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Kim KE, Jeon YR, Bae SU, Jeong WK, Baek SK. Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:14-22. [PMID: 38494182 PMCID: PMC10961233 DOI: 10.7602/jmis.2024.27.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
Purpose This study was performed to evaluate the safety and feasibility of skin adhesives and to compare postoperative and cosmetic outcomes after wound closure in single-port laparoscopic appendectomy (SPLA) between skin adhesives and steri-strips. Methods This was a single-center retrospective study. We included 22 and 47 patients in whom skin adhesive and steri-strips were used respectively, for skin closure after subcuticular suturing in SPLA between August 2014 and 2020. The patient scar assessment questionnaire (PSAQ) was completed postoperatively to assess postoperative cosmetic outcomes. Results On the postoperative day, patients in whom skin adhesive was used had significantly lower numeric rating scores than in whom steri-strips were used (2.8 ± 0.8 vs. 3.9 ± 0.8, p < 0.001). The frequency of analgesic administration within 24 hours and between 24 and 48 hours after surgery was significantly lower in the skin adhesive group compared to the wound closure strip group (1.4 ± 0.8 vs. 2.7 ± 1.2, p = 0.013 and 0.2 ± 0.4 vs. 0.7 ± 0.9, p = 0.002, respectively). In the PSAQ, "satisfaction with appearance" and "satisfaction with symptoms" subitem scores were significantly lower in patients in whom skin adhesive was used (11.3 ± 3.0 vs. 15.1 ± 4.5, p = 0.006 and 6.5 ± 1.8 vs. 9.5 ± 3.3, p = 0.003), whereas, "appearance" and "consciousness" subitems revealed no statistically significant differences between the groups. Conclusion Liquid skin adhesive closures seem to be safe and feasible and cause less postoperative pain, resulting in greater patient satisfaction with postoperative scars than wound closure strip closure after subcuticular suturing in SPLA.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Ra Jeon
- Department of Surgery, School of Medicine, Keimyung University, Dongsan Medical Center, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Kim KE, Cho IS, Bae SU, Jeong WK, Kim HJ, Baek SK. A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:55-63. [PMID: 37347098 PMCID: PMC10280108 DOI: 10.7602/jmis.2023.26.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
Purpose This study aimed to compare the postoperative outcomes and patient-surveyed scar assessments of single-port laparoscopic appendectomy (SPLA) with the outcomes of multiport laparoscopic appendectomy (MPLA). Methods Between August 2014 and November 2017, the prospective randomized study comprised 98 patients diagnosed with acute appendicitis and indicated for surgery. Fifty-one patients had MPLA and 47 patients received SPLA. The primary endpoint was the total score of Patient Scar Assessment Questionnaire (PSAQ) administered to patients 6 weeks after surgery. Results SPLA involved a shorter median operative time than MPLA (47.5 minutes vs. 60.0 minutes, p = 0.02). There were no apparent differences in the time before diet tolerance, length of hospital stay, and postoperative complication. SPLA patients had shorter total incision length (2.0 cm vs. 2.5 cm, p < 0.01) and required fewer analgesics on the day of surgery than MPLA patients (p = 0.011). The PSAQ favored the SPLA approach, revealing significant differences in total score (48 vs. 55, p = 0.026), appearance (15 vs. 18, p = 0.002), and consciousness (8 vs. 10, p = 0.005), while satisfaction with appearance and symptoms scale did not (p = 0.162 and p = 0.690, respectively). Conclusion The postoperative scar evaluated by the patient was better with SPLA than with MPLA, and patient satisfaction with the scar was comparable between the two techniques.
