A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

Background: Acute appendicitis is one of the most common emergencies encountered by surgeons. Although laparoscopic appendectomy is the preferred approach complicated appendicitis with a mass, abscess or perforation do present with a challenge to the operating surgeon compelling him to convert to open surgery. Our study aimed at identifying pre-operative factors that would help us predict the risk of conversion to open surgery.Methods: This was a prospective analytical study. All cases admitted over a period of one year undergoing emergency appendectomy were included in the study. The duration of history, clinical presentation, laboratory and radiological investigations were noted. The reason for conversion to open surgery was recorded. The post-operative stay and complications were analyzed.Results: A total of 160 patients fulfilling the inclusion criteria were included in the study. The mean age was 33.78 years with a male preponderance of 58%. The duration of history, clinical and radiological evidence of complicated appendicitis and peritonitis, total leucocyte count and serum bilirubin levels were identified as pre-operative predictors for risk of conversion to open surgery from laparoscopic appendectomy.Conclusions: These predictors are useful in predicting conversion to open surgery in laparoscopic emergency appendectomy. In these cases, proceeding with an open surgical approach may be beneficial to the patient in reducing operative time, cost, hospital stay and complications as laparoscopic approach may prove to be unsuccessful. This would help in enhanced communication between the surgeon and the patient with respect to the outcome and prognosis.

A study of single sight two port laparoscopic appendectomy for its feasibility, advantages and disadvantages

Minimally invasive techniques revolutionized surgery with severe reduction of access trauma, prompt mobilization, lessened hospital stays and better cosmesis.1 Laparoscopic appendectomy can be further categorized into three port and reduced port appendectomy. All the selected cases have been put in a tabulated form on the basis of their age, clinical features and signs, ultrasonography findings, intra op complications, duration of surgery, duration of post op pain, early post op complications, cosmetic outcome and trochar size. 20 patients fulfilling inclusion and exclusion criteria, who were admitted in our hospital (SMIMER Surat) from 1st December, 2019 to 1st April 2020 and were included in the study and underwent single sight two port laparoscopic appendectomy (SSTPLA) after their consent. We have covered the entire procedure of single sight two port appendectomy, its technique, feasibility, advantages, and disadvantages. From our study, we conclude that this new technique of SSTPLA is technically safe and feasible. Our experience of this innovative surgical technique is suggestive of the fact that SSTPLA has better patient satisfaction with respect to cosmesis, decreased post-operative pain, decreased hospital stay, decreased operative time, fewer intra operative and post-operative complications and surgeon satisfaction with respect to ergonomics and decreased chances of collision of laparoscope with only single working instrument.

Primary appendectomy in appendicular masses of children: an institutional experience

Background: Early appendectomy (EA) for appendicular mass (AM) has been found to be a safer alternative in various studies in adults, while very few studies report such advantages in pediatric population. The purpose of this study was to assess the safety, efficacy and practical implications of EA in pediatric patients with AM.Methods: All patients with acute appendicitis or its complications that underwent EA between January 2016 and December 2018 were retrospectively reviewed. AM was defined if any or combination of the following criteria were satisfied with other signs of appendicitis: palpable mass in right iliac fossa (RIF), sonologically identified mass in RIF, per-operatively confirmed as a mass by surgeon.Results: 37 patients (among a total of 642 patients) were determined to have AM per-operatively and were included in the analysis. 29.7% (n=11) had a contained appendicular abscess. Age group ranged from 4-12 years (mean 7.8 years). The key per-operative findings were fecolith (21.6%), gangrenous appendix (56.8%), difficult adhesiolysis (48.6%), and full thickness bowel injury (2.7%). Postoperatively, wound infection in 9 (24.3%), intra-abdominal abscess in 1 (2.7%), prolonged ileus in 2 (5.4%) and sepsis in 2 (5.4%) were managed medically.Conclusions: EA approach in AM is a safe option in children as it avoids misdiagnosis, treats complicated appendicitis early, avoids second admission, and has shorter hospital stay with better compliance. Failures of non-operative management and potentially lethal complications of complicated appendicitis are also eliminated.

