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Destek S, Kundakcioglu H, Bektasoglu HK, Kunduz E, Yigman S, Tak AY, Gul VO, Deger KC. Comparison of open and laparoscopic techniques in the surgical treatment of acute appendicitis. North Clin Istanb 2023; 10:704-710. [PMID: 38328728 PMCID: PMC10846568 DOI: 10.14744/nci.2022.08941] [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: 08/15/2022] [Revised: 08/31/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Acute appendicitis (AA) is the most common cause of acute abdomen and appendectomy is one of the most common surgical procedures. In this study, we aimed to compare open appendectomy (OA) and laparoscopic (LA) surgical techniques in the treatment of AA. METHODS The data of 236 patients treated with the diagnosis of AA in 2019-2020 were analyzed. Of these patients, 85 patients who received OA and 84 patients who received LA were included in the study. Then, the two groups were compared in terms of demographic, laboratory, clinical, and surgical treatments. RESULTS A total of 169 patients were included in the study. The mean age was 34.9 years (range 16-78), and the male-to-female ratio was 0.69. Statistical analysis revealed that the OA group had more leukocytosis, more female gender, and longer operation time than the LA group, but the LA group's complication rate was lower (p<0.05). CONCLUSION LA offers less morbidity, a shorter duration of hospital stay, and a fast return to normal activities compared to OA. In the surgical treatment of AA, LA can be applied as a routine and first-line treatment.
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Affiliation(s)
- Sabahattin Destek
- Department of General Surgery, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkiye
| | - Hacer Kundakcioglu
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | | | - Enver Kunduz
- Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | - Samet Yigman
- Department of General Surgery, Koc University Faculty of Medicine, Istanbul, Turkiye
| | - Aysegul Yabaci Tak
- Department of Biostatistics, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkiye
| | - Vahit Onur Gul
- Department of General Surgery, Koru Hospital, Ankara, Turkiye
| | - Kamuran Cumhur Deger
- Department of General Surgery, Biruni University Faculty of Medicine, Istanbul, Turkiye
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2
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Kim H, Kang BM. Impact of the COVID-19 pandemic on the outcomes of laparoscopic appendectomy for acute appendicitis. Ann Surg Treat Res 2023; 104:274-280. [PMID: 37179695 PMCID: PMC10172030 DOI: 10.4174/astr.2023.104.5.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose This retrospective study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the time interval from symptom onset to surgery and on the operative outcomes of laparoscopic appendectomy for patients with acute appendicitis. Methods Between October 2018 and July 2021, laparoscopic appendectomy was performed in 502 patients with acute appendicitis admitted to Hallym University Chuncheon Sacred Heart Hospital in Chuncheon, Korea. We compared demographic data, serum levels of inflammatory markers, time to event of appendicitis, and operative outcomes between the pre-COVID-19 and post-COVID-19 pandemic groups. Results Laparoscopic appendectomy was performed in 271 patients in the pre-COVID-19 group and in 231 patients in the post-COVID-19 group. There were no differences in baseline characteristics, serum inflammatory marker levels, or the proportions of complicated appendicitis between the groups (25.1%, pre-COVID-19 vs. 31.6%, post-COVID-19; P = 0.106). The time intervals between symptom onset and hospital arrival (24.42 hours vs. 23.59 hours, P = 0.743) and between hospital arrival and the start of surgery (10.12 hours vs. 9.04 hours, P = 0.246) did not increase post-COVID-19. The overall 30-day postoperative complication rate did not differ significantly between the groups (9.6% vs. 10.8%, P = 0.650), and the severity of 30-day postoperative complications was also similar in both groups (P = 0.447). Conclusion This study demonstrates that hospitalization and surgeries were not delayed in patients with acute appendicitis and that the operative outcomes of laparoscopic appendectomy did not worsen despite the COVID-19 pandemic.
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Affiliation(s)
- Hanbaro Kim
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung Mo Kang
- Department of Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Laparoscopic versus open appendicectomy for complicated appendicitis in children: A systematic review and meta-analysis. J Pediatr Surg 2022; 57:394-405. [PMID: 34332757 DOI: 10.1016/j.jpedsurg.2021.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) is the preferred approach in uncomplicated appendicitis. However, in patients with complicated appendicitis (CA), the best approach is still unclear though laparoscopy is being increasingly preferred over open appendicectomy (OA) nowadays. AIM To comprehensively review the current literature and compare the associations of LA and OA concerning various postoperative outcomes in order to determine the best approach for children with CA. METHODS The PRISMA guidelines were adhered to and an electronic database search was extensively performed. Data analysis, including subgroup analysis of randomized-control trials, was performed using RevMan 5.3. Methodological and statistical heterogeneity, as well as publication bias of the included studies, were assessed. RESULTS Four randomized controlled trials (266 LA versus 354 OA) and thirty-six case-controlled trials (2580 LA versus 3043 OA) were included in the analysis. Compared to OA, LA has a shorter length of stay, a lower rate of surgical site infection as well as a significantly lower overall complication rate. The rates of intraabdominal abscess formation, post-operative fever, pneumonia and ileus are similar in the two groups. So are the rates of readmissions and reoperations. LA was also shown to have a shorter time taken to oral intake and a lesser requirement of analgesics as well as intravenous antibiotics. Operative time for OA was found to be significantly shorter than that for LA. CONCLUSION This meta-analysis objectively demonstrates that laparoscopy has a better overall complication profile compared to OA and should be the procedure of choice in children with complicated appendicitis.
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Mahajan A, Jarupla S, Vadthya G, Chowdhary M, Tiwari H, Pandey P, Syed A. An evaluation of the choice of the treatment for the acute appendicitis an original research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S188-S190. [PMID: 36110638 PMCID: PMC9469240 DOI: 10.4103/jpbs.jpbs_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/18/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction: Material and Methods: Results: Conclusion:
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Han J, Kim H, Han SH, Kang BM. Hybrid Appendectomy in Pediatric Appendicitis: A Comparative Analysis of Single-Port and Multiport Laparoscopic Appendectomy. J Laparoendosc Adv Surg Tech A 2021; 32:330-335. [PMID: 34748411 DOI: 10.1089/lap.2021.0625] [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: Hybrid appendectomy (HA) has the technical advantages of the excellent visual field provided by laparoscopic surgery and is fast and easy similar to open surgery. We aimed to compare the safety and effectiveness of HA with single- and multiport laparoscopic appendectomy (SPLA and MPLA) in pediatric patients with acute appendicitis. Materials and Methods: This retrospective study compared the short-term operative outcomes between HA, SPLA, and MPLA groups. From January, 2010 to December, 2019, 239 patients aged <12 years who underwent laparoscopic appendectomy for acute appendicitis were included. The primary outcome was the 30-day postoperative complication rate, stratified according to the modified Clavien-Dindo classification. Results: In 239 patients, HA was more frequently performed in patients with a low body mass index (17.42 versus 18.97 kg/m2 in the SPLA group versus 18.44 kg/m2 in the MPLA group, P = .029) and tended to be more frequently adopted in uncomplicated appendicitis. In uncomplicated appendicitis, the HA group had a significantly shorter operation time than the MPLA group (31.77 versus 40.09 min, P < .001), but had a comparable operation duration with the SPLA group. The rate of 30-day postoperative complications was not significantly different between the groups (HA 7.6% versus SPLA 7.8% versus MPLA 5.4%, P = .841). The postoperative time to resume water intake was significantly longer in the SPLA group than in the HA and MPLA groups (P = .008). Conclusions: HA showed a short operation time, fast functional recovery, and acceptable postoperative complication rate in patients with uncomplicated appendicitis and can be safely and effectively performed in these patients.
