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| |
Collapse
|
16
|
Yeom S, Kim MS, Park S, Son T, Jung YY, Lee SA, Chang YS, Kim DH, Han JK. Comparison of the Outcomes of Laparoscopic and Open Approaches in the Treatment of Periappendiceal Abscess Diagnosed by Radiologic Investigation. J Laparoendosc Adv Surg Tech A 2014; 24:762-9. [PMID: 25313667 DOI: 10.1089/lap.2014.0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sunchul Yeom
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Min Sung Kim
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Seulkee Park
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Taeil Son
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Yoon Young Jung
- Department of Radiology, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Seung Ah Lee
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Yeon Soo Chang
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Dong Hee Kim
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| | - Joon Kil Han
- Department of Surgery, Eulji General Hospital, Eulji University College of Medicine, Seoul, South Korea
| |
Collapse
|
17
|
Lin HF, Lai HS, Lai IR. Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 2014; 20:14338-14347. [PMID: 25339821 PMCID: PMC4202363 DOI: 10.3748/wjg.v20.i39.14338] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/18/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.
Collapse
|
18
|
Shelton JA, Brown JJS, Young JA. Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy. Ann R Coll Surg Engl 2014; 96:369-72. [PMID: 24992421 DOI: 10.1308/003588414x13946184901722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy. METHODS Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter. RESULTS During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2-86 years) and a mean C-reactive protein (CRP) level of 71 mg/l (range: 0-480 mg/l) while the LCOA group had a mean age of 46 years (range: 11-92 years) and a mean CRP level of 162 mg/l (range: 3-404 mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150 mg/l (p<0.05). CONCLUSIONS A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150 mg/l.
Collapse
|
19
|
Di Saverio S, Mandrioli M, Sibilio A, Smerieri N, Lombardi R, Catena F, Ansaloni L, Tugnoli G, Masetti M, Jovine E. A cost-effective technique for laparoscopic appendectomy: outcomes and costs of a case-control prospective single-operator study of 112 unselected consecutive cases of complicated acute appendicitis. J Am Coll Surg 2013; 218:e51-65. [PMID: 24559968 DOI: 10.1016/j.jamcollsurg.2013.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/20/2013] [Accepted: 12/03/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Salomone Di Saverio
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy; Upper GI Surgery Unit, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Matteo Mandrioli
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Andrea Sibilio
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Nazareno Smerieri
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Raffaele Lombardi
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Luca Ansaloni
- General and Emergency and Trauma Surgery, I Unit, Ospedali Riuniti, Bergamo, Italy
| | - Gregorio Tugnoli
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Michele Masetti
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| | - Elio Jovine
- Emergency and General Surgery Department, CA Pizzardi Maggiore Hospital, Bologna Local Health District, Bologna, Italy
| |
Collapse
|
20
|
A prospective randomized comparison of single-port laparoscopic procedure with open and standard 3-port laparoscopic procedures in the treatment of acute appendicitis. Surg Laparosc Endosc Percutan Tech 2013; 23:74-8. [PMID: 23386157 DOI: 10.1097/sle.0b013e3182754543] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This prospective randomized study aimed to evaluate the surgical outcomes of single-incision laparoscopic appendectomy (SILA) comparing with open appendectomy (OA) and standard 3-port laparoscopic appendectomy (SLA) in the treatment of acute appendicitis (AA). METHODS Adult patients older than 18 years presenting with AA were randomized into 3 groups to undergo OA, SLA, and SILA from September 2010 to May 2011. The groups were compared with regard of patient's characteristics, perioperative findings/complications, operative time, pain severity, analgesic requirement, time to oral tolerance and flatus, length of hospital stay, and cosmetic results. RESULTS A total of 75 consecutive patients enrolled in the study. Each group included 25 patients. The groups showed no significant differences in patient's characteristics. The mean operative time was significantly longer in SILA than OA with a mean difference of 7 minutes (P < 0.05). Postoperative pain after OA were significantly higher than SLA and SILA (P < 0.05). The average time to oral tolerance and flatus was significantly higher in OA than the laparoscopic groups with a mean difference of 1 and 2.5 hours (P = 0.04 and 0.023, respectively). The length of hospital stay in SLA and SILA was significantly lower than OA with a mean difference of 0.8 days (P < 0.05). There was no difference in overall complications between the groups. There was no difference between SLA and SILA in terms of surgical outcomes. CONCLUSIONS Either SLA or SILA offer patients faster recovery period with acceptable complications than OA. Hence, laparoscopic approach might be considered as first option in the treatment of AA. However, all 3 techniques provide equivalent clinical outcomes despite the significant findings. Therefore, technique selection is based on surgeon's decision, experience, and availability of laparoscopic instruments.