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Affiliation(s)
- Kyeong Eui Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - In Soo Cho
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyung Jin Kim
- Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Seong Kyu Baek
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Zhong A, Short C, Sundin A, Austin C, Gao L, Tabarsi E, Chen S, Wang K, Pelayo JC. Postoperative narcotic utilization in single incision laparoscopic-assisted extracorporeal appendectomy (SILEA): a single-institution retrospective review. Pediatr Surg Int 2022; 38:1997-2003. [PMID: 36138321 DOI: 10.1007/s00383-022-05252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Laparoscopic appendectomy for pediatric acute appendicitis is commonly performed by pediatric surgeons. A single incision approach has been investigated, but the lack of technical uniformity has resulted in conflicting data. We hypothesized that an initial single incision laparoscopic-assisted extracorporeal appendectomy (SILEA) approach is associated with similar complication rates as compared to the standard three-incision laparoscopic appendectomy (TILA). METHODS Approximately 1300 laparoscopic appendectomies were retrospectively reviewed for acute appendicitis over a 5 year period. Patients were split into TILA or SILEA cohorts. Propensity score matching identified 102 matched cases in both cohorts. Case and control cohort comparisons were then analyzed. RESULTS Successful SILEA was associated with no difference in post-operative complication rate. SILEA was associated with decreased postoperative narcotic dosage and shorter operative time than TILA. CONCLUSIONS An initial SILEA approach is safe and associated with similar complication rates as TILA. Based on this data, the authors advocate adoption of the an initial SILEA approach for uncomplicated, freely mobile, acute appendicitis with seamless conversion to TILA if the appendix is not amendable to SILEA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Allen Zhong
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Celia Short
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Andrew Sundin
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Charlotte Austin
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Leland Gao
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Emiliano Tabarsi
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Stephanie Chen
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Kasper Wang
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA
| | - Juan Carlos Pelayo
- Department of Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop 100, Los Angeles, CA, 90027, USA.
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4
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St Peter SD, Ostlie DJ. Techniques of Laparoscopic Appendectomy for Pediatric Appendicitis: How I Do It. J Laparoendosc Adv Surg Tech A 2021; 31:1195-1199. [PMID: 34449256 DOI: 10.1089/lap.2021.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Appendicitis is the most common operative emergency in children. As a result of accumulating evidence from randomized trials, observational studies, database work, and meta-analyses, the management of appendicitis in children has been shifting the past 15 years with many new debates emerging. In this article, we review our current management schemes. Methods: We reviewed the current and critical literature relevant to the rationale for our current management. Results: Clinical pathways appear to reduce variation and cost while improving the ability to diagnose and treat the disease. Minimally invasive approaches can be used to treat all forms of appendicitis. Conclusions: The future role of non-operative management deserves ongoing exploration. Refining diagnostic treatment algorithms and enhancing antibiotic stewardship are important moving forward.
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Affiliation(s)
- Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Daniel J Ostlie
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
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5
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Jacobson JC, Pandya SR. A narrative review of gastroesophageal reflux in the pediatric patient. Transl Gastroenterol Hepatol 2021; 6:34. [PMID: 34423155 DOI: 10.21037/tgh-20-245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus. It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms. While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H2-antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER. In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.
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Affiliation(s)
| | - Samir R Pandya
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
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6
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Dekonenko C, Holcomb GW. Laparoscopic Cholecystectomy in Children. J Laparoendosc Adv Surg Tech A 2021; 31:1180-1184. [PMID: 34382817 DOI: 10.1089/lap.2021.0397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The incidence of gallbladder disease in children is rising due to an increase in the development of nonhemolytic cholelithiasis in this age group. Laparoscopic cholecystectomy is the gold standard for treatment for gallbladder disease in adults and, with the technique's widespread adoption, it has now become the mainstay of treatment for gallbladder disease in children as well. Complications are infrequent and is now often performed as an outpatient surgery. Although the standard approach is through a 4-port technique, it can also be performed using a single-site technique. We describe our thoughts on laparoscopic cholecystectomy in children with a focus on the standard approach.
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Affiliation(s)
- Charlene Dekonenko
- Department of Surgery, Vanderbilt University School of Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
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Affiliation(s)
- Katherine He
- Department of General Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street CA-034, Boston, MA 02115, USA
| | - Shawn J Rangel
- Department of Pediatric & Thoracic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue - Fegan 3, Boston, MA 02115, USA.
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8
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Goodman LF, Lin AC, Sacks MA, McRae JJLH, Radulescu A, Khan FA. Single site versus conventional laparoscopic appendectomy: some pain for no gain? J Surg Res 2021; 264:321-326. [PMID: 33848830 DOI: 10.1016/j.jss.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The optimal laparoscopic appendectomy approach is not clear, comparing single site laparoscopic appendectomy (SILA) to conventional 3-port appendectomy (CLA). We investigated outcomes in pediatric patients comparing SILA to CLA: length of operation, length of stay, time to resumption of regular diet, follow up, rehospitalization, and cost. METHODS Data was collected from children 1 to 18 years with appendectomy at Loma Linda University from 2018 to 2020, operated by two surgeons. Analysis utilized two-sample T, chi-squared, and Fisher's exact tests. RESULTS Of 173 patients, 77 underwent SILA and 96 had CLA. There was no gender, age, or race difference between groups. Mean WBC was 17.5 × 103/mL in SILA group, compared to 15.3 × 103/mL in CLA group (P = 0.004). Operative time was 47.0 SILA compared to 49.5 minutes CLA (P = 0.269). Of SILA cases, 55.8% were simple appendicitis, while 53.3% of the CLA cases were simple (P = 0.857). Regular diet was resumed after 1.7 days in the SILA group, 1.1 days in CLA (P = 0.018). Length of stay was 2.9 days for SILA, 2.4 days for CLA (P = 0.144). Seven children required hospital readmission, 5 SILA and 2 CLA (P = 0.244). Five of the children who returned had intra-abdominal abscesses, of whom 4 had SILA. There was no difference in cost. CONCLUSIONS The operative techniques had similar outcomes and operative times. There was a trend toward more intra-abdominal abscesses in the SILA group. Further study and longer follow up is needed to determine if there is an advantage to one laparoscopic approach over another.