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Affiliation(s)
- Jeonghee Han
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Hanbaro Kim
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Hyup Han
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Fernández-Moreno MC, Pérez Santiago L, Martí Fernández R, León Espinoza C, Ortega Serrano J. Is laparoscopic approach still a risk factor for postappendectomy intra-abdominal abscess? J Trauma Acute Care Surg 2021; 90:163-169. [PMID: 33003018 DOI: 10.1097/ta.0000000000002957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of laparoscopic appendectomy (LA) on the incidence of intra-abdominal abscess (IAA) remains controversial. We aimed to identify risk factors for postappendectomy IAA and assess the impact of appendectomy approach in postoperative morbidity. METHODS A retrospective single-center study including consecutive patients who underwent appendectomy for acute appendicitis between 2015 and 2018 was performed. Demographic, clinical, intraoperative, and perioperative variables were collected. Univariate and multivariate analyses was performed to detect independent risk factors for IAA. Comparison of LA and open appendectomy was conducted, and propensity score model (PSM) was used to overcome differences between groups. Independent risk factors for IAA were identified by univariate and multivariate analyses in the PSM cohort. RESULTS A total of 532 appendectomies were included. The median age was 35 years. Three hundred two patients (56.7%) underwent LA. The most frequent operative finding was American Association for the Surgery of Trauma (AAST) grade 1 appendicitis in 303 patients (57%). Peritonitis was found in 109 patients (20.5%). Postoperative morbidity and mortality were 14.4% and 0%, respectively. Intra-abdominal abscess rate was 6.2%. An AAST grade of ≥2, a preoperative C-reactive protein level of >100 mg/dL, and diabetes mellitus were identified as independent risk factors for IAA in the multivariate analysis. Comparing LA and open appendectomy, there were no differences in IAA rates. After PSM, LA showed lower morbidity and shorter hospital stay. CONCLUSIONS Laparoscopic appendectomy is a safe approach and not related to a higher risk of IAA. Patients with an AAST grade of ≥2, a preoperative C-reactive protein level of >100, and diabetes mellitus have higher risk for postappendectomy IAA. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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Affiliation(s)
- María-Carmen Fernández-Moreno
- From the Department of Surgery (M.-C.F.-M., L.P.S., R.M.F., C.L.E., J.O.S.), Hospital Clínico Universitario de Valencia; and Biomedical Research Institute (INCLIVA) (J.O.S.), University of Valencia, Valencia, Spain
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Lee HJ, Woo JY, Byun J. Right hydronephrosis as a sign of complicated appendicitis. Eur J Radiol 2020; 131:109241. [PMID: 32916410 DOI: 10.1016/j.ejrad.2020.109241] [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: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acute appendicitis is known for one of the most common cause of acute abdomen. However, it is still challenging to clearly distinguish complicated from uncomplicated appendicitis preoperatively. We investigated the association between right hydronephrosis and complicated appendicitis compared with other computed tomography (CT) findings of acute appendicitis. MATERIALS AND METHODS 1275 patients who pathologically diagnosed with acute appendicitis were included. They were classified into the complicated appendicitis and uncomplicated appendicitis groups based on their histopathological results. We reviewed their CT findings, including right hydronephrosis, appendiceal wall defect, periappendiceal abscess, extraluminal or intraluminal free air, appendicolith, appendiceal dilatation, appendiceal wall thickening, periappendiceal infiltration, periappendiceal fluid collection, and ascites. Comparison between the two groups was performed and the diagnostic performance of each CT finding was evaluated. The location of appendix and periureteral extension of periappendiceal infiltration were evaluated in patients with right hydronephrosis. RESULTS Out of 1275 patients, 29 (2.3 %) patients showed right hydronephrosis. Right hydronephrosis was significantly related to complicated appendicitis with the odds ratio of 4.90 (95 % confidence interval, 1.62-14.83; P = 0.005). Right hydronephrosis yielded specificity of 99.3 %. All patients with right hydronephrosis accompanied with periappendiceal infiltration and 28 (96.6 %) patients showed periureteral extension. Subcecal and pelvic areas are the most common locations, with 11 (37.9 %) patients each. CONCLUSION The presence of right hydronephrosis was specific finding for complicated appendicitis and it could be considered as one of indirect sign of complicated appendicitis.
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Affiliation(s)
- Hyung Ju Lee
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Jieun Byun
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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Martínez-Pérez A, Payá-Llorente C, Santarrufina-Martínez S, Sebastián-Tomás JC, Martínez-López E, de'Angelis N. Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults. Surg Endosc 2020; 35:3628-3635. [PMID: 32767147 DOI: 10.1007/s00464-020-07841-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Appendicitis-related hospitalizations linked with peritonitis or postoperative complications result in longer lengths of stay and higher costs. The aim of the present study was to assess the independent association between potential predictors and prolonged hospitalization after laparoscopic appendectomy (LA) for complicated acute appendicitis (CAA). METHODS A retrospective cohort study was conducted on adult patients diagnosed with CAA in which LA was attempted. The primary outcome was a prolonged length of stay (LOS) after surgery, defined as hospitalizations longer than or equal to the 75th percentile for LOS, including the day of discharge. Hierarchical regression models were run to elucidate the independent predictors for the variable of interest. RESULTS The present study involved 160 patients with a mean age of 50.71 years. The conversion rate was 1.9%, and the overall postoperative morbidity rate was 23.8%. The median length of stay (LOS) was 5 days (75th percentile: 7 days). Multivariate analyses included nine variables that are statistically and/or clinically relevant to assess its relationship with a prolonged LOS: three preoperative (age, sex, and comorbidity), four intraoperative (appendix gangrene, perforation, degree of peritonitis, and drain placement), and two postoperative (immediate ICU admission and complications). The development of postoperative complications (OR 6.162, 95% CI 2.451-15.493; p = 0.000) and the placement of an abdominal drain (OR 3.438, 95% CI 1.107-10.683; p = 0.033) were found to be independent predictors for prolonged LOS. For patients not presenting postoperative complications, drain placement was the only independent predictor for the outcome (OR 7.853, 95% CI 1.520-40.558; p = 0.014). Sensitivity analyses showed confirmatory results. CONCLUSION The intraoperative process of care has a clear impact on LOS after LA for CAA in adults; therefore, the decision of whether to drain in these situations should be made more restrictively yet with judicious caution.
