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Tazeoglu D, Cem Esmer A. Is LigaSure Alone Sufficient for the Closure of the Appendix Stump? Surg Innov 2024; 31:167-172. [PMID: 38357718 DOI: 10.1177/15533506241234005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
PURPOSES Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump. METHODS Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment. RESULT The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (P > .05). The operation time of group I was longer than group II (P < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (P = .76, P = .99, respectively). CONCLUSION Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.
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Affiliation(s)
- Deniz Tazeoglu
- Surgical Oncology, Republic of Turkey Ministry of Health Osmaniye State Hospital, Osmaniye, Turkey
| | - Ahmet Cem Esmer
- Department of Surgical Oncology, Antalya City Hospital, Antalya, Turkey
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Aday U, Çetin E, Kafadar MT, Oğuz A, Bahadır MV, Ülger BV, Gedik E, Girgin S, Yılmaz M. Single versus double Hem-o-lok clips to secure the apendiceal stump during laparoscopic appendectomy: a prospective randomized multicentric clinical trial. Langenbecks Arch Surg 2024; 409:89. [PMID: 38457041 PMCID: PMC10924000 DOI: 10.1007/s00423-024-03281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. METHODS This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. RESULTS One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1-10) in the single hem-o-lok group and 1 day (range 1-12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. CONCLUSIONS The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 ( http://www. CLINICALTRIALS gov ).
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Affiliation(s)
- Ulaş Aday
- Department of Gastroenterologycal Surgery, Dicle University School of Medicine, 21280, Sur/Diyarbakır, Turkey.
| | - Erman Çetin
- Department of General Surgery, Batman Regional Hospital, Batman, Turkey
| | - Mehmet Tolga Kafadar
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Veysi Bahadır
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Ercan Gedik
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Yılmaz
- Department of General Surgery, Dicle University School of Medicine, Diyarbakır, Turkey
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Poon SHT, Law SY, Lai ATY. Clips closure versus endoloop ligation in laparoscopic appendectomy: a systematic review and meta-analysis of comparative studies. Ann Med Surg (Lond) 2023; 85:5011-5021. [PMID: 37811063 PMCID: PMC10553101 DOI: 10.1097/ms9.0000000000001260] [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: 07/09/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Appendiceal stump closure (ASC) is a key step in performing laparoscopic appendicectomy. Currently, there is no gold standard method to achieve this goal. The ideal method should be safe, easily available, and have a short learning curve. Out of all those appendiceal stump closure methods, the use of hem-o-Lok demonstrates its feasibility in replacing the traditionally used endoloop. In this systematic review and meta-analysis, the authors aim to review the currently available evidence addressing the topic of interest. Method The PubMed and Embase databases were searched with the paired search terms appendicitis, clip, and endoloop by two authors separately. The quality of the randomized controlled trials was assessed with the Cochrane risk of bias tool, and the quality of the observational studies was assessed with the Newcastle-Ottawa scale. Meta-analysis was conducted with Cochrane Review Manager version 5.4. Result Eighteen studies were included for quantitative analysis. The appendiceal stump closure time was shortened by 2 min 7 s using a hem-o-lok with 95% CI 1 min 48 s-2 min 26 s, p less than 0.00001. The pooled results of 6 randomized controlled trials demonstrated a statistically significant reduction in operative time of 5.15 min from adopting the hem-o-lok approach (p=0.001, 95% CI -2.05 to -8.24 min). Both endoloop and hem-o-lok demonstrated a comparable postoperative hospital stay and infective complication profile. Conclusion The application of Hem-o-Lok demonstrates a comparable to endoloop ligation in terms of operative time and a potential benefit on the complication. When considering financial and technical aspects, it serves as an alternative to endoloop.