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Affiliation(s)
- Laura F Goodman
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California
| | - Ann C Lin
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Marla A Sacks
- Department of Surgery, Loma Linda University, Loma Linda, California; Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California
| | | | - Andrei Radulescu
- Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California
| | - Faraz A Khan
- Department of Surgery, Loma Linda University, Loma Linda, California; Division of Pediatric Surgery, Department of Surgery, Loma Linda University, Loma Linda, California; School of Medicine, Loma Linda University, Loma Linda, California.
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9
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Zimmermann P, Martynov I, Perger L, Scholz S, Lacher M. 20 Years of Single-Incision-Pediatric-Endoscopic-Surgery: A Survey on Opinion and Experience Among International Pediatric Endosurgery Group Members. J Laparoendosc Adv Surg Tech A 2020; 31:348-354. [PMID: 33395367 DOI: 10.1089/lap.2020.0797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim/Background: Assessment of current role and future trends of Single-Incision-Pediatric-Endoscopic-Surgery (SIPES) in pediatric surgery among International Pediatric Endosurgery Group (IPEG) members two decades after introduction. Materials and Methods: An online survey was conducted between December 2019 and April 2020 on behalf of the IPEG Research Committee. All IPEG members were contacted by e-mail and asked to complete an anonymous questionnaire that included 39 items on SIPES. Results: One hundred eighty-four practicing pediatric surgeons completed the questionnaire from a pool of 890 IPEG members. The majority (76%) of respondents performed SIPES for more than 6 years with the following caseload per month: 1 case (31%), 2-5 cases (30%), 6-10 cases (24%), and >10 cases (17%). The four most commonly performed procedures were appendectomy (95%), Meckel diverticulectomy (55%), treatment of ovarian pathologies (43%), and U-stitch gastrostomy (40%). Complex reconstructive SIPES procedures were performed rarely. Most surgeons (95%) stated that better cosmesis is the predominant advantage of SIPES procedures. The majority of respondents (70%) felt that there is no convincing scientific evidence that SIPES offers benefits to multi-port minimally invasive procedures. Conclusion: Twenty years after introduction of SIPES, this technique has found its place in pediatric endoscopic surgery. Eighty percent of participating IPEG members of this survey apply SIPES for cases of lower complexity, such as appendectomy mainly for cosmetic reasons. The fact that 70% of respondents state that the scientific evidence for the benefits of SIPES is not convincing suggests that further studies and discussion on this technique are needed.