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Affiliation(s)
- Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Carmen Payá-Llorente
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain
| | | | - Juan Carlos Sebastián-Tomás
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain
| | - Elías Martínez-López
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri-Mondor University Hospital, AP-HP, Université Paris Est - UPEC, Créteil, France
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Comparison of three techniques for appendiceal stump closure during laparoscopy. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.781614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Groves LB, Ladd MR, Gallaher JR, Swanson J, Becher RD, Pranikoff T, Neff LP. Comparing the Cost and Outcomes of Laparoscopic versus Open Appendectomy for Perforated Appendicitis in Children. Am Surg 2020. [DOI: 10.1177/000313481307900915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although laparoscopic appendectomy (LA) is accepted treatment for perforated appendicitis (PA) in children, concerns remain whether it has equivalent outcomes with open appendectomy (OA) and increased cost. A retrospective review was conducted of patients younger than age 17 years treated for PA over a 12.5-year period at a tertiary medical center. Patient characteristics, pre-operative indices, and postoperative outcomes were analyzed for patients undergoing LA and OA. Of 289 patients meeting inclusion criteria, 86 had LA (29.8%) and 203 OA (70.2%), the two groups having equivalent patient demographics and preoperative indices. Inpatient costs were not significantly different between LA and OA. LA had a lower rate of wound infection (1.2 vs 8.9%, P = 0.017), total parenteral nutrition use (23.3 vs 50.7%, P < 0.0001), and length of stay (5.56 ± 2.38 days vs 7.25 ± 3.77 days, P = 0.0001). There was no significant difference in the rate of postoperative organ space abscess, surgical re-exploration, or rehospitalization. In children with PA, LA had fewer surgical site infections and shorter lengths of hospital stay compared with OA without an increase in inpatient costs.
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Affiliation(s)
- Leslie B Groves
- Department of Surgery, Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - John Swanson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Robert D. Becher
- Department of Surgery, Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Thomas Pranikoff
- Department of Surgery, Section of Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lucas P. Neff
- Department of Surgery, University of California at Davis, Sacramento, California
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Sabbagh C, Siembida N, Dupont H, Diouf M, Schmit JL, Boddaert S, Regimbeau JM. The value of post-operative antibiotic therapy after laparoscopic appendectomy for complicated acute appendicitis: a prospective, randomized, double-blinded, placebo-controlled phase III study (ABAP study). Trials 2020; 21:451. [PMID: 32487213 PMCID: PMC7268648 DOI: 10.1186/s13063-020-04411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Approximately 30% of appendectomies are for complicated acute appendicitis (CAA). With laparoscopy, the main post-operative complication is deep abscesses (12% of cases of CAA, versus 4% for open surgery). A recent cohort study compared short and long courses of postoperative antibiotic therapy in patients with CAA. There was no significant intergroup difference in the post-operative complication rate (12% of organ/space surgical site infection (SSI)). Moreover, antibiotic therapy is increasingly less indicated for other situations (non-complicated appendicitis, post-operative course of cholecystitis, perianal abscess), calling into question whether post-operative antibiotic therapy is required after laparoscopic appendectomy for CAA. METHODS/DESIGN This study is a prospective, multicenter, parallel-group, randomized (1:1), double-blinded, placebo-controlled, phase III non-inferiority study with blind evaluation of the primary efficacy criterion. The primary objective is to evaluate the impact of the absence of post-operative antibiotic therapy on the organ/space surgical site infection (SSI) rate in patients presenting with CAA (other than in cases of generalized peritonitis). Patients in the experimental group will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, a placebo for ceftriaxone (2 g/24 h in one intravenous injection) and a placebo for metronidazole (1500 mg/24 h in three intravenous injections, for 3 days). In the control group, patients will receive at least one dose of preoperative and perioperative antibiotic therapy (2 g ceftriaxone by intravenous injection every 24 h up to the operation) and metronidazole (500 mg by intravenous injection every 8 h up to the operation) and, in the post-operative period, antibiotic therapy (ceftriaxone 2 g/24 h and metronidazole 1500 mg/24 h for 3 days). In the event of allergy to ceftriaxone, it will be replaced by levofloxacin (500 mg/24 h in one intravenous injection, for 3 days). The expected organ space SSI rate is 12% in the population of patients with CAA operated on by laparoscopy. With a non-inferiority margin of 5%, a two-sided alpha risk of 5%, a beta risk of 20%, and a loss-to-follow-up rate of 10%, the calculated sample size is 1476 included patients, i.e., 738 per group. Due to three interim analyses at 10%, 25%, and 50% of the planned sample size, the total sample size increases to 1494 patients (747 per arm). TRIAL REGISTRATION Ethical authorization by the Comité de Protection des Personnes and the Agence Nationale de Sécurité du Médicament: ID-RCB 2017-00334-59. Registered on ClinicalTrials.gov (NCT03688295) on 28 September 2018.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France.,Jules Verne University of Picardie, Amiens, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France
| | - N Siembida
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France
| | - H Dupont
- Jules Verne University of Picardie, Amiens, France.,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France.,Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - M Diouf
- Department of Methodology, Biostatistics, Direction of Clinical Research, Amiens University Medical Center, Amiens, France
| | - J L Schmit
- Jules Verne University of Picardie, Amiens, France.,Department of Infectious Diseases, Amiens University Medical Center, Amiens, France
| | - S Boddaert
- Department of Pharmacology, Amiens University Medical Center, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens University Medical Center, Avenue Laennec, F-80054, Amiens cedex 01, France. .,Jules Verne University of Picardie, Amiens, France. .,SSPC (Simplifications des Soins Patients Chirurgicaux Complexes) Research Unit, University of Picardie Jules Verne, Amiens, France.
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Diaconescu B, Uranues S, Fingerhut A, Vartic M, Zago M, Kurihara H, Latifi R, Popa D, Leppäniemi A, Tilsed J, Bratu M, Beuran M. The Bucharest ESTES consensus statement on peritonitis. Eur J Trauma Emerg Surg 2020; 46:1005-1023. [PMID: 32303796 DOI: 10.1007/s00068-020-01338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Peritonitis is still an important health problem associated with high morbidity and mortality. A multidisciplinary approach to the management of patients with peritonitis may be an important factor to reduce the risks for patients and improve efficiency, outcome, and the cost of care. METHODS Expert panel discussion on Peritonitis was held in Bucharest on May 2017, during the 17th ECTES Congress, involving surgeons, infectious disease specialists, radiologists and intensivists with the goal of defining recommendations for the optimal management of peritonitis. CONCLUSION This document is an updated presentation of management of peritonitis and represents the summary of the final recommendations approved by a panel of experts.
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Affiliation(s)
- Bogdan Diaconescu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania.