Collapse
|
21
|
Mohamed AA, Mahran KM. Laparoscopic appendectomy in complicated appendicitis: Is it safe? J Minim Access Surg 2013; 9:55-8. [PMID: 23741109 PMCID: PMC3673574 DOI: 10.4103/0972-9941.110963] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/24/2012] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Because of lack of good evidence supporting laparoscopic approach for complicated appendicitis, we carried out this study to evaluate efficacy of laparoscopic appendectomy (LA) in management of patients with complicated appendicitis. MATERIALS AND METHODS This study was carried out in Surgical Department, Minia University, Egypt involving 214 patients underwent appendectomy for complicated appendicitis over three years. 132 patients underwent LA and remaining 82 patients underwent OA. Parameters studied included operating time, return to oral feeding, postoperative pain, wound infection, intra-abdominal abscess, duration of abdominal drainage and hospital stay. RESULTS There were four conversions, two due to extensive cecal adhesions and two due to friable appendix. LA took longer time to perform (p = 0.0002) but with less use of analgesics (p < 0.0001), shorter hospital stay (p < 0.0001), shorter duration of abdominal drainage (p < 0.0001) and lower incidence of wound infection (p = 0.0005). Nine patients in LA and seven patients in OA group developed intra-abdominal abscess treated successfully with sonographic guided percutaneous drainage. Postoperative ileus was recorded in two patients in LA group and three patients in OA group, chest infection in one patient in OA group, hernia in one patient in LA and fecal fistula was present in one patient in OA. Overall complications were significantly lower in laparoscopy group and managed conservatively with no mortality in either group. CONCLUSIONS LA in complicated appendicitis is feasible and safe with lower incidence of complications than OA and should be the initial choice for all patients with complicated appendicitis.
Collapse
Affiliation(s)
- Ashraf A Mohamed
- Department of General Surgery, Minia University Hospital, Minia City, Egypt
| | - Khaled M Mahran
- Department of General Surgery, Minia University Hospital, Minia City, Egypt
| |
Collapse
|
22
|
Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 2013; 27:2928-33. [PMID: 23443482 DOI: 10.1007/s00464-013-2858-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of laparoscopy in the setting of perforated appendicitis remains controversial. A retrospective study was conducted to evaluate the early postoperative outcomes of laparoscopic appendectomy (LA) compared to open appendectomy (OA) in patients with perforated appendicitis. METHODS A total of 1,032 patients required an appendectomy between January 2005 and December 2009. Among these patients, 169 presented with perforated appendicitis. Operation times, length of hospital stay, overall complication rates within 30 days, and surgical site infection (SSI) rates were analyzed. RESULTS Out of the 169 evaluated patients, 106 required LA and 63 OA. Although operation times were similar in both groups (92 ± 31 min for LA vs. 98 ± 45 for OA, p = 0.338), length of hospital stay was shorter in the LA group (6.9 ± 3.8 days vs. 11.5 ± 9.2, p < 0.001). Overall complication rates were significantly lower in the LA group (32.1 vs. 52.4 %, p < 0.001), as were incisional SSI (1.9 vs. 22.2 %, p < 0.001). Organ/space SSI rates were similar in both groups (23.6 % after LA vs. 20.6 % after OA, p = 0.657). CONCLUSIONS For perforated appendicitis, LA results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to OA. Organ/space SSI rates were similar for both procedures. LA provides a safe option for treating patients with perforated appendicitis.