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Affiliation(s)
- Peter Zimmermann
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Illya Martynov
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Lena Perger
- Division of Pediatric Surgery, Department of General Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Stefan Scholz
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
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10
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Traynor MD, Camazine MN, Potter DD, Moir CR, Klinkner DB, Ishitani MB. A Comparison of Single-Incision Versus Multiport Laparoscopic Splenectomy in Children. J Laparoendosc Adv Surg Tech A 2020; 31:106-109. [PMID: 33259743 DOI: 10.1089/lap.2020.0392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although single-incision endoscopic splenectomy (SIES-Sp) has been shown to be feasible and safe, few have compared the SIES-Sp with multiport laparoscopic splenectomy (MPLS). The purpose of this study was to compare the two techniques in children undergoing total splenectomy. Materials and Methods: We reviewed all children (age <18 years) who underwent minimally invasive total splenectomy at a single tertiary referral center from January 1, 2000 to January 1, 2019. The primary outcome was complication rate 30 days after discharge defined by maximum Clavien-Dindo score. Secondary outcomes included conversion, operative time, hospital length of stay, postoperative pain scores, and readmission within 30 days of discharge. SIES-Sp and MPLS were compared using univariate analysis. Results: Of 48 children undergoing laparoscopic total splenectomy, 60% (n = 29) were SIES-Sp and 40% (n = 19) were MPLS. Subjects were 48% female (n = 23). Common diagnoses were idiopathic thrombocytopenic purpura (33% [n = 16]), hereditary spherocytosis (29% [n = 14]), and other congenital hemolytic anemias (23% [n = 11]). There were no differences in age, gender, or diagnosis between groups (all P > .05). One in three cases involved additional procedures. Spleens were smaller in both greatest dimension (13.0 cm versus 16.4 cm) and weight (156.5 g versus 240.0 g) in SIES-Sp compared with MPLS patients (both P < .05). Readmission and reoperation rates were similar (both P > .05). Complications occurred in 7% (n = 2) of SIES-Sp and in 11% (n = 2) of MPLS patients (P > .99). Severe complications included: cardiac arrest in 1 SIES-Sp patient and bleeding requiring reoperation in 1 MPLS patient. Conclusion: SIES-Sp is a safe alternative to the traditional MPLS for children. Additional procedures do not preclude a less invasive approach, but larger spleens may present a challenge.
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Affiliation(s)
- Michael D Traynor
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maraya N Camazine
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA.,University of Missouri School of Medicine, Columbia, Missouri, USA
| | - D Dean Potter
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher R Moir
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Denise B Klinkner
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael B Ishitani
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Sujka J, Alemayehu H, Benedict LA, Sobrino JA, St. Peter SD, Fraser JD. Outcomes of Ostomy Location in Children: Placement of the Ostomy at the Umbilicus. J Laparoendosc Adv Surg Tech A 2019; 29:243-247. [DOI: 10.1089/lap.2018.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Justin A. Sobrino
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Jason D. Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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12
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Alemayehu H, Sola R, Le NH, Juang D, Aguayo P, Fraser JD, St. Peter SD. Abdominal Exploration in Neonates Using Transumbilical Exposure Compared with Transverse Laparotomies. J Laparoendosc Adv Surg Tech A 2018; 28:751-754. [DOI: 10.1089/lap.2017.0301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hanna Alemayehu
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Richard Sola
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Nhatrang H. Le
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - David Juang
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Pablo Aguayo
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Jason D. Fraser
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
| | - Shawn D. St. Peter
- Department of Surgery, The Children's Mercy Hospital, Kansas City, Missouri
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Pediatric Surgical Fellowship and Scholars Programs, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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14
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Deng L, Xiong J, Xia Q. Single-incision versus conventional three-incision laparoscopic appendectomy: A meta-analysis of randomized controlled trials. J Evid Based Med 2017; 10:196-206. [PMID: 28276643 DOI: 10.1111/jebm.12238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/06/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Conventional three-incision laparoscopic appendectomy (CTLA) is considered the new golden standard for the treatment of acute appendicitis. However, single-incision laparoscopic appendectomy (SILA) can further reduce the number of abdominal incisions and visible scars. METHODS Major databases were researched for randomized clinical trials (RCTs) comparing SILA and CTLA for acute appendicitis from January 1983 and to March 2015. The technical feasibility, effectiveness, and safety between SILA and CTLA were compared. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. RESULTS In total, 11 RCTs with 1489 patients were analyzed. The patients in the SILA group had a significantly shorter hospital duration (WMD: -0.63; 95% CI: -1.04, -0.21; P = 0.003) and return to activity (WMD: -2.91; 95% CI: -5.45, -0.37; P = 0.02) but experienced a longer operating time (WMD: 6.56; 95% CI: 3.55, 9.58; P < 0.0001) and higher rate of conversion (OR: 6.82; 95% CI: 3.14, 14.79; P < 0.00001). There were no differences between the two groups in visual analog pain scores, doses of analgesics, overall complication rates, wound infection, or cosmesis (all P > 0.05). CONCLUSIONS SILA is a safer and more effective than CTLA in both pediatric and adult patients.
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Affiliation(s)
- Lihui Deng
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junjie Xiong
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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15
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Abstract
Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited. A minimally invasive (laparoscopic) appendectomy is the current standard in US and European children's hospitals. This article reviews the current 'state of the art' in the evaluation and management of pediatric appendicitis.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA.