| | - Selman Uranues
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, P.R. China
| | - Mihaela Vartic
- Intensive Care Unit, Emergency Clinic Hospital Bucharest, Bucharest, Romania
| | - Mauro Zago
- General and Emergency Surgery Division, Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Section, Department of General Surgery, Humanitas Clinical and Research Hospital Head, Milan, Italy
| | - Rifat Latifi
- Westchester Medical Center, Valhalla, New York, USA
| | - Dorin Popa
- Surgery Department, University Hospital Linkoping, Linköping, Sweden
| | - Ari Leppäniemi
- Division of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jonathan Tilsed
- Honorary Senior Lecturer Hull York Medical School, Chairman UEMS Division of Emergency Surgery, Heslington, UK
| | - Matei Bratu
- Anatomy Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
| | - Mircea Beuran
- Surgery Department, Carol Davila University of Medicine and Phamacy, Bucharest, Romania
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Lasek A, Wysocki M, Mavrikis J, Myśliwiec P, Bobowicz M, Dowgiałło-Wnukiewicz N, Kenig J, Stefura T, Walędziak M, Pędziwiatr M. Comparison of stump closure techniques during laparoscopic appendectomies for complicated appendicitis - results from Pol-LA (Polish laparoscopic appendectomy) multicenter large cohort study. Acta Chir Belg 2020; 120:116-123. [PMID: 30747049 DOI: 10.1080/00015458.2019.1573527] [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: 12/29/2022]
Abstract
Background: In general, the three main options for stump closure in laparoscopic appendectomy are clips, endoscopic staplers and endoloops. However, there is no gold standard, especially regarding complicated acute appendicitis which is generally associated with worse outcomes.Objectives: We aimed to assess the outcomes of different stump closure techniques during laparoscopic appendectomies for complicated appendicitisMethods: Our multicenter observational study of 18 surgical units assessed the outcomes of 1269 laparoscopic appendectomies for complicated appendicitis that used the three main stump closure techniques: clips, staplers and endoloops. Groups were compared in terms of peri- and postoperative outcomes.Results: Staplers were superior in terms of overall morbidity (9.79 vs. 3.29% vs. 7.41%, p = .017) and length of stay (4 vs. 3 vs. 4 days, p < .001) respectively for clips, staplers and endoloops. However, no differences in major complication rates, postoperative intraabdominal abscess formation, reintervention rates and readmission rates were found.Conclusion: Although our results show some clinical benefits of staplers for appendix stump closure, they are based on a non-randomized group of patients and are therefore prone to selection bias. Further well-designed trials taking into consideration not only the clinical benefits, but also, the economic aspects of the surgical treatment of complicated acute appendicitis are needed to confirm our results.
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Affiliation(s)
- Anna Lasek
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Center for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Judene Mavrikis
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Myśliwiec
- 1st Department of General and Endocrinological Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Maciej Bobowicz
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Natalia Dowgiałło-Wnukiewicz
- Department of General, University of Warmia and Mazury in Olsztyn, Minimally Invasive and Elderly Surgery, Olsztyn, Poland
| | - Jakub Kenig
- Department of General, Oncologic and Geriatric Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Stefura
- Students’ Scientific Society of 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Center for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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Laparoscopic Lavage Versus Aspiration Alone in Perforated Acute Appendicitis: A Prospective Randomized Controlled Study. Surg Laparosc Endosc Percutan Tech 2019; 30:14-17. [PMID: 31855922 DOI: 10.1097/sle.0000000000000745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Leary JC, Walsh KE, Morin RA, Schainker EG, Leyenaar JK. Quality and Safety of Pediatric Inpatient Care in Community Hospitals: A Scoping Review. J Hosp Med 2019; 14:694-703. [PMID: 31532739 PMCID: PMC6827538 DOI: 10.12788/jhm.3268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the majority of children are hospitalized in nonchildren's hospitals, little is known about the quality and safety of pediatric care in community hospitals. OBJECTIVE The aim of this study was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in United States community hospitals. METHODS We performed a systematic literature search in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set in general, nonuniversity, or nonchildren's hospitals. We extracted data on study design, patient descriptors, and quality outcomes and assessed the risk of bias using modified Newcastle-Ottawa Scales. RESULTS A total of 44 articles met the inclusion criteria. Study designs, patient populations, and quality outcome measures were heterogeneous; only three clinical domains, (1) perinatal regionalization, (2) telemedicine, and (3) imaging radiation, were explored in multiple studies with consistent directionality of results. A total of 30 studies were observational, and 22 studies compared community hospital quality outcomes with other hospital types. The remaining 14 studies reported testing of interventions; 12 showed improved quality of care postintervention. All studies reported an outcome addressing safety, effectiveness, or efficiency, whereas timeliness, patient-centeredness, and equity were infrequently addressed. Risk of bias was moderate or high for 72% of studies. CONCLUSIONS Literature on the inpatient care of children in community hospitals is limited, making it difficult to evaluate healthcare quality. Measures of timeliness, patient-centeredness, and equity are underrepresented. The field would benefit from more multicenter collaborations to facilitate the application of robust study designs and to enable a systematic assessment of individual interventions and community hospital quality outcomes.
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Affiliation(s)
- Jana C Leary
- The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
- Corresponding Author: Jana C. Leary, MD, MS; E-mail: ; Telephone: 617-636-4624
| | - Kathleen E Walsh
- James M Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Rebecca A Morin
- Tufts University, Hirsh Health Sciences Library, Boston, Massachusetts
| | | | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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16
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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: 50] [Impact Index Per Article: 10.0] [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.
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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.
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Allaway MGR, Eslick GD, Cox MR. The Unacceptable Morbidity of Negative Laparoscopic Appendicectomy. World J Surg 2018; 43:405-414. [PMID: 30209573 DOI: 10.1007/s00268-018-4784-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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18
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Laparoscopic Appendectomy for Complicated Acute Appendicitis in the Elderly: A Single-center Experience. Surg Laparosc Endosc Percutan Tech 2018; 27:366-368. [PMID: 28708770 DOI: 10.1097/sle.0000000000000447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of laparoscopic appendectomy for complicated acute appendicitis remains controversial in the elderly. This study aimed to compare the postoperative outcomes of elderly patients who received either laparoscopic appendectomy or open appendectomy. PATIENTS AND METHODS A single-centre retrospective analysis of the clinical records of elderly patients (age, above 65 y) who underwent operations from January 2012 to November 2015 was performed. Demographic data, intraoperative variables, length of stay, and surgical complications were retrieved. RESULTS A total of 145 elderly patients were preoperatively diagnosed with acute appendicitis. There were 43 (29.66%) complicated and 102 (70.34%) uncomplicated appendicitis cases. A total of 65 (44.83%) procedures were performed using the open technique (OA group) and 80 (55.17%) using the laparoscopic technique (LA group). In the laparoscopic group, 19 (23.75%) patients had complicated acute appendicitis (CLA group), and 61 (76.25%) had uncomplicated acute appendicitis (UCLA group). In the complicated group, 19 (44.19%) patients underwent operation using the laparoscopic technique (CLA group) and 24 (55.81%) using the open technique (COA group). There were no significant differences between the LA and OA groups in terms of age, sex distribution, duration of symptoms, American Society of Anesthesiologists score, white blood cells, complicated appendicitis, operation time, drain apposition, days to resumption of liquids, and postoperative complications (P>0.05). Significant differences were found in days to start walking and days to resumption of solids in the LA group (P<0.05). The OA group had a longer length of hospital stay than the LA group (P<0.05). Postoperative complications were not significantly different between the groups (P>0.05). The CLA group had a significantly longer duration of symptoms, operation times, days to resumption of liquids, and days to resumption of solids than the UCLA group (P<0.05). The COA group had significantly longer days to walking and hospital stays than the CLA group (P<0.05). CONCLUSIONS Our study demonstrated that using LA to treat complicated acute appendicitis in the elderly was not associated with additional surgical complications. Therefore, it seems feasible to use LA as a safe technique for complicated acute appendicitis in the elderly.
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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).
