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Freys JC, Bigalke SM, Mertes M, Lobo DN, Pogatzki-Zahn EM, Freys SM. Perioperative pain management for appendicectomy: A systematic review and Procedure-specific Postoperative Pain Management recommendations. Eur J Anaesthesiol 2024; 41:174-187. [PMID: 38214556 DOI: 10.1097/eja.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).
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Affiliation(s)
- Jacob C Freys
- From the Department of Surgery, Agaplesion Bethesda Krankenhaus Hamburg (JCF), Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Münster, Germany (EMP-Z, MM), Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham (DNL), MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom (DNL), Department of Anaesthesiology, Intensive and Pain Medicine, Ruhr-University Bochum, BG-University Hospital Bergmannsheil gGmbH, Bochum (SMB) and Department of Surgery, DIAKO Ev. Diakonie-Krankenhaus, Bremen, Germany (SMF)
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Costantini C, Pani E, Negri E, Beretta F, Bisoffi S, Fati F, Mazzero G, Revetria C, Sadri HR, Ciardini E. Is transumbilical laparoscopic-assisted appendectomy feasible for complicated appendicitis? A single-center experience. Pediatr Surg Int 2024; 40:50. [PMID: 38308698 DOI: 10.1007/s00383-023-05624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Transumbilical laparoscopic-assisted surgery (TULS) mixed benefits of laparoscopic and open surgeries. Transumbilical laparoscopic-assisted appendectomy (TULAA) is a well-known procedure, accepted and currently used by pediatric surgeons for treatment of uncomplicated appendicitis (UA). There is no current agreement in its use for the complicated appendiceal infections (CA). We reported our results using TULAA for both UA and CA. METHODS We retrospectively collected TULAA performed between April 2017 and April 2022. Appendicitis were classified in UA and CA. We analyzed conversion rate, operative time, length of stay, surgical site infections (SSIs) rate, postoperative intra-abdominal abscess and costs. RESULTS Over 5 years, 316 children underwent TULAA. Conversion rate was 3%. Mean age at surgery was 9.36 years (IQR 2-16). Forty-nine appendicitis were CA. Operative time and hospital stay was higher in CA than in UA group (38.33 vs. 60.73 min, p < 0.00001; 4 vs. 7 days, p < 0.00001). SSIs rate showed no statistically significant difference between two groups. Incidence of postoperative intra-abdominal collections was 11% in CA and 1% in UA. TULAA's cost was 192.07 €. CONCLUSION In our series, TULAA seems to be safe, feasible and cost-effective for both uncomplicated and complicated appendicitis, with no disadvantage in terms of outcomes compared to what is reported in literature for CLS.
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Affiliation(s)
- Chiara Costantini
- Pediatric Surgery, Woman and Child Health Department, Hospital of Padua, Padua, Italy.
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy.
| | - Elisa Pani
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | - Elisa Negri
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | - Fabio Beretta
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | | | - Federica Fati
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
| | | | | | - Hamid R Sadri
- Pediatric Surgery, Santa Chiara Hospital, Trento, Italy
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Han Y, Yuan H, Li S, Wang WF. Single-incision versus conventional three-port laparoscopic appendectomy for acute appendicitis: A meta-analysis of randomized controlled trials. Asian J Surg 2024; 47:864-873. [PMID: 38185558 DOI: 10.1016/j.asjsur.2023.12.179] [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: 08/01/2023] [Revised: 12/18/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024] Open
Abstract
While consensus on single-incision laparoscopic appendectomy (SILA) for acute appendicitis is lacking, our meta-analysis evaluated the safety and efficacy of SILA compared to conventional three-port laparoscopic appendectomy (CTLA). A computer-based search was conducted in the China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biological Medicine (CBM), PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing SILA with CTLA groups. Meta-analysis was performed using RevMan 5.3 software. A total of 26 RCTs were included. The meta-analysis results indicated that, compared to the CTLA group, the SILA group had a longer operation time [MD = 7.97, 95 % CI (5.84, 10.10), P < 0.00001], and a higher rate of conversion to open surgery [RR = 2.60, 95 % CI (1.27, 5.31), P = 0.009], but had a shorter time to return to normal activities [MD = -0.76, 95 % CI (-1.15, -0.37), P = 0.0001]. Additionally, the SILA group had higher satisfaction scores [SMD = 1.21, 95 % CI (0.75, 1.68), P < 0.00001] and cosmetic scores [SMD = 0.68, 95 % CI (0.45, 0.90), P < 0.00001]. There was no significant difference between the two groups in terms of pain scores at 24 h postoperatively [MD = -0.21, 95 % CI (-0.56, 0.14), P = 0.25], the incidence of wound infection [RR = 1.13, 95 % CI (0.74, 1.73), P = 0.58], or the overall complication rate [RR = 0.86, 95 % CI (0.66, 1.12), P = 0.27]. SILA is a safe and effective surgical approach that allows patients to recover to normal activities earlier, particularly for patients with a strong demand for better cosmetic outcomes. However, the quality of some RCTs in this meta-analysis is low, and further verification is needed through future high-quality RCTs.