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA
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16
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Abstract
Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis. This article discusses the workup and management, modes of treatment, and continued areas of controversy in pediatric appendicitis.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Pediatric Surgical Fellowship and Scholars Programs, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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Bae SU, Jeong WK, Baek SK. Robot-Assisted Colectomy for Left-Sided Colon Cancer: Comparison of Reduced-Port and Conventional Multi-Port Robotic Surgery. J Laparoendosc Adv Surg Tech A 2016; 27:398-403. [PMID: 27870592 DOI: 10.1089/lap.2016.0427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The robotic single-port access plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colon cancer, can enable lymphovascular dissection using the wristed instrumentation and safe rectal transection through an additional port maintaining the cosmetic advantage of the single-port surgery. The aim of this study is to compare the clinicopathological outcomes between reduced-port and conventional multi-port robotic colectomy for left-sided colon cancer. METHODS The study group included 23 patients who underwent an RPRS and 16 patients who underwent a multi-PRS (MPRS) for left-sided colon cancer between August 2013 and January 2016. RESULTS The operative time was significantly shorter in the RPRS group than in the MPRS group (mean time 258 ± 67 vs. 319 ± 66 minutes, P = .009). There were no apparent differences in tolerance of diet, postoperative pain score, length of hospital stay, the rate of postoperative complications, and the mean number of harvested lymph node, but the RPRS group had a significantly smaller total incision length (38 ± 12 mm vs. 83 ± 6 mm, P = .013). CONCLUSIONS This study shows the feasibility and safety of the RPRS, with clinicopathological outcomes that is comparable with that of the MPRS for left-sided colon cancer.
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Affiliation(s)
- Sung Uk Bae
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center , Daegu, Korea
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Juang D, Fraser JD, Holcomb GW. The laparoscopic approach for repair of indirect inguinal hernias in infants and children. Transl Pediatr 2016; 5:222-226. [PMID: 27867843 PMCID: PMC5107372 DOI: 10.21037/tp.2016.10.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Repair of an indirect inguinal hernia is one of the most common operations performed around the world by pediatric surgeons. Until the last 15 years, most inguinal hernia repairs were performed using an inguinal crease incision and extraperitoneal ligation of the patent processes vaginalis. However, since 2000, the laparoscopic approach has gained popularity and there have been increasing descriptions about various techniques for laparoscopic hernia (LH) repair. At our institution, we have transitioned the majority of inguinal hernia repairs to the laparoscopic approach. In this article, we will describe the technique that is utilized at Children's Mercy Hospital in Kansas City, Missouri (USA) and express our thoughts on the current debate regarding laparoscopic versus open inguinal hernia repair in infants and children.
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Affiliation(s)
- David Juang
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - George W Holcomb
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
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A cost and outcome analysis of pediatric single-incision appendectomy. J Surg Res 2016; 203:253-7. [PMID: 27363629 DOI: 10.1016/j.jss.2016.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/26/2016] [Accepted: 04/15/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND For appendicitis, single-incision laparoscopic appendectomy (SIA) has been proposed as an alternative to 3-port appendectomy (3PA). However, there remains controversy regarding outcomes and cost of SIA. We sought to review our experience with these two techniques to identify differences in these factors. MATERIALS AND METHODS The charts of children (0-17 y) who underwent appendectomy at a tertiary pediatric hospital from 2011-2014 were retrospectively reviewed. Appendectomy was either performed through traditional 3PA or SIA (laparoscopically assisted via externalization through an umbilical incision). Demographic data including age, body mass index, comorbidities, and gender were examined. Information on perforation, operative time and cost, length of stay, and infectious complications for both SIA and 3PA was identified. Data were analyzed using student t tests and chi square analysis. RESULTS A total of 337 patients underwent appendectomy (141 SIA and 197 3PA), 35.6% of whom (40 SIA, 80 3PA) had perforated appendicitis. For nonperforated appendicitis, SIA had significantly shorter operative times, decreased operative costs, and length of stay. However, these differences were not found for perforated appendicitis. Regardless of appendicitis severity, there was no difference in rates of wound infection, abscess, or readmission between the two techniques. CONCLUSIONS Our study suggests that SIA is a faster, more cost effective alternative than 3PA for acute appendicitis. SIA did not result in increased infection rates for acute or perforated appendicitis and can be considered an equivalent alternative to 3PA in the surgical management of appendicitis.