Collapse
|
23
|
Fahrner R, Schöb O. Laparoscopic appendectomy as a teaching procedure: experiences with 1,197 patients in a community hospital. Surg Today 2012; 42:1165-9. [PMID: 22426772 DOI: 10.1007/s00595-012-0163-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 09/12/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE Since laparoscopic procedures have become more common, resident surgeons have to learn complex laparoscopic skills at an early stage of their career. The aim of this study was to compare the short-term clinical outcome parameters of laparoscopic appendectomy (LA) performed by resident surgeons (RS) or attending surgeons (AS). METHODS A total of 1197 LA and 57 open appendectomies were performed in a Swiss community hospital between 1999 and 2009. RS performed 684 operations. Parameters including the duration of the operation and hospital stay, intraoperative complications, surgical reinterventions, and a 30-day morbidity and mortality were observed. RESULTS The mean age of the patients was 35.6 ± 18.17 years. The duration of the operation was longer (61.34 ± 25.73 min [RS] vs. 53.65 ± 29.89 [AS] min; p = 0.0001), but the hospital stay was shorter, in patients treated by RS (3.92 ± 2.61 days [RS] vs. 4.87 ± 3.23 [AS] days; p = 0.0001). The rate of intraoperative complications was not significantly different between the two groups (1.02 % [RS] vs. 0.8 % [AS]; p = 0.6). The need for surgical reintervention (0.6 % [RS] vs. 2.5 % [AS]; p = 0.005) and the 30-day morbidity were higher in patients treated by AS (3.7 % [AS] vs. 1.8 % [RS]; p = 0.04). There was no postoperative mortality. CONCLUSIONS Under appropriate supervision, surgical residents are able to perform LA with results comparable to those of experienced surgeons.
Collapse
Affiliation(s)
- René Fahrner
- Department of Surgery, Spital Limmattal, 8952 Schlieren, Switzerland.
| | | |
Collapse
|
24
|
Comparison of outcomes of laparoscopic and open appendectomy in management of uncomplicated and complicated appendicitis. Ann Surg 2012; 254:927-32. [PMID: 21804381 DOI: 10.1097/sla.0b013e31822aa8ea] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have demonstrated the superiority of the laparoscopic approach in uncomplicated and complicated appendicitis with conflicting results. As a result the role of laparoscopy in the management of appendicitis in general and complicated or perforated appendicitis, in particular, is still undefined. METHODS A retrospective, observational study design was used to analyze multicenter outcomes using the University HealthSystem Consortium database. A 3-year discharge data of all open appendectomy (OA) and laparoscopic appendectomy (LA) procedures from 2006 to 2008 in adult patients older than 18 years for complicated or uncomplicated appendicitis was accessed using International Classification of Diseases, Ninth Revision codes. Data on several surgical outcome measures such as observed mortality, overall patient morbidity, intensive care unit admission rate, 30-day readmission rate, length of hospital stay, and hospital costs were collected from the University HealthSystem Consortium database. Stratification by University HealthSystem Consortium-specific severity of illness groups and disease diagnosis of complicated or perforated and uncomplicated appendicitis was performed. RESULTS A total of 40,337 appendectomy procedures performed during 2006 to 2008 in adult patients were included in the study. Laparoscopic appendectomy for uncomplicated appendicitis resulted in significantly better surgical outcomes. However, surprisingly, these outcomes resulted in comparable but not significantly reduced hospital costs (7825 ± 6,009 for LA vs 7841 ± 13,147 for OA; P > 0.05). Laparoscopic appendectomy for complicated or perforated appendicitis showed lower mortality, reduced overall morbidity (17.43% for LA vs 26.68% for OA; P < 0.001), relatively less 30-day readmission rate, fewer intensive care unit admissions, significantly shorter length of hospital stay (4.34 ± 4.84 days for LA vs 7.31 ± 9.43 for OA; P < 0.001), and reduced hospital costs (12,125 ± 14,430 for LA vs 17,594 ± 28,065 for OA; P < 0.001) compared with patients undergoing OA. On stratification for severity of illness in both complicated and uncomplicated appendicitis, laparoscopic appendectomy resulted in a greater or comparable clinical benefit than open appendectomy. Comparable clinical benefit was observed in minor severity patients and moderate and major/extreme severity patients showed vastly improved surgical outcomes with the laparoscopic approach. CONCLUSIONS Laparoscopic appendectomy is superior or comparable to open appendectomy in terms of several surgical outcome measures for both uncomplicated and complicated appendicitis, across most illness severity groups. Thus, laparoscopic appendectomy may be the preferred technique, irrespective of appendicitis diagnosis or disease severity.