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Affiliation(s)
- Samuel Ho Ting Poon
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong
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Ding H, Li Y. Effect of endoscopic loop ties in acute appendicitis on wound infection rate: A meta-analysis. Int Wound J 2023; 20:3048-3056. [PMID: 37165758 PMCID: PMC10502295 DOI: 10.1111/iwj.14180] [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: 03/11/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 05/12/2023] Open
Abstract
A meta-analysis study to measure the consequence of endoscopic loop ties (ELT) in acute appendicitis (AA) on wound infection rate. A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. The 27 chosen studies enclosed 15 093 subjects with AA in the chosen studies' starting point, 7141 of them were ELT, and 7952 were open surgery. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of ELT in AA on wound infection rate by the dichotomous and continuous styles and a fixed or random model. Open surgery had a significantly higher postoperative surgical site wound infection (SSWI). (OR, 1.41; 95% CI, 1.09-1.83, P = 0.009) with low heterogeneity (I2 = 34%) compared to ELT in AA subjects. Although no significant difference was detected between open surgery and ELT in intra-abdominal abscess rate (OR, 0.88; 95% CI, 0.56-1.40, P = 0.59) with moderate heterogeneity (I2 = 51%) in AA subjects. Open surgery had a significantly higher postoperative SSWI, however, no significant difference was found in intra-abdominal abscess rate compared to ELT in AA subjects. However, caused by the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Hongling Ding
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
| | - Yong Li
- Department of Digestive Internal MedicineThe First Hospital of Zibo CityZiboChina
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Lee KY, Lee J, Park YY, Oh ST. Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study. World J Emerg Surg 2023; 18:39. [PMID: 37386447 PMCID: PMC10311724 DOI: 10.1186/s13017-023-00507-6] [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: 05/10/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Polymeric clips are easy to apply, but whether they present more advantages than endoloops is unclear. This single-center, open-label, randomized controlled trial study was conducted to compare the advantages of using a polymeric clip versus an endoloop in terms of the surgical time. METHODS Adult patients who were diagnosed with acute appendicitis without perforation on preoperative abdominal computed tomography and underwent laparoscopic appendectomy between August 6, 2019, and December 26, 2022, were included. Single-blinded randomization was performed in a 1:1 ratio between the endoloop and polymeric clip groups. The primary endpoint was the difference in surgery time between the polymeric clip and endoloop groups. The secondary endpoints were the difference in the application time of each instrument, difference in operation and anesthesia fees, as well as the frequency of complications. RESULTS The completed trial included 104 and 103 patients in the polymeric clip and endoloop groups, respectively. The median surgery time with a polymeric clip was shorter than that with an endoloop; however, the difference was not significant (18 min 56 s vs 19 min 49 s, p = 0.426). Interestingly, the median time from applying the instrument to appendiceal cutting in the polymeric clip group was significantly shorter than that in the endoloop group (49.0 s vs 84.5 s, p < 0.001). No significant difference was observed between the two groups in terms of surgical (p = 0.120) and anesthetic (p = 0.719) costs, as well as the total number of postoperative complications (p > 0.999). CONCLUSION A polymeric clip is a safe instrument that can reduce the time from applying the instrument to appendiceal cutting, although it does not affect the overall surgical time and operation fee when performing laparoscopic appendectomy for uncomplicated appendicitis. TRIAL REGISTRATION KCT0004154.
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Affiliation(s)
- Kil-yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
| | - Youn Young Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 11765 Republic of Korea
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6
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Damous SHB, Menegozzo CAM, Rocha MC, Collet-E-Silva FS, Utiyama EM. Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil. Rev Col Bras Cir 2023; 50:e20233527. [PMID: 37222347 PMCID: PMC10508672 DOI: 10.1590/0100-6991e-20233527-en] [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: 01/17/2023] [Accepted: 03/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. MATERIALS AND METHODS retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. RESULTS we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team's adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. CONCLUSION the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.
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Affiliation(s)
| | | | - Marcelo Cristiano Rocha
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Cirurgia - São Paulo - SP - Brasil
| | | | - Edivaldo Massazo Utiyama
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Cirurgia - São Paulo - SP - Brasil
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7
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Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy. Medicina (B Aires) 2023; 59:medicina59030533. [PMID: 36984534 PMCID: PMC10059700 DOI: 10.3390/medicina59030533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Background: Closure of the appendix stump is critical to avoid serious postoperative complications. There are a number of options, but the best one has not been identified yet. The purpose of this study is to evaluate the outcomes of appendiceal stump closure using self-locking polymeric clips and endoloops. Methods: A retrospective analysis of the prospectively maintained database of patients with acute appendicitis was performed. Patient demographic details and surgical characteristics, including the duration of hospital stay, postoperative complications, and also the cost of the appendix stump closure, were recorded. Patients were divided into two groups according to the appendix stump closure method: the clips group if it was closed with self-locking polymeric clips and the loops group if Vicryl or PDS loops were used. Statistical analysis was performed using Pearson’s chi-squared test, Wilcoxon rank sum (Mann–Whitney U) test, and Fisher’s exact test in R statistical software package version 4.2.1. Results: 515 patients were included in the study from June 2016 to April 2021. There were no significant differences in terms of demographics (p-value in comparison of groups’ sex > 0.99, age p-value 0.16), postoperative complications (p-value > 0.99), histological findings (p-value 0.27), or length of hospital stays (p-value 0.18) between the two patient groups (clips group, N = 454 and loops group, N = 61). The price of operation while using different appendiceal stump closures is significantly different. In a laparoscopic appendectomy, one stump closure with self-locking clips costs 7.69 €, with Vicryl loops—91.35 €, with PDS loops—96.51 €, and with a stapler—514.50 €. Conclusions: Self-locking polymeric clips can be used for the safe and effective closure of an appendiceal stump. There were no significant differences in the postoperative time (30 days) or complication rates among patients in both (clips and loops) groups. Thus, this might be a technique to reduce expenses while maintaining good postoperative results after laparoscopic appendectomy.