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Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been described in adults with Crohn's disease, but its use in pediatric Crohn's patients has been limited. The purpose of this study was to review our experience with SILS in pediatric patients with Crohn's disease. METHODS A retrospective review was performed for patients diagnosed with Crohn's disease who underwent small bowel resection or ileocecectomy at a freestanding children's hospital from 2006 to 2014. Data collected included demographic data, interval from diagnosis to surgery, operative time, length of stay, and postoperative outcomes. RESULTS Analysis identified 19 patients who underwent open surgery (OS) and 41 patients who underwent SILS. One patient (2.4 %) within the SILS group required conversion to OS. Demographic characteristics were similar between the 2 cohorts. The most common indication for surgery was stricture/obstruction (SILS 70.7 % vs. OS 68.4 %, p = 0.86), and ileocecectomy was the most common primary procedure performed (SILS 90.2 % vs. OS 100 % OS). Operative times were longer for SILS (135 ± 50 vs. 105 ± 37 min, p = 0.02). However, when the last 20 SILS cases were compared to all OS cases, the difference was no longer statistically significant (SILS 123.3 ± 34.2 vs. OS 105 ± 36.5, p = 0.12). No difference was noted in postoperative length of stay (SILS 6.5 ± 2.2 days vs. OS 7.4 ± 2.2 days, p = 0.16) or overall complication rate (SILS 24.4 % vs. OS 26.3 %, p = 0.16). CONCLUSION SILS ileocecectomy is feasible in pediatric patients with Crohn's disease, achieving outcomes similar to OS. As experience increased, operative times also became comparable.
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21
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Bae SU, Jeong WK, Baek SK. Current status of robotic single-port colonic surgery. Int J Med Robot 2016; 13. [PMID: 26913985 DOI: 10.1002/rcs.1735] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/18/2015] [Accepted: 01/05/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The present paper reviews evidence and examines updates in single-port robotic surgery for colonic diseases reported in contemporary studies. MATERIALS AND METHODS A comprehensive online systematic search of PubMed databases was carried out in June 2015, identifying studies conducted on robotic single-port colectomy from 2008 to 2015. RESULTS The advantages and disadvantages of several available port-access systems, techniques for configuring robotic arms, and robotic surgical platforms, were presented. CONCLUSIONS Current studies show that single-port robotic colectomy is a safe and feasible procedure despite the lack of supporting evidence. Although significant advancements in the development and modification of single-access ports, configuration of robotic arms, and robotic surgical platforms have been achieved in the field of single-port robotic surgery for colonic disease, significant improvements to surgical platforms for single-port robotic surgery are needed. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sung Uk Bae
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Woon Kyung Jeong
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Seong Kyu Baek
- Department of Surgery, School of Medicine, Keimyung University and Dongsan Medical Center, Daegu, Korea
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22
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Zhang Z, Wang Y, Liu R, Zhao L, Liu H, Zhang J, Li G. Systematic review and meta-analysis of single-incision versus conventional laparoscopic appendectomy in children. J Pediatr Surg 2015; 50:1600-9. [PMID: 26095165 DOI: 10.1016/j.jpedsurg.2015.05.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 05/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increasing evidence has indicated that single-incision laparoscopic appendectomy (SILA) is a safe procedure that has a comparable clinical outcome to conventional multiport laparoscopic appendectomy (CLA) in adult patients. Nevertheless, the use of SILA in pediatric patients is still controversial, and systematic reviews that compare SILA and CLA in children are lacking in the current literature. METHODS A literature search in MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov was performed to identify eligible studies that were conducted between January 1998 and September 2014. Primary outcome measures were total postoperative complications, wound infection, intra-abdominal abscess, ileus, and wound hematoma. Secondary outcome measures were operative time, length of hospital stay and the frequency of use of additional analgesics. The random effect model was used for the meta-analysis. RESULTS The literature search identified 2 randomized clinical trials and 12 nonrandomized clinical trials that met the inclusion criteria for the meta-analysis. These studies included a total of 2249 patients: 744 who underwent SILA and 1505 who underwent CLA. No significant differences were observed between the groups with respect to the incidence of total postoperative complications, intraabdominal abscess, ileus, wound hematoma, length of hospital stay, or the frequency of use of additional analgesics. However, SILA was associated with a higher incidence of wound infection (OR=2.25; 95%=1.21-4.17; P=0.01) compared with CLA and required a longer operative time (WMD=5.73 minutes; 95% CI=4.17-7.28; P<0.00001). CONCLUSIONS SILA seems to be a relatively feasible and safe procedure without any superiority to CLA. Thus, SILA may not be a better approach for pediatric patients.