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Laparoscopic Procedure is Not Independently Associated With the Development of Intra-Abdominal Abscess After Appendectomy: A Multicenter Cohort Study With Propensity Score Matching Analysis. Surg Laparosc Endosc Percutan Tech 2017; 27:409-414. [DOI: 10.1097/sle.0000000000000460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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The evolving management of the appendix mass in the era of laparoscopy and interventional radiology. Surgeon 2016; 15:109-115. [PMID: 27612947 DOI: 10.1016/j.surge.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 12/15/2022]
Abstract
AIM An appendix mass is the result of a walled-off perforation of the appendix which localises, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. However, its management is controversial due to the lack of high level evidence. This review article sets out a rationale diagnostic and therapeutic strategy for the appendix mass based upon up-to-date available evidence. METHODS A literature review of the investigation and management of appendix mass/complicated appendicitis was undertaken using PubMed, EMBASE and Google Scholar. RESULTS/CONCLUSION No prospective studies were identified. The great majority of recent evidence supports a conservative management approach avoiding urgent appendicectomy because of the high risk of major complications and bowel resection. Appendix abscesses over 5 cm in diameter and persistent abscesses should be drained percutaneously along with antibiotics. Appendix phlegmon should be treated with antibiotics alone. Surgery is reserved for patients who fail conservative treatment. Routine interval appendicectomy is not recommended, but should be considered in the context of persistent faecolith, ongoing right iliac fossa pain, recurrent appendicitis and appendix mass persistent beyond 2 weeks. Clinicians should be particularly wary of patients with appendix mass aged over 40 and those with features suggesting malignancy.
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Kim JK, Kang J, Kim WR, Park EJ, Baik SH, Lee KY. Does Conversion Adversely Impact the Clinical Outcomes for Patients with Complicated Appendicitis? J Laparoendosc Adv Surg Tech A 2016; 26:635-40. [PMID: 27258692 DOI: 10.1089/lap.2016.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the feasibility of laparoscopic appendectomy (LA) in complicated appendicitis (CA) has been demonstrated, LA is typically underused in CA due to its high conversion rate. However, little is known regarding the clinical course of conversion in CA. MATERIALS AND METHODS Between January 2005 and April 2012, 1699 patients older than 16 years underwent an appendectomy at our institution. Of these, 207 were confirmed to have CA, which was defined as operative findings of gangrenous or perforated appendix, with or without abscess formation. Patients were divided into the following three groups: open group (OG), laparoscopy group (LG), and converted group (CG). Perioperative outcomes were compared between the three groups. RESULTS Thirty-eight patients underwent open surgery. Among the 169 patients for whom laparoscopic surgery was originally attempted, 20 (11.8%) were converted. Operation time was significantly longer and estimated blood loss was higher in the CG than in the other groups. Fewer overall complications were observed and the length of hospital stay (LOH) was shorter in the LG than in the OG and CG. However, no significant differences were observed between the OG and CG regarding the overall complication rate or LOH. Operation method was the only factor associated with postoperative morbidity in multivariate analysis. CONCLUSION While completion by laparoscopy was associated with better outcomes than the other two procedures at all levels, open conversion did not increase the overall morbidity or LOH compared with open appendectomy. Laparoscopic approach could be a viable option even in the management of CA.
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Affiliation(s)
- Jin Kyong Kim
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, Korea
| | - Jeonghyun Kang
- 2 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Woo Ram Kim
- 3 Department of Surgery, CHA Bundang Medical Center, CHA University , Seongnam, Korea
| | - Eun Jung Park
- 4 Division of Colon and Rectal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hyuk Baik
- 2 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Kang Young Lee
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, Korea
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Mán E, Németh T, Géczi T, Simonka Z, Lázár G. Learning curve after rapid introduction of laparoscopic appendectomy: are there any risks in surgical resident participation? World J Emerg Surg 2016; 11:17. [PMID: 27148395 PMCID: PMC4855767 DOI: 10.1186/s13017-016-0074-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/29/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND With the spread of the minimally invasive technique, laparoscopic appendectomy (LA) is performed with increasing frequency with excellent results. The method provides surgical residents with an excellent opportunity to learn basic laparoscopic skills and prepares them for more complex interventions. METHODS We evaluated the results of 600 laparoscopic appendectomies performed by 5 surgical residents (Group A) and 5 consultant surgeons (Group B) between 2006 and 2009. Comparing the two groups based on patient demographics, duration of surgery, operation time depending on the severity of inflammation, intraoperative blood loss, conversion rate, hospital stay in days, and postoperative complications. We also assessed the extent to which the minimum of 20 surgeries to be performed in the learning curve period as recommended by the EAES corresponds to our experience. SPPS 20 was used for the statistical analysis. RESULTS Six hundred laparoscopic appendectomies were performed in the study period (Group A: n = 319; Group B: n = 281). A significant difference was found between the two groups in duration of surgery during the learning curve period and when comparing the duration of LA surgeries in the learning curve period with the duration of later surgeries in both groups. The operation time in case of more severe inflammation also showed a significant difference when comparing with simple appendicitis operation time. CONCLUSIONS The rapid introduction of laparoscopy involves few risks, the surgery is also performed with sufficient safety by surgical residents, and it provides them with an excellent opportunity to learn the basic laparoscopy skills.
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Affiliation(s)
- Eszter Mán
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary
| | - Tibor Németh
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary
| | - Tibor Géczi
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy Béla u. 6, H-6720 Szeged, Hungary
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Kang BM, Hwang JW, Ryu BY. Single-port laparoscopic surgery in acute appendicitis: retrospective comparative analysis for 618 patients. Surg Endosc 2016; 30:4968-4975. [PMID: 26983434 DOI: 10.1007/s00464-016-4840-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
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Kim DY, Nassiri N, Saltzman DJ, Ferebee MP, Macqueen IT, Hamilton C, Alipour H, Kaji AH, Moazzez A, Plurad DS, de Virgilio C. Postoperative antibiotics are not associated with decreased wound complications among patients undergoing appendectomy for complicated appendicitis. Am J Surg 2015; 210:983-7; discussion 987-9. [PMID: 26453292 DOI: 10.1016/j.amjsurg.2015.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/02/2015] [Accepted: 07/16/2015] [Indexed: 01/03/2023]
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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
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Brümmer S, Sohr D, Gastmeier P. Intra-abdominal Abscesses and Laparoscopic Versus Open Appendectomies. Infect Control Hosp Epidemiol 2015; 30:713-5. [DOI: 10.1086/598246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Shan CX, Ni C, Qiu M, Jiang DZ, Li M. Influence of laparoscopy vs. laparotomy on bacterial translocation and systemic inflammatory responses in a porcine model with peritonitis. J INVEST SURG 2014; 27:73-80. [PMID: 24665843 DOI: 10.3109/08941939.2013.837564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to compare the effects of laparoscopy vs. laparotomy on bacterial translocation and immunologic responses in a porcine model with peritonitis caused by small bowel injuries (SBIs). METHODS Pigs with SBIs were first established, assigned into either the laparoscopy group or the laparotomy group, and then received surgical intervention. During 72 hours (72 hr) observation period, blood, and tissues of different organs were obtained for bacterial cultures; endotoxin and peripheral leukocyte were determined; serum levels of IL-6, TNF-α, and CRP were measured. RESULTS Blood cultures confirmed systemic bacteremia in all animals and the endotoxin level was comparable between groups at 24 hr after surgery. However, two days later, positive bacteremia was only detected in four pigs following laparoscopy and five following laparotomy. Eight and four pigs during laparoscopy (seven and six pigs during laparotomy) had translocated bacteria in mesenteric lymph nodes (MLN) and liver. The 72 hr later, bacteria in MLN, liver, lung, and kidney was found in 2, 1, 2, and 0 pig after laparoscopy, respectively (3, 2, 2, and 1 pig after laparotomy). The peripheral blood monocytes (PBMC) counts remained at a much lower level after laparoscopy than after laparotomy. Serum IL-6, TNF-α, and CRP increased notably after both procedures when compared to preoperative levels. However, significantly faster and lower regression of IL-6, TNF-α, and CRP were observed in the laparoscopy group. CONCLUSION Compared with laparotomy, laparoscopy does not result in increased bacterial translocation, but decrease IL-6, TNF-α, and CRP release.