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8
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Martinez C, Drennan C, Vachhrajani S, Aranda A. Safety and Cost Savings Using Polymeric Clips in Appendectomies in the Pediatric Population: Single-center Experience. J Pediatr Surg 2023:S0022-3468(23)00097-0. [PMID: 36931941 DOI: 10.1016/j.jpedsurg.2023.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Although laparoscopic appendectomy is standard management for appendicitis, management of the appendiceal stump remains debated. Even though most surgeons can agree on the safety and effectiveness of various closure methods for the appendiceal stump, such as the surgical stapler (SS) or the Endoloop, the cost of these methods should also be considered. A relatively new alternative method, the polymeric clips (PC), has been gaining acceptance in the surgical community as it has repeatedly proven to be as safe as other methods, while being significantly cheaper. METHODS For the period of January 2019 to December 2021, we performed a retrospective chart review of a single surgeon's laparoscopic appendectomies in children 18 years or younger for acute, non-complicated appendicitis and grouped the cases by appendiceal stump management (SS or PC). Demographics collected included gender, age, BMI percentile, race, and ASA score. Surgical variables included length of stay, surgical time, and anesthesia time. Outcomes were number of intra- and post-operative complications, reoperations, ER visits within 30 days, and total implant cost. Mann-Whitney U tests were performed to test for differences between SS and PC groups in surgical variables. Chi-square or Fisher's exact tests were performed to test differences in demographics and outcome variables. RESULTS There were 107 patients identified. The PC group represented 16% (n = 17) of our study population. The PC group was significantly younger than the SS group at 10 years (2.8) vs 12 years (3.5) p = 0.04. No differences were observed in length of stay and anesthesia time between the two groups. However, a significantly longer length of surgery was observed in the PC group at 33.5 min [30.0-43.3] when compared to the SS group at 28.0 min [23.0-36.0] (p = 0.003). No significant differences were seen in post-op complications, post-op ED visits and reoperations within 30 days. The median total implant cost of the PC closure method was significantly lower than the SS method ($35.36 vs. $375.67 p = <0.001). CONCLUSION There were no significant differences in clinical outcomes. However, the significant difference in the implant cost between the 2 methods could favor the use of PC for selected cases. The increase in length of surgery can be attributed to the learning curve associated with a new device. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Carlos Martinez
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, OH, USA.
| | - Chelsea Drennan
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, OH, USA
| | | | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, OH, USA
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Liu D, Xia AD, Li S, Chen D. Clinical analysis of 48 cases of acute complex appendicitis treated by appendectomy with double purse-bag method. Asian J Surg 2023:S1015-9584(23)00069-6. [PMID: 36690536 DOI: 10.1016/j.asjsur.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Dong Liu
- Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua, 321000, Zhejiang Province, China
| | - A-Dong Xia
- Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Song Li
- Department of Hepatobiliary and Pancreatic Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua, 321000, Zhejiang Province, China
| | - Dan Chen
- Department of Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua, 321000, Zhejiang Province, China.
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Muacevic A, Adler JR. Laparoscopic Repair Modality of Perforated Peptic Ulcer: Less Is More? Cureus 2022; 14:e30926. [PMID: 36337818 PMCID: PMC9621601 DOI: 10.7759/cureus.30926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
Perforation, per se, presents the most serious complication of peptic ulcer disease with a mortality rate that cannot be underestimated. Surgery is the only treatment option, which can be performed laparoscopically or via conventional laparotomy. The present study aimed to compare the short-term outcomes of laparoscopy and laparotomy techniques in the surgical treatment of peptic ulcer perforation. A retrospective study design was structured to compare the perioperative and short-term postoperative outcomes of 102 patients who had undergone laparoscopic and conventional repair of the perforated peptic ulcer over a six-year interval (January 1, 2016, to December 31, 2021). Of these, 44 (43.1%) had undergone laparoscopic repair while 58 (56.9%) had surgical repair via conventional laparotomy. The operative time and length of hospital stay were comparable in both subgroups (p=0.984 and p =0.585). Nevertheless, 30-day postoperative morbidity was significantly higher in the open surgery subgroup (75.9% vs. 59.1%, p= 0.032). The risk of relaparotomy was similar in both study subgroups; however, suture dehiscence as a reason for surgical revision was significantly more frequent in the laparoscopic subgroup (13.6% vs 3.4%). Of note, the mortality rate in the laparoscopic group of patients was 13.6%, and in the laparotomy group 41.4%. The laparoscopic approach to peptic ulcer perforation is the procedure of choice for low-risk patients. Conventional surgery seems to be associated with a significantly higher incidence of severe postoperative complications and mortality. However, the higher mortality in these patients is probably related to their worse initial clinical condition.