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Affiliation(s)
- Ze Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoyan Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Zhang Z, Wang Y, Liu R, Zhao L, Liu H, Zhang J, Li G. Suprapubic single-incision versus conventional laparoscopic appendectomy. J Surg Res 2015; 200:131-8. [PMID: 26279236 DOI: 10.1016/j.jss.2015.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/02/2015] [Accepted: 07/21/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suprapubic single-incision laparoscopic appendectomy (SSILA), a promising new approach with potential benefits such as improved cosmetic results, has been preliminarily shown to be safe and feasible in previous single-arm studies. This study used a propensity-matched analysis to compare SSILA and conventional laparoscopic appendectomy (CLA). METHODS Patients undergoing SSILA between March 2012 and November 2013 were matched with patients undergoing CLA during the same period at a single institution. These patient groups were compared using a propensity score analysis. The model covariates for the propensity scores included gender, age, body mass index, American Society of Anesthesiologists score, history of abdominal operation, and pathology of the resected appendix. The clinical outcomes were compared between the two groups, and the cosmetic results were evaluated via a patient scar assessment questionnaire and an objective scar evaluation scale. RESULTS No patient in either group required additional port placement or conversion to open surgery. One patient in the SSILA group developed a wound infection, and one patient in the CLA group developed a postoperative intra-abdominal abscess. No significant differences were observed between the groups with respect to the length of hospital stay, time to semi-liquid diet, time to first flatus or hospital cost. The operative time and the number of patients requiring postoperative analgesics were greater with SSILA. Compared with CLA, SSILA was associated with better scores in the patient scar assessment questionnaire consciousness subscale and with similar scores in the appearance, satisfaction with appearance and satisfaction with symptoms subscales. The two approaches yielded similar results for the objective scar evaluation scale. CONCLUSIONS SSILA is a feasible and safe approach with similar outcomes as CLA. SSILA results in reduced scar consciousness at the expense of relatively longer operative times and more postoperative analgesic use.
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Affiliation(s)
- Ze Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoyan Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianming Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Hall NJ, Kapadia MZ, Eaton S, Chan WWY, Nickel C, Pierro A, Offringa M. Outcome reporting in randomised controlled trials and meta-analyses of appendicitis treatments in children: a systematic review. Trials 2015; 16:275. [PMID: 26081254 PMCID: PMC4499220 DOI: 10.1186/s13063-015-0783-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/28/2015] [Indexed: 01/07/2023] Open
Abstract
Background Acute appendicitis is the most common surgical emergency in children. Despite this, there is no core outcome set (COS) described for randomised controlled trials (RCTs) in children with appendicitis and hence no consensus regarding outcome selection, definition and reporting. We aimed to identify outcomes currently reported in studies of paediatric appendicitis. Methods Using a defined, sensitive search strategy, we identified RCTs and systematic reviews (SRs) of treatment interventions in children with appendicitis. Included studies were all in English and investigated the effect of one or more treatment interventions in children with acute appendicitis or undergoing appendicectomy for presumed acute appendicitis. Studies were reviewed and data extracted by two reviewers. Primary (if defined) and all other outcomes were recorded and assigned to the core areas ‘Death’, ‘Pathophysiological Manifestations’, ‘Life Impact’, ‘Resource Use’ and ‘Adverse Events’, using OMERACT Filter 2.0. Results A total of 63 studies met the inclusion criteria reporting outcomes from 51 RCTs and nine SRs. Only 25 RCTs and four SRs defined a primary outcome. A total of 115 unique and different outcomes were identified. RCTs reported a median of nine outcomes each (range 1 to 14). The most frequently reported outcomes were wound infection (43 RCTs, nine SRs), intra-peritoneal abscess (41 RCTs, seven SRs) and length of stay (35 RCTs, six SRs) yet all three were reported in just 25 RCTs and five SRs. Common outcomes had multiple different definitions or were frequently not defined. Although outcomes were reported within all core areas, just one RCT and no SR reported outcomes for all core areas. Outcomes assigned to the ‘Death’ and ‘Life Impact’ core areas were reported least frequently (in six and 15 RCTs respectively). Conclusions There is a wide heterogeneity in the selection and definition of outcomes in paediatric appendicitis, and little overlap in outcomes used across studies. A paucity of studies report patient relevant outcomes within the ‘Life Impact’ core area. These factors preclude meaningful evidence synthesis, and pose challenges to designing prospective clinical trials and cohort studies. The development of a COS for paediatric appendicitis is warranted. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0783-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nigel J Hall
- Faculty of Medicine, University of Southampton, Southampton, UK. .,Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, UK.
| | - Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), SickKids Research Institute, Toronto, Canada.
| | - Simon Eaton
- Developmental Biology Programme, UCL Institute of Child Health, London, UK.
| | - Winnie W Y Chan
- Toronto Outcomes Research in Child Health (TORCH), SickKids Research Institute, Toronto, Canada.
| | - Cheri Nickel
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Canada.