Collapse
|
25
|
Lim SG, Ahn EJ, Kim SY, Chung IY, Park JM, Park SH, Choi KW. A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:293-7. [PMID: 22259744 PMCID: PMC3259425 DOI: 10.3393/jksc.2011.27.6.293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/27/2011] [Indexed: 02/07/2023]
Abstract
Purpose Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA. Methods We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed. Results There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 ± 1.2 vs. 3.5 ± 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 ± 2.3 vs. 5.8 ± 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028). Conclusion The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.
Collapse
Affiliation(s)
- Sun Gu Lim
- Department of Surgery, National Medical Center, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
26
|
Markides G, Subar D, Riyad K. Laparoscopic versus open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis. World J Surg 2010; 34:2026-40. [PMID: 20549210 DOI: 10.1007/s00268-010-0669-z] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The goal of the present study was to critically review and identify the strength of available evidence in the literature on the use of laparoscopic appendectomy (LA) in complicated appendicitis (CA). METHODS The Cochrane Library and Controlled Trials Registry, MEDLINE (Ovid), PubMed, Web of knowledge, and SCOPUS databases were electronically searched, using the keywords "appendectomy," "laparoscopy," "appendicitis." "complicated appendicitis." "gangrenous appendicitis," "perforated appendicitis," with English language as a limit. Backward chaining was also employed. The NHS Public Health Resource Unit Critical Appraisal Skills Programme Tools were used for critical appraisal. RESULTS Twelve retrospective case-control studies were included in the review. Overall methodological quality was moderate to poor, with heterogeneity, absence of randomization and blinding, and presence of important methodological flaws. Meta-analysis showed that LA in CA has reduced surgical site infection (SSI) rates compared to open appendectomy (OA), odds ratio (OR) 0.23, 95% confidence intervals (CI): 0.14-0.37 (level 3a evidence), and no difference with regard to intra-abdominal abscess (IAA) complication rates OR: 1.02, 95% CI 0.56-1.86 (level 3a evidence). CONCLUSIONS When compared to OA, laparoscopic appendectomy is advantageous in CA with regard to SSIs, with no significant additional risk of IAA (level 3a evidence).
Collapse
|
27
|
Allemann P, Probst H, Demartines N, Schäfer M. Prevention of infectious complications after laparoscopic appendectomy for complicated acute appendicitis--the role of routine abdominal drainage. Langenbecks Arch Surg 2010; 396:63-8. [PMID: 20830485 DOI: 10.1007/s00423-010-0709-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/12/2010] [Indexed: 12/11/2022]
Abstract
PURPOSE Complicated acute appendicitis is still associated with an increased morbidity. If laparoscopy has been accepted as a valid approach, some questions remain concerning intra-abdominal abscess formation. Routine prophylactic drainage of the abdomen has been proposed. However, this practice remains a matter of debate, poorly validated in the literature. With the present study, we investigated the impact of drainage in laparoscopic appendectomy for complicated appendicitis. METHOD This is a case match study of consecutive patients operated on by laparoscopy in a single institution. One hundred and thirty patients operated for complicated appendicitis (local peritonitis without perforation, with perforation, or with periappendicular abscess) with prophylactic intraperitoneal drainage were matched one by one to 130 patients operated without drainage. Uncomplicated appendicitis and generalized peritonitis were excluded. Primary endpoint was surgical complications and secondary endpoints were transit recovery time and length of hospital stay. RESULTS Patients without drain had significantly less overall complications (7.7% vs. 18.5%, p = 0.01). Moreover, the absence of drainage was of significant benefit for transit recovery time (2.5 vs. 3.5 days, p = 0.0068) and length of hospital stay (4.2 vs. 7.3 days, p < 0.0001). CONCLUSION No benefits were observed for prophylactic drainage of the abdominal cavity during emergency laparoscopic treatment of complicated appendicitis. For this reason, this practice may be abandoned.