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Zorzetti N, Lauro A, Bellini MI, Vaccari S, Dalla Via B, Cervellera M, Cirocchi R, Sorrenti S, D’Andrea V, Tonini V. Laparoscopic appendectomy, stump closure and endoloops: A meta-analysis. World J Gastrointest Surg 2022; 14:1060-1071. [PMID: 36185568 PMCID: PMC9521468 DOI: 10.4240/wjgs.v14.i9.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute appendicitis (AA) is one of the main indications for urgent surgery. Laparoscopic appendectomy (LA) has shown advantages in terms of clinical results and cost-effectiveness, even if there is still controversy about different devices to utilize, especially with regards to the endoloop (EL) vs endostapler (ES) when it comes to stump closure.
AIM To compare safety and cost-effectiveness of EL vs ES.
METHODS From a prospectively maintained database, data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery - St Orsola University Hospital, Bologna (Italy) were retrieved. A meta-analysis was performed in terms of surgical complications, in comparison to the international literature published from 1995 to 2021.
RESULTS The meta-analysis showed no evidence regarding wound infections, abdominal abscesses, and total post-operative complications, in terms of superiority of a surgical technique for the stump closure in LA.
CONCLUSION Even when AA is complicated, the routine use of EL is safe in most patients.
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Affiliation(s)
- Noemi Zorzetti
- Department of General Surgery, Ospedale Civile A Costa, Porretta Terme 40046, Italy
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | | | - Samuele Vaccari
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
- Department of General Surgery, Ospedale di Bentivoglio, Bologna 40010, Italy
| | - Barbara Dalla Via
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
| | - Maurizio Cervellera
- Department of General Surgery, Ospedale Santissima Annunziata, Taranto 74121, Italy
| | - Roberto Cirocchi
- Department of General Surgery, Ospedale di Terni, Università di Perugia, Terni 05100, Italy
| | | | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, Rome 00161, Italy
| | - Valeria Tonini
- Department of Emergency Surgery, St Orsola University Hospital, Bologna 40138, Italy
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Chen Y, Guo S, Liu Y, Yuan J, Fan Z. Single-port laparoscopic appendectomy using a needle-type grasping forceps compared with conventional three-port laparoscopic appendectomy for patients with acute uncomplicated appendicitis: a single-center retrospective study. J Int Med Res 2022; 50:3000605221119647. [PMID: 35993249 PMCID: PMC9403465 DOI: 10.1177/03000605221119647] [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] [Indexed: 11/22/2022] Open
Abstract
Objective To compare the clinical outcomes between single-port laparoscopic
appendectomy using a needle-type grasping forceps (SLAN) and conventional
three-port laparoscopic appendectomy (CLA) for patients with uncomplicated
appendicitis. Methods We retrospectively collected clinical data of patients with uncomplicated
appendicitis who underwent SLAN or CLA from May 2019 to May 2021 in our
center. The patients’ baseline characteristics, perioperative outcomes, and
follow-up data were compared between the two groups. Additionally, baseline
characteristics were compared with postoperative outcomes in the SLAN
group. Results Ninety-six patients were enrolled (SLAN group, n = 32; CLA group, n = 64).
The SLAN group had a shorter hospital stay, lower 24-hour postoperative
visual analogue scale scores, shorter postoperative fasting time, lower
frequency of antibiotic administration, and longer operative time than the
CLA group. In the SLAN group, younger patients had a longer appendix and
male patients had a thicker appendix; additionally, patients with an
appendiceal diameter of 0.6 to 1.0 cm had a longer postoperative hospital
stay and higher frequency of antibiotic administration. Conclusions Compared with CLA, SLAN may be less invasive, provide faster postoperative
recovery, and result in better cosmesis for patients with uncomplicated
appendicitis. Further research should be performed to evaluate the long-term
outcomes.
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Affiliation(s)
- Yang Chen
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Yanjie Liu
- Department of Oncology, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Jieqing Yuan
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Zongqi Fan
- Graduate School, Jinzhou Medical University, Jinzhou, Liaoning, China
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