Obstructive ileus caused by metal staples 6 years after the initial surgery: A case report

Revisiting the closed stapler laryngectomy: Technique and review of recent evidence

OBJECTIVE

To review the current literature regarding stapler-assisted closed total laryngectomy (TL), present a case series, and provide details on operative technique.

FINDING

Several meta-analyses and randomized controlled trials have demonstrated lower rates of pharyngocutaneous fistula (PCF) with closed stapler-assisted TL compared to traditional manual closure. Operative time, hospital stay, and time to oral feeding also appear to be lower. We present a five-patient case series of stapler-assisted closed TL with successful outcomes, including the first reported salvage case with free flap reconstruction, and provide technical detail including intraoperative photographs.

CONCLUSION

Stapler-assisted closed TL appears to be a safe alternative to traditional manual closure in select patients with endolaryngeal tumors with potential for lower rates of PCF and shorter operative time, hospital stay, and time to oral feeding.

Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review

Introduction

Appendectomy is a common emergency surgery performed globally. Despite the frequency of laparoscopic appendectomy, consensus does not exist on the best way to perform each procedural step. We identified literature on key intraoperative steps to inform best technical practice during laparoscopic appendectomy.

Methods

Research questions were framed using the population, indication, comparison, outcome (PICO) format for 6 key operative steps of laparoscopic appendectomy: abdominal entry, placement of laparoscopic ports, division of mesoappendix, division of appendix, removal of appendix, and fascial closure. These questions were used to build literature queries in PubMed, EMBASE, and the Cochrane Library databases. Evidence quality and certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) definitions.

Results

Recommendations were rendered for 6 PICO questions based on 28 full length articles. Low quality evidence favors direct trocar insertion for abdominal entry and establishment of pneumoperitoneum. Single port appendectomy results in improved cosmesis with unclear clinical implications. There was insufficient data to determine the optimal method of appendiceal stump closure, but use of a specimen extraction bag reduces rates of superficial surgical site infection and intra-abdominal abscess. Port sites made with radially dilating trocars are less likely to necessitate closure and are less likely to result in port site hernia. When port sites are closed, a closure device should be used.

Conclusion

Key operative steps of laparoscopic appendectomy have sufficient data to encourage standardized practice.