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Affiliation(s)
- Cheng-Xiang Shan
- 1Department of General Surgery, Chang Zheng Hospital affiliated to the Second Military Medical University, Shang Hai, China
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Quezada F, Quezada N, Mejia R, Brañes A, Padilla O, Jarufe N, Pimentel F. Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience. Int J Surg 2014; 13:80-83. [PMID: 25461855 DOI: 10.1016/j.ijsu.2014.11.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/03/2014] [Accepted: 11/22/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversial evidence exists regarding the laparoscopic approach in patients with acute appendicitis complicated with peritonitis due to a higher rate of surgical complications. The aim of this study was to compare post-operatory outcomes in patients with acute appendicitis complicated exclusively with peritonitis approached by laparoscopy versus open surgery. METHODS Single center retrospective analysis of clinical records of patients with appendicitis complicated with peritonitis operated from January 2003 until October 2013. Demographic data, intra-operative variables, length of stay, surgical complications, mortality, readmissions and reoperations were retrieved. RESULTS 227 patients were identified, 43% males, mean age 39±17 years (range: 12-85 years). Ninety-seven patients (43%) underwent laparoscopic appendectomy, 13 of them were converted to open surgery (13%). Ninety-four patients presented with diffuse peritonitis (41.4%). Laparoscopic appendectomy showed longer operative time but shorter hospital stay (p<0.05). There were no differences in post-operatory complications (intra-abdominal abscess, surgical site infection and prolonged ileus). Laparoscopic appendectomy was associated with lower odds for developing any surgical complication in the multivariate analysis (OR 0.301, p=0.036). CONCLUSION Both approaches showed no differences in complications in the management of appendicitis complicated exclusively with peritonitis. In our experience, laparoscopic appendectomy is a safe approach in cases of appendicitis complicated exclusively with peritonitis.
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Affiliation(s)
- Felipe Quezada
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Quezada
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Ricardo Mejia
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Brañes
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oslando Padilla
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas Jarufe
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Pimentel
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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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
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Xiao Y, Shi G, Zhang J, Cao JG, Liu LJ, Chen TH, Li ZZ, Wang H, Zhang H, Lin ZF, Lu JH, Yang T. Surgical site infection after laparoscopic and open appendectomy: a multicenter large consecutive cohort study. Surg Endosc 2014; 29:1384-93. [PMID: 25303904 DOI: 10.1007/s00464-014-3809-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022]
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Aranda-Narváez JM, Prieto-Puga Arjona T, García-Albiach B, Montiel-Casado MC, González-Sánchez AJ, Sánchez-Pérez B, Titos-García A, Santoyo-Santoyo J. Infección de sitio quirúrgico tras apendicectomía urgente: tasa global y tipo según la vía de abordaje (abierta/laparoscópica). Enferm Infecc Microbiol Clin 2014; 32:76-81. [PMID: 23582194 DOI: 10.1016/j.eimc.2013.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
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Thereaux J, Veyrie N, Corigliano N, Servajean S, Czernichow S, Bouillot JL. Is laparoscopy a safe approach for diffuse appendicular peritonitis? Feasibility and determination of risk factors for post-operative intra-abdominal abscess. Surg Endosc 2014; 28:1908-13. [PMID: 24414463 DOI: 10.1007/s00464-013-3412-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies have assessed feasibility and early outcomes of the laparoscopic approach for complicated appendicitis (CA). However, these studies suffer from limitations due to the heterogeneous definitions used for CA. No studies have assessed feasibility and early post-operative outcomes of the laparoscopic approach in the specific management of diffuse appendicular peritonitis (DAP). Consequently, outcomes of the laparoscopic approach for the management of DAP are poorly documented. METHODS The laparoscopic approach is the first-line standardised procedure used by our team for the management of DAP. All patients (aged >16 years) who underwent laparoscopy for DAP (CA with the presence of purulent fluid with or without fibrin membranes in at least a hemi abdomen) between 2004 and 2012 were prospectively included. Post-operative outcomes were analysed according to the Clavien-Dindo classification. RESULTS Laparoscopy for DAP was performed for 141 patients. Mean age was 39.6 ± 20 (16-92) years. A total of 45 patients (31.9%) had pre-operative contracture. The mean pre-operative leukocyte count was 14,900 ± 4,380 mm(-3). The mean pre-operative C-reactive protein (CRP) serum concentration was 135 ± 112 (2-418) mg/dl. The conversion rate was 3.5%. The mean operative time was 80 ± 27 (20-180) min. There were no deaths. The rate of grade III morbidity was 6.5%. Ten patients (7.1%) experienced intra-abdominal abscess (IAA); seven of these cases were treated conservatively. The mean length of hospital stay was 6.9 ± 5 (2-36) days. A pre-operative leukocyte count >17,000 mm(-3), and CRP serum concentration >200 mg/dl were significant predictive factors for IAA in multivariate analyses [odds ratio (OR) 25.0, 95% confidence interval (CI) 2.4-250, p = 0.007 and OR 16.4, 95% CI 1.6-166, p = 0.02, respectively]. CONCLUSION The laparoscopic approach for DAP is a safe and feasible procedure with a low conversion rate and an acceptable rate of IAA in view of the severity of the disease. Pre-operative leukocyte counts >17,000 mm(-3) and pre-operative CRP serum concentrations >200 mg/dl indicate a high risk of IAA.
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Affiliation(s)
- Jérémie Thereaux
- Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France,
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Chang HK, Han SJ, Choi SH, Oh JT. Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J 2013; 54:1478-83. [PMID: 24142654 PMCID: PMC3809857 DOI: 10.3349/ymj.2013.54.6.1478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study evaluated the feasibility of a laparoscopic approach in children with generalized peritonitis secondary to perforated appendicitis. MATERIALS AND METHODS We retrospectively analyzed the medical records of patients who underwent laparoscopic appendectomy with drainage for generalized peritonitis secondary to perforated appendicitis at our hospital between September 2001 and April 2012. Laparoscopic outcomes were compared with outcomes of an open method for perforated appendicitis. RESULTS Ninety-nine patients underwent laparoscopic appendectomy (LA) for generalized peritonitis from perforated appendicitis, and 87 patients underwent open appendectomy (OA) for perforated appendicitis. Wound infection was more common in the OA group (12.6%) than in the LA group (4.0%; p=0.032). The incidence of intestinal obstruction during long-term follow-up was significantly higher in the OA group (4.6% vs. 0.0% in the LA group; p=0.046). LA was possible in most patients for whom LA was attempted, with a conversion rate of 10.8%. Conversion to OA was affected by the preoperative duration of symptoms and the occurrence of intraoperative complications. CONCLUSION LA is feasible for use in children with generalized peritonitis from perforated appendicitis, with reasonable open conversion and perioperative complication rates comparable to those of the OA group.