Collapse
Affiliation(s)
- Pierre Allemann
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | | | | | | |
Collapse
|
28
|
Gurrado A, Faillace G, Bottero L, Frola C, Stefanini P, Piccinni G, Longoni M. Laparoscopic appendectomies: experience of a surgical unit. MINIM INVASIV THER 2010; 18:242-7. [PMID: 20334502 DOI: 10.1080/13645700903053840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Appendicitis is one of the most common causes of acute abdomen in adults and appendectomy is the most common emergency abdominal procedure. Laparoscopic appendectomy has gained popularity only in recent years and the optimal approach for the treatment of acute appendicitis is still under debate. This retrospective study aimed at examining the current indications for laparoscopic appendectomy. 1024 patients undergoing laparoscopic appendectomy between February 1992 and December 2007 were retrospectively reviewed. 39.9% of patients (n=408) underwent emergency surgery. In 616 cases (60.1%) conservative management was performed in vain and these patients underwent an elective operation. In the 36 patients with an intraoperative normal appendix, other pathological findings were laparoscopically detected and treated. Conversion to an open procedure was required for 13 (1.3%) cases. The mean operative time was 38 min and the average length of postoperative hospitalization was 2.5 days. The overall morbidity rate was 2.6%. Laparoscopic appendectomy should be considered a procedure of choice for the treatment of non-complicated appendicitis. We stress the possibility to laparoscopically treat even complicated appendicitis in the surgical setting with substantial experience in minimally invasive surgery.
Collapse
Affiliation(s)
- Angela Gurrado
- Department of Applications in Surgery of Innovative Technologies, University Medical School of Bari, Italy.
| | | | | | | | | | | | | |
Collapse
|
29
|
Tuggle KRM, Ortega G, Bolorunduro OB, Oyetunji TA, Alexander R, Turner PL, Chang DC, Cornwell EE, Fullum TM. Laparoscopic versus open appendectomy in complicated appendicitis: a review of the NSQIP database. J Surg Res 2010; 163:225-8. [PMID: 20599209 DOI: 10.1016/j.jss.2010.03.071] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 03/11/2010] [Accepted: 03/30/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) has been an established treatment method for uncomplicated acute appendicitis. Controversy still exits regarding the superiority of either laparoscopic or open technique for the treatment of complicated appendicitis. OBJECTIVE To examine for benefits in postoperative morbidity comparing laparoscopic versus open appendectomy for complicated appendicitis. METHODS A retrospective analysis was performed using the American College of Surgeon's National Surgical Quality Improvement Project (ACS-NSQIP) dataset between 2005 and 2007. Inclusion criteria were patients undergoing either open or laparoscopic appendectomy, and had complicated appendicitis. Patients with negative appendectomies and age less than 18 y old were excluded. The primary outcome variable was postoperative complications. Multivariate analysis was performed adjusting for demographics and standard NSQIP comorbidities. RESULTS We identified 2,790 complicated appendicitis cases treated with laparoscopic or open appendectomy. The majority were male (56.6%), White (70.3%), and 39.1% were younger than 40 y of age. On unadjusted analyses, the mean length of stay was significantly shorter for LA cases (3.97 d) than OA cases (5.13 d) (P < 0.001). On multivariate analysis, superficial surgical site infection was 70% less likely to occur in LA (OR 0.304 P = 0.000), organ space infection was 2-fold more likely to occur in LA (OR 2.19 P = 0.003), and dehiscence was 78% less likely to occur in LA (OR 0.22 P = 0.015). CONCLUSION In cases of complicated appendicitis, laparoscopic appendectomy is superior in terms of superficial and deep wound infections; however, it is associated with an increased incidence of postoperative intra-abdominal abscess.