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Affiliation(s)
- Yin Han
- Department of Gastrointestinal Surgery, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, 610200, Sichuan, China.
| | - Hao Yuan
- Department of Gastrointestinal Surgery, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, 610200, Sichuan, China
| | - Shuang Li
- Department of Gastrointestinal Surgery, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, 610200, Sichuan, China
| | - Wei-Fa Wang
- Department of Gastrointestinal Surgery, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, 610200, Sichuan, China
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Liu J, Chen G, Mao X, Jiang Z, Jiang N, Xia N, Lin A, Duan G. Single-incision laparoscopic appendectomy versus traditional three-hole laparoscopic appendectomy for acute appendicitis in children by senior pediatric surgeons: a multicenter study from China. Front Pediatr 2023; 11:1224113. [PMID: 37492606 PMCID: PMC10364637 DOI: 10.3389/fped.2023.1224113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective The aim of this study was to evaluate the clinical efficacy of single-incision laparoscopy appendectomy (SILA) and traditional three-hole laparoscopy appendectomy (THLA) for the treatment of acute appendicitis in children. Methods The clinical data of children (<14 years old) who underwent laparoscopic appendectomy at Yijishan Hospital of Wannan Medical College, Hubei Provincial Maternal Health Hospital and Qingdao Women and Children's Medical Center from January 2019 to June 2022 were retrospectively analyzed. According to the operation method, the patients were assigned to the SILA group or the THLA group. The clinical data, including the efficacy, and the surgical details, including the complications, of the two surgical methods were compared. The personal information of the children and the time of disease onset were recorded. Results In this study, the data of 588 patients, including 385 patients in the THLA group and 203 patients in the SILA group were collected. The baseline characteristics between the two groups of patients before surgery were comparable. There was no significant difference in the average operation time between the THLA group and the SILA group (56.31 ± 1.83 min vs. 57.48 ± 1.15 min, P > 0.05). There was also no significant difference in the average length of hospital stay between the THLA group and the SILA group (6.91 ± 0.24 days vs. 7.16 ± 0.36 days, P > 0.05). However, the FLACC scores of the SILA group (3.71 ± 0.78) were significantly lower than those of the THLA group (3.99 ± 0.56) on the second postoperative day, and the difference was significant (P < 0.05). The score of the questionnaire evaluating cosmetic appearance of the postoperative abdomen was significantly higher in the SILA group (15.81 ± 0.36) than in the THLA group (13.10 ± 0.24) (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05). Conclusion SILA is more advantageous in terms of postoperative FLACC scores and cosmetic appearance in children than THLA. There was no significant difference in the incidence of complications or other aspects between the two surgical methods.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
- Clinical Medicine School of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Guoxian Chen
- Clinical Medicine School of Wannan Medical College, Wannan Medical College, Wuhu, China
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xiaowen Mao
- Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihui Jiang
- Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Nannan Jiang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Nan Xia
- Institute of Digital Medicine and Computer-Assisted Surgery of Qingdao University, Qingdao University, Qingdao, China
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-Assisted Surgery, Qingdao, China
| | - Aiqin Lin
- Department of Medical Biology of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
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Chen Y, Fan Z, Zhang X, Fu X, Li J, Yuan J, Guo S. A brief overview of single-port laparoscopic appendectomy as an optimal surgical procedure for patients with acute appendicitis: still a long way to go. J Int Med Res 2023; 51:3000605231183781. [PMID: 37466195 PMCID: PMC10363874 DOI: 10.1177/03000605231183781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Single-port laparoscopic appendectomy (SPLA) has become a good alternative to the traditional surgical treatment of acute appendicitis, due to its advantages of small incision, mild postoperative pain, short hospital stay, and good cosmetic effect. However, the further application of SPLA has been restricted by its relatively long operating time, high level of operating difficulty, and increased equipment and technical requirements. Clinical teams worldwide have attempted to improve and optimize SPLA technical protocols and equipment to maintain stable intraoperative pneumoperitoneal pressure, improve the 'triangle relationship' of operating angles, and develop new surgical procedures with less trauma and higher cost-effectiveness. Here, new SPLA techniques reported over the past decade are reviewed and compared, with the aim of providing new insights into technical improvements, equipment upgrades and clinical studies in the coming years.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Zongqi Fan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiaoxin Zhang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xinao Fu
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jushang Li
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
- Graduate School, China Medical University, Shenyang, Liaoning Province, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning Province, China
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