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Affiliation(s)
- Hye Kyung Chang
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Salloum C, Subar D, Memeo R, Tayar C, Laurent A, Malek A, Azoulay D. Laparoscopic robotic liver surgery: the Henri Mondor initial experience of 20 cases. J Robot Surg 2013; 8:119-24. [DOI: 10.1007/s11701-013-0437-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/23/2013] [Indexed: 12/14/2022]
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Vahdad MR, Troebs RB, Nissen M, Burkhardt LB, Hardwig S, Cernaianu G. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 2013; 48:555-61. [PMID: 23480912 DOI: 10.1016/j.jpedsurg.2012.07.066] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 07/23/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children with perforated appendicitis (PA). METHODS We reviewed the medical files of 221 children who underwent LA (n=75), OA (n=122), and conversion (CO) (n=24), comparing duration of operation, re-admissions, re-operations, intra-abdominal abscesses (IAA), and wound infections. RESULTS Compared to OA, LA resulted in fewer re-admissions (1.3% vs. 12.3%; P=.006), fewer re-operations (4% vs. 17.2%; P=.006), and fewer wound infections (0% vs. 11.5%; P=.001). No differences in the duration of operation (72.9 ± 23.0 min vs. 77.7 ± 48.0 min; P=.392) or IAA (4% vs. 11.5%; P=.114) were observed. Compared to LA, CO had more complications. CONCLUSIONS We report that LA is superior to OA with regard to incidence of re-admission, re-operation, and wound infection.
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Affiliation(s)
- Mohammad Reza Vahdad
- Department of Pediatric Surgery, Marienhospital-Kinderchirurgische Klinik der Ruhr-Universität Bochum, Widumerstr. 8, 44627 Herne, Germany.
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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.
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Dimitriou I, Reckmann B, Nephuth O, Betzler M. Single institution's experience in laparoscopic appendectomy as a suitable therapy for complicated appendicitis. Langenbecks Arch Surg 2012; 398:147-52. [PMID: 23212182 DOI: 10.1007/s00423-012-1035-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 11/19/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE Although laparoscopic appendectomy (LA) for acute appendicitis (AA) is widely performed, the value of LA for the treatment of complicated appendicitis (CA) is still controversially discussed. METHODS In a retrospective study, we analyzed the clinical records of 404 patients who underwent LA or conversion (intention-to-treat group) or open appendectomy (OA) for AA or CA at the Alfried Krupp Hospital Essen-Rüttenscheid, Germany between January 2007 and December 2010. RESULTS AA was treated in 64.2 % by LA and in 35.8 % by OA; the LA-to-OA conversion rate amounts to 3.7 %. CA was treated in 56 % by LA and in 44 % by OA. The LA-to-OA conversion rate here is 13.1 %, and compared to AA, it is significantly (P < 0.01) higher. Comparing LA with OA in both patient groups, we find no significant difference in the overall complication rate, the rate of postoperative intraabdominal abscesses and postoperative ileus. However, in both patient groups, the wound infection rate was significantly lower in patients who had undergone LA (AA P < 0.05 versus CA P < 0.01). In contrast to patients suffering from AA, patients with CA needed significantly less resurgery when treated by LA as compared to OA (P < 0.001). While the duration of surgery for the treatment of AA and CA was similar, the hospitalization time was significantly shorter with LA than with OA (AA P < 0.05 versus CA P < 0.001). CONCLUSIONS The data suggest that LA is advantageous not only in the treatment of AA, but also in the therapy of CA. Thus, LA may become a proper and safe routine method if performed by an experienced surgeon.
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Affiliation(s)
- Ioannis Dimitriou
- Department of Surgery I, Alfried Krupp Hospital Essen-Rüttenscheid, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
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Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 2012; 16:1993-2004. [PMID: 22810297 DOI: 10.1007/s11605-012-1962-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/01/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Appendectomy is one of the most common emergency operations performed in the pediatric population. The aim of this pooled analysis is to compare the outcome from complicated appendicitis (CA) and uncomplicated appendicitis (UA) following laparoscopic appendectomy (LA) and open appendectomy (OA) in children. METHODS A systematic literature search was performed. Primary outcome measures were incidence of complications, intra-abdominal abscess, and wound infection. Secondary outcomes were length of operation, length of hospital stay, incidence of bowel obstruction, and readmission. RESULTS Seventy-three thousand one hundred fifty appendectomies for UA and 34,474 appendectomies for CA were included. For UA, the only significant difference between the groups was a reduced length of hospital stay following LA. LA in CA was associated with reduced complications (pooled odds ratio [POR] = 0.53; P < 0.05), wound infections (POR = 0.42; P < 0.05), length of hospital stay (WMD = -0.67; P < 0.05), and bowel obstruction episodes (POR = 0.8; P < 0.05), but an increased incidence of intra-abdominal abscess and length of operation. CONCLUSION Pooled analysis demonstrates that, in children with uncomplicated acute appendicitis, LA is associated with a reduced hospital stay but broad equivalence in postoperative morbidity when compared with the conventional approach. Although overall morbidity is reduced when the laparoscopic approach is utilized, in cases of CA, the risk of intra-abdominal abscess is increased.
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Oyetunji TA, Turner PL, Onguti SK, Ehanire ID, Dorsett FO, Fullum TM, Cornwell EE, Haider AH. Predictors of postdischarge complications: role of in-hospital length of stay. Am J Surg 2012; 205:71-6. [PMID: 22771450 DOI: 10.1016/j.amjsurg.2012.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 04/25/2012] [Accepted: 04/25/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical length of stay (LOS) has been correlated with quality of care, with shorter stays implying better care. The relationship between LOS and postdischarge complications (PDCs) has not been evaluated effectively. METHODS The 2005 to 2007 National Surgical Quality Improvement Program data were queried for patients undergoing elective colectomies. The outcome of interest was the development of a PDC. Multivariate analysis was then performed adjusting for demographics, surgical approach, and comorbidities. RESULTS A total of 12,956 colectomies were analyzed with an overall PDC of 8.7%. LOS was not associated with increased odds of developing a PDC. The laparoscopic approach reduced the risk of PDCs by 30% (odds ratio = .70, 95% confidence interval, 0.61-0.81). Body mass index, female sex, the presence of diabetes mellitus, and prolonged operative time increased the odds of developing a PDC. CONCLUSIONS A shorter LOS did not correlate with a reduction in the likelihood of PDCs. Further investigation into the role of LOS as a measure of quality care is needed.
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Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Howard University College of Medicine, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
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Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications. J Pediatr Surg 2012; 47:1170-6. [PMID: 22703789 DOI: 10.1016/j.jpedsurg.2012.03.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 03/06/2012] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis. METHODS We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters. RESULTS The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P < .0001). The median hospital cost per case attributable to readmission was $3401 (reflecting a 44% relative increase in cumulative treatment-related cost), and this varied significantly by disease severity and management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001). CONCLUSION In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies.