Collapse
|
30
|
Lin YY, Shabbir A, So JBY. Laparoscopic appendectomy by residents: evaluating outcomes and learning curve. Surg Endosc 2010; 24:125-30. [PMID: 19760332 DOI: 10.1007/s00464-009-0691-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 05/01/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is being performed increasingly, worldwide. To the resident, it provides a valuable opportunity to master basic laparoscopic skills. Studies have shown that laparoscopic appendectomy performed by residents is safe. However, to date, there is no clear evidence for the minimum number of these operations required to achieving proficiency and safety. The aim of this study is to assess the outcome of laparoscopic appendectomies performed by surgical residents and to evaluate the effect of learning curve on patient outcome. METHODS All patients undergoing laparoscopic appendectomies performed by six residents during the study period were reviewed. Data on patient demographics,clinical and histological diagnosis, and outcome variables including operative duration, conversion to open surgery, complications, and length of stay were analyzed. We evaluated the effect of the learning curve by dividing patients into two groups: a first group consisting of the initial 20 patients and a second group consisting of the next 20 patients operated upon independently by each resident. Variables were analyzed to determine any difference between the two groups. RESULTS Three hundred six patients with the clinical diagnosis of acute appendicitis underwent laparoscopic appendectomy by residents. Mean operative time was 83.8 min. Of patients, 14.6% required conversion to open surgery. Mean length of hospitalization was 2.82 days. Operative duration and complication rate were significantly reduced with increasing experience of residents. The length of hospital stay and conversion rate to open surgery remained unchanged. CONCLUSION Operative duration and complications can be reduced with increasing experience of a resident.
Collapse
Affiliation(s)
- Yap Yan Lin
- Department of Surgery, National University Hospital, Singapore, Singapore
| | | | | |
Collapse
|
31
|
Park HC, Yang DH, Lee BH. The laparoscopic approach for perforated appendicitis, including cases complicated by abscess formation. J Laparoendosc Adv Surg Tech A 2010; 19:727-30. [PMID: 19792868 DOI: 10.1089/lap.2009.0196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the laparoscopic approach for perforated appendicitis is commonly performed, there is some controversy over its use because of postoperative complications. These may be associated with various types of disease entities, from gangrenous change to diffuse peritonitis with abscess formation. The aim of the present study was to evaluate the safety and benefits of the laparoscopic approach for perforated appendicitis, including cases complicated by abscess, compared to open. MATERIALS AND METHODS A total of 1747 patients underwent treatment for appendicitis over a period of 3 years. The diagnosis of perforated appendicitis was made by radiology, operative finding, and pathology. Of our five attending surgeons, three performed open surgery for perforated appendicitis, while two performed laparoscopy. RESULTS There were 474 patients (27%) with perforated appendicitis without abscess (156 underwent laparoscopy, 318 underwent open) and 113 patients (6.4%) with perforated appendicitis and abscess (44 underwent laparoscopy, 69 underwent open). The duration for resumption of diet and hospital stay was shorter in the laparoscopy group than in the open group. There were no significant differences in postoperative complications between patients who had no abscess with laparoscopy and those with open: 5 intra-abdominal abscesses and 10 wound infections versus 11 intra-abdominal abscesses and 25 wound infections (P = 0.88, 0.12), and between patients who had abscesses with laparoscopy and those with open: 4 intra-abdominal abscesses and 3 wound infections versus 6 intra-abdominal abscesses and 6 wound infections (P = 0.94, 0.72). CONCLUSIONS The laparoscopic approach may be a safe, effective treatment for perforated appendicitis, even in the presence of an abscess.