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada.
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), SickKids Research Institute, Toronto, Canada.
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Wu K, Yang L, Wu A, Wang J, Xu S, Zhao H, Huang Z. Single-site laparoscopic appendectomy in children using conventional instruments: a prospective, randomized, control trial. Pediatr Surg Int 2015; 31:167-71. [PMID: 25381588 DOI: 10.1007/s00383-014-3636-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Single-site laparoscopic surgery (SSLS) is still only used in limited situations to treat children with appendicitis. Using conventional laparoscopic (CL) equipment to perform SSLS appendectomy is considered a valuable application in China. This prospective randomized trial aims to evaluate the surgical outcome of SSLS and CL appendectomy using CL equipment. METHODS Sixty patients were recruited and randomly assigned to receive SSLS or 3-port CL appendectomy between February 2011 and June 2013. Each case of SSLS appendectomy was performed using CL instruments. Surgery outcomes, including operative time, conversion rates, postoperative complications, hospital stays, and hospital costs were evaluated. RESULTS Patient characteristics were similar between groups. The SSLS using CL instruments was successful in all the 30 patients and no conversions occurred. Mean operative time was longer in the SSLS group than the CL group (64.3 ± 3.1 vs 53.0 ± 2.9 min, respectively; p = 0.000). Complication rates, lengths of hospital stay, and hospital costs were similar between the two groups. CONCLUSIONS The findings of this study demonstrate that using conventional instruments to perform SSLS is technically feasible and safe in children. Although SSLS appendectomy does increase the operative time, it does not increase the complication rate and hospital cost.
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Affiliation(s)
- Kai Wu
- Department of Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong Province, China
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Seims AD, Nice TR, Mortellaro VE, Lacher M, Ba'Ath ME, Anderson SA, Beierle EA, Martin CA, Rogers DA, Harmon CM, Chen MK, Russell RT. Routine utilization of single-incision pediatric endosurgery (SIPES): a 5-year institutional experience. J Laparoendosc Adv Surg Tech A 2015; 25:252-5. [PMID: 25594666 DOI: 10.1089/lap.2014.0492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Single-incision pediatric endosurgery (SIPES) allows operation through one access site, eliminating the multiple sites traditionally used. There are few large series evaluating the versatility of SIPES. The purpose of this study is to review a 5-year single-institution experience with routine SIPES use. PATIENTS AND METHODS This is an Institutional Review Board-approved retrospective analysis of prospectively collected data. All SIPES cases from March 2009 to December 2013 were included. Our database contains demographics, procedure type, operative duration, estimated blood loss, instance of added ports or conversion to open, complications, and follow-up duration. RESULTS Of 1322 SIPES operations performed, most (82.1%) were appendectomies and cholecystectomies. Of 871 (66%) patients seen in follow-up, with a median duration of 26 days, 53 (6.1%) experienced postoperative complications. Forty-two cases (4.8%) were surgical-site infections, of which 4 required drainage. Less frequent complications that required operative intervention include recurrent inguinal hernia (n=4), umbilical hernia (n=3), intraabdominal abscess (n=1), bleeding (n=1), abdominal compartment syndrome (n=1), bowel obstruction (n=1), stitch granuloma (n=1), and persistent postoperative pain (n=1). CONCLUSIONS Operative times and complication rates are comparable to those in prior reported multiport laparoscopic series, allowing safe integration of SIPES into the routine of a surgical practice for most common procedures.
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Ponsky TA, Nalugo M, Ostlie DJ. Pediatric Laparoscopic Inguinal Hernia Repair: A Review of the Current Evidence. J Laparoendosc Adv Surg Tech A 2014; 24:183-7. [DOI: 10.1089/lap.2014.9998] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Todd A. Ponsky
- Akron Children's Hospital, Ohio Medical University, Akron, Ohio
| | - Margaret Nalugo
- Akron Children's Hospital, Ohio Medical University, Akron, Ohio
| | - Daniel J. Ostlie
- Department of Surgery, American Family Children's Hospital, University of Wisconsin, Madison, Wisconsin
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