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Lin YM, Hsieh CH, Cheng CI, Tan BL, Liu HT. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 2012; 35:113-6. [PMID: 22884268 DOI: 10.1016/j.asjsur.2012.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 09/14/2011] [Accepted: 12/01/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/OBJECTIVES Septic postoperative complications are debated in patients with complicated acute appendicitis treated with laparoscopic appendectomy (LA). The aim of this study was to investigate the results of LA in both complicated and uncomplicated cases of acute appendicitis. METHODS From January to December 2009, 94 patients with acute appendicitis underwent LA by the same surgeon using the three-port technique. Data were accumulated and compared between complicated and uncomplicated acute appendicitis. RESULTS Of the 94 patients (45 women and 49 men), 19 had complicated and 75 uncomplicated acute appendicitis. The group with complicated acute appendicitis, as compared to the uncomplicated group, was significantly older (55.7 ± 20.5 years vs. 41.0 ± 18.0 years), and had a significantly increased operation time (117.6 ± 45.5 minutes vs. 78.2 ± 39.4 minutes), longer length of hospital stay (9.0 ± 3.3 days vs. 5.2 ± 6.0 days) and higher conversion rate (21.1% vs. 2.7%). No increase in surgical complications was noted in patients with complicated acute appendicitis, as compared to those with uncomplicated acute appendicitis. CONCLUSION This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.
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Affiliation(s)
- Yueh-Ming Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Mayhew PD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007–2008). J Am Vet Med Assoc 2012; 240:193-8. [DOI: 10.2460/javma.240.2.193] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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.
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Affiliation(s)
- Sun Gu Lim
- Department of Surgery, National Medical Center, Seoul, Korea
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Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ. Comparison of outcomes of laparoscopic versus open appendectomy in adults: data from the Nationwide Inpatient Sample (NIS), 2006-2008. J Gastrointest Surg 2011; 15:2226-31. [PMID: 21725700 DOI: 10.1007/s11605-011-1613-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although laparoscopic appendectomy (LA) is being performed with increased frequency, the utilization of laparoscopy in the management of acute appendicitis remains controversial, and it continues to be used selectively. OBJECTIVES This study aims to evaluate outcomes of LA vs. open appendectomy (OA) in perforated and non-perforated appendicitis in adults. METHODS Using the Nationwide Inpatient Sample database, clinical data of adults who underwent LA and OA for suspected acute appendicitis were evaluated from 2006 to 2008. Incidental and elective appendectomies were excluded. RESULTS A total of 573,244 adults underwent urgent appendectomy during these 3 years. Overall, 65.2% of all appendectomies were performed laparoscopically. Utilization of LA increased 23.7% from 58.2% in 2006 to 72.0% in 2008. In acute non-perforated appendicitis, LA had a lower overall complication rate (4.13% vs. 6.39%, p < 0.01), lower in-hospital mortality (0.03% vs. 0.05%, p < 0.01), and shorter mean length of hospital stay (LOS; 1.7 vs. 2.4 days, p < 0.01) compared with OA; however, hospital charges were higher in the LA group ($22,948 vs. $20,944, p < 0.01). Similarly, in perforated appendicitis, LA was associated with a lower overall complication rate (18.75% vs. 26.76%, p < 0.01), lower in-hospital mortality (0.06% vs. 0.31%, p < 0.01), lower mean hospital charges ($32,487 vs. $38,503, p < 0.01), and shorter mean LOS (4.0 vs. 6.0 days, p < 0.01) compared with OA. CONCLUSION LA is safe and associated with lower morbidity, lower mortality, and shorter hospital stay with acute perforated and non-perforated appendicitis. Also, in perforated cases, LA had an advantage over OA in hospital charges. LA should be considered the procedure of choice for perforated and non-perforated appendicitis in adults.
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Affiliation(s)
- Hossein Masoomi
- Department of Surgery, University of California, Irvine, Medical Center, Orange, CA 92868, USA
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Acute appendicitis—not just for the young. Am J Surg 2011; 202:286-90. [PMID: 21871982 DOI: 10.1016/j.amjsurg.2010.08.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 01/07/2023]
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Vettoretto N, Gobbi S, Belli F, Corradi A, Mannino L, Ricciardelli L, Vinciguerra M, Piccolo D. Diffusion of laparoscopic appendectomies in Italy: a national audit. MINIM INVASIV THER 2011; 21:101-7. [PMID: 21417831 DOI: 10.3109/13645706.2011.557079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A national audit focused on laparoscopic appendectomy was promoted by the Italian Association of Hospital Surgeons (ACOI). Four-hundred and sixty surgical practices received an e-mail questionnaire. Data concerning epidemiology, timetable, surgeon's age, selection of patients, laparotomic conversion, behaviour in the case of a normal appendix, and technical aspects were investigated. The response rate was 51.7%. The median number of appendectomies performed is 50-100 each year in a surgery ward. Laparoscopic operations are very common (93%), but mostly performed in less than 50% of the observed cases. There is no significant difference between the number of operations during the day vs. at night, and they are performed by a limited (<30%) group of surgeons, equally composed of physicians aged above and below 40. The majority of surgeons adopt an "all comers" policy regarding laparoscopic appendectomy, including selected older patients (>70 years old). There are no standard indications for conversion, while the behaviour in the presence of a normal appendix is generally removal. Even if laparoscopic appendectomy is not yet considered a gold standard, it is widely diffused in Italy, and the audit's data show different behaviours between subgroups.
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Affiliation(s)
- Nereo Vettoretto
- Chirurgia Generale e Vascolare, A.O. M. Mellini, Chiari (BS), Italy.
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Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM. Incidence of postoperative intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 2011; 25:2678-83. [PMID: 21416175 DOI: 10.1007/s00464-011-1628-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 02/03/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Risk for intraabdominal abscess (IAA) after laparoscopic appendectomy (LA) remains controversial. A 2008 Cochrane Review suggests almost a threefold increase in the incidence of IAA after LA compared with open appendectomy (OA). METHODS The authors conducted a retrospective chart review of all appendicitis patients 18 years and older undergoing appendectomy from 1996 to 2007 at one military treatment facility and one civilian hospital in Hawaii. Data collection included demographics, procedure, presence of complicated appendicitis (defined as perforated or gangrenous appendicitis at surgical or pathologic assessment), and presence of postoperative IAA on computed axial tomography (CAT) scan. RESULTS The review identified 2,464 patients with appendicitis. A total of 1,924 LAs (78%) and 540 OAs (22%) were performed. The comparison of laparoscopic and open appendectomies showed no significant differences in the number of postoperative abscesses (2.2% vs 1.9%; p = 0.74). The patients with a diagnosis of complicated appendicitis were significantly associated with a higher incidence of postoperative abscess formation (67% vs 25%; p < 0.01), which had an unadjusted odds ratio of 6.1 (95% confidence interval [CI], 3.4-11.0; p < 0.01). No significant difference in the development of abscess in patients with complicated appendicitis could be found between LA and OA (5.9% vs 4.1%; p = 0.44). CONCLUSIONS No significant difference in the occurrence of IAA after LA versus OA was found. The patients with complicated appendicitis experienced a greater number of IAA than the patients with uncomplicated appendicitis.
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Affiliation(s)
- Jennifer R Asarias
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA
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