Collapse
Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea.
| | | | | |
Collapse
|
32
|
Blanc B, Pocard M. [Surgical techniques of appendectomy for acute appendicitis]. ACTA ACUST UNITED AC 2009; 146 Spec No 1:22-31. [PMID: 19846093 DOI: 10.1016/j.jchir.2009.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over the last 20 years, the treatment of acute appendicitis has been transformed by the development of the laparoscopic approach. And yet the net value of this approach continues to be debated. Laparoscopic appendectomy is associated with a lower complication rate and a shorter period of disability in the general population. While operative costs are higher, the global cost of laparoscopic appendectomy is lower than for open appendectomy. There is a somewhat higher rate of abdominal abscess for the laparoscopic route. Laparoscopic appendectomy shows clear advantages in obese patients and in those with gangrenous or ruptured appendicitis. The laparoscopic approach is contra-indicated during pregnancy due to a higher incidence of miscarriage. Treatment of the appendiceal stump by ligature decreases the expense associated with the use of a surgical stapler. When Meckel's diverticulum is encountered during appendectomy, it should be removed in all pediatric patients; in adults, Meckel's diverticulectomy in adults should be performed only for clear-cut pathology. Surgeons continue to innovate and refine appendectomy techniques but many questions remain to be answered.
Collapse
Affiliation(s)
- B Blanc
- Service de chirurgie digestive, hôpital Lariboisière, université Paris Diderot-Paris 7, 2, rue Ambroise-Paré, 75010 Paris, France
| | | |
Collapse
|
33
|
Garg CP, Vaidya BB, Chengalath MM. Efficacy of laparoscopy in complicated appendicitis. Int J Surg 2009; 7:250-2. [PMID: 19393776 DOI: 10.1016/j.ijsu.2009.04.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 04/14/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic appendectomy has been widely practiced for uncomplicated appendicitis. The role of laparoscopy in management of complicated appendicitis remains undefined. We undertook this study to evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. METHOD This study involved a total of 110 consecutive patients who had undergone appendectomy for perforated or gangrenous appendicitis between March 2004 and December 2008. Sixty-one patients underwent open appendectomy (OA) and remaining 49 patients underwent laparoscopic appendectomy (LA). Parameters studied were operative time, conversion rate, wound infections, intra-abdominal abscess and duration of pain and hospital stay. RESULTS There were two conversions due to extremely friable appendix. Laparoscopic appendectomy took longer to perform (98 min versus 79 min) but was associated with less analgesic use, shorter median hospital stay (LA- 3 days; OA- 6 days, p<0.05), and lower rate of wound infections (LA, 8.2%; OA, 24.6 %, p<0.05). Intra-abdominal abscess occurred in four patients (8.2%) in LA group and fourteen patients (22.9%) in OA group (p<0.05). More patients in OA group experienced prolonged ileus than LA group but the difference was statistically insignificant. All complications were managed conservatively and there was no mortality in either group. CONCLUSIONS Laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with less postoperative pain, lower incidence of infectious complications and reduced length of hospital stay when compared with patients who had open appendectomy.
Collapse
Affiliation(s)
- Chaitanya P Garg
- Department of Surgery, Govt Medical College & New Civil Hospital, Surat-395001, Gujarat, India.
| | | | | |
Collapse
|
34
|
Jun YW, Jung H, Kim SJ, Jun KH, Chin HM, Park WB. Comparison of Clinical Outcomes between Laparoscopic and Open Appendectomy: A Retrospective Analysis of 2,745 Patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.5.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ye-Won Jun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hun Jung
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Sung-Jeep Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Kyong Hwa Jun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hyung Min Chin
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Woo Bae Park
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| |
Collapse
|
35
|
Dede K, Mersich T, Zaránd A, Besznyák I, Baranyai Z, Atkári B, Jakab F. [Laparoscopic or open appendectomy?]. Orv Hetil 2008; 149:2357-61. [PMID: 19073442 DOI: 10.1556/oh.2008.28467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Despite the fact that laparoscopic appendectomy was one of the first performed minimally invasive surgical procedures, the benefits and indications of its use are still controversial. METHODS Data of patients with the diagnosis of appendicitis operated either with laparoscopic (LA) or open (OA) appendectomy were collected and analyzed. PATIENTS This study involved 273 consecutive patients who had undergone appendectomy with the diagnosis of acute appendicitis at the Uzsoki Teaching Hospital, Department of Surgery between January 2005 and December 2007. 185 patients (68%) operated with the laparoscopic, 88 (32%) with the open technique, in the third year 89% of the cases underwent laparoscopic appendectomy. RESULTS The conversion rate was 27%, the reason of the conversion was the progression of the disease in 35 patients (70%) and technical in 15 cases (30%). The wound infection rate was 8% in the LA and 18% in the OA group ( p = 0.022). No significant difference was found in the reoperation rate and in the hospital readmission rate between the two groups. There was one insufficiency which was treated with conservative therapy. The hospital stay was significantly lower in the laparoscopic group ( p = 0.031). CONCLUSIONS This study demonstrated that laparoscopic appendectomy has significant advantages over open appendectomy. In our practice, laparoscopic appendectomy is the first choice of procedure in acute appendicitis.
Collapse
Affiliation(s)
- Kristóf Dede
- Fovárosi Onkormányzat Uzsoki Utcai Kórház Sebészeti-Ersebészeti Osztály Budapest Uzsoki utca 29. 1145.
| | | | | | | | | | | | | |
Collapse
|
36
|
Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: A prospective study. Int J Surg 2008; 6:374-7. [PMID: 18789777 DOI: 10.1016/j.ijsu.2008.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 06/20/2008] [Indexed: 11/22/2022]
|
37
|
Hussain A, Mahmood H, Singhal T, Balakrishnan S, El-Hasani S. Laparoscopic appendectomy in a district hospital: does the technique influence the outcome? J Laparoendosc Adv Surg Tech A 2008; 18:204-8. [PMID: 18373444 DOI: 10.1089/lap.2007.0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Laparoscopic appendicectomy (LA) has proved to be a safe, effective procedure for appendicitis. However, its application in the current surgical practice is still far less than the laparoscopic cholecystectomy. Therefore, its role as a gold standard operation for acute appendicitis (AA) is less well established. METHODS Between September 1999 and January 2007, a series of 200 patients (112 female, 88 male) with AA underwent LA in our surgical unit. A single consultant surgeon performed all the cases. Outcomes, including the length of stay, operative time, and complications, were evaluated. Follow-up assessment of patients was performed by outpatient appointment. RESULTS The indications for LA were clinical diagnosis of AA for 177 patients (85%) and interval appendicectomy for 23 patients (15%). The mean age of these patients was 18.8 years (range, 8-83). Operative diagnosis of inflamed appendix, including perforated appendicitis in 9 patients (7.5%), was made in 139 patients (69.5%), and the appendix was macroscopically normal in 40 patients (20%). Different pathologies were found in 21 patients (11.5%). Of the 40 (20%) macroscopically normal appendices, 10 (5%) appendices were reported as inflamed by histopathology examination. The operative time ranged from 13 to 62 minutes, with a mean of 18 minutes. Minor morbidity was reported in 11 patients (5.5%) CONCLUSION In experienced hands using a meticulous technique, LA provides diagnostic and therapeutic options, decreased operative time, rapid recovery, short hospital stay, fewer postoperative complications, and no intra-abdominal abscesses. Appendicectomy has cured right iliac fossa pain in almost all the patients.
Collapse
Affiliation(s)
- Abdulzahra Hussain
- Department of General Surgery, Princess Royal University Hospital, Kent, UK.
| | | | | | | | | |
Collapse
|