Laparoscopic versus open appendectomy in children with complicated appendicitis in a tertiary teaching hospital

Background: Acute appendicitis in children is the most common surgical emergency. Good outcomes have been reported with laparoscopic appendectomy (LA) in children for uncomplicated appendicitis. But the use of laparoscopy for complicated appendicitis in children is more controversial. Higher incidences of postoperative abdominal and wound infections have been reported. The purpose of this study was to retrospectively compare LA and open appendectomy (OA) for complicated appendicitis in children.Methods: The outcome of 73 patients with complicated appendicitis was retrospectively analyzed. There were 36 children in the LA group and 37 in the OA group. Data collection included demographics, duration of symptoms, type of complicated appendicitis, operative time, resumption of diet, early and late complication, length of hospitalization and duration of antibiotic use.Results: No significant difference was found with respect to age, duration of symptoms and total leucocyte count between two groups.  The operative time for LA (55.83±4.81 minutes for LA versus 67.16±4.27 minutes for OA; p=0.0001) was shorter. Patients in the LA group returned to oral intake earlier (2.83±0.31 days for LA versus 3.84±0.33 days for OA; p=0.001) and had a shorter length of hospital stay (5.11±0.55 days for LA versus 7.92±1.06 days for OA; p=0.0001).  The incidence of wound infection in group LA was 5.5% compared to 18.9% in OA group.Conclusions: The laparoscopic technique for complicated appendicitis in children is feasible, safe. Laparoscopic appendectomy should be the initial procedure of choice for most cases of complicated appendicitis in children.

Evaluation the role of laparoscopic management of complicated appendicitis

Background: A laparoscopic appendectomy (LA) was performed mostly on uncomplicated appendicitis due to opinions about its safety when it was first introduced. Nevertheless, there are still concerns about surgical difficulties in managing complicated appendicitis with laparoscopy, possible post-op complications and conversion to an open appendectomy (OA) during the surgery.Methods: The study consists of 30 patients who underwent laparoscopic appendectomy in department of General Surgery at Assiut University hospitals. The study population was enrolled after fulfilling the selection criteria from department of General Surgery. Informed consent was taken from all the patients who are involved in this study. Patients diagnosis was based on clinical findings, complete blood counts, and abdominal sonography.Results: Thirty patients underwent laparoscopic appendectomy for complicated appendicitis. Of the 30 patients, perforated appendix cases are 27, gangrenous appendix are 1, appendicular abscess only one case. Post operation wound infection, conversion rate and hospital stay rate very less.Conclusions: The present study proved that laparoscopic appendectomy is the best approach in complicated appendicitis.

A comparative study of laparoscopic appendectomy versus open appendectomy

Background: Obstruction of appendiceal lumen resulting in acute appendicitis is diagnosed by clinical examination, supported by raised neutrophil count, computed tomography and/or ultrasonography.Appendectomy one of the most commonly done surgeries is the standard line of management for acute appendicitis. Trend is towards greater utilization of laparoscopic appendectomy despite lack of consensus on superiority of laparoscopic procedure, hence imperative to prove scientifically the effectiveness of the two methods. The aim of the present study was a comparative study of laparoscopic appendectomy versus open appendectomy.Methods: A prospective cohort study of 100 cases of acute appendicitis above 16 years of age with no co morbidities was carried out in Dr. D. Y. Patil Medical College, Hospital and Research Centre from July 2017 to September 2019.Results: Mean age was 28.82 years, 64 (64%) males and 36 (36%) females, pain in abdomen (100%) being most common complaint followed by fever (77%) with positive correlation with severity of appendicitis (Alvarado score) and with total leukocyte count. Mean duration of surgery and hospital stay in laparoscopic appendectomy was lesser than open and difference was statistically highly significant (p=0.000). No difference in pain score observed. Retrocaecal (58%) was the most common position, slightly higher rate of complications in open appendectomy, no conversion of laparoscopic to open. Subjective level of satisfaction score (0-10) in laparoscopic appendectomy was higher than in open and difference was statistically highly significant (p=0.000).Conclusions: Laparoscopic appendectomy had advantages like better cosmesis, shorter duration of procedure and hospital stay, fewer post-operative complications and early return to work with disadvantage of steep learning curve, while open appendectomy, does not require special instruments, and is performed under direct three-dimensional vision.

Comparative Evaluation of Intraoperative and Postoperative Parameters in Laparoscopic vs Open Appendicectomy in Cases of Acute Appendicitis

Background: Appendectomy is the most common surgicalprocedure performed in emergency surgery. Appendectomy isstill being performed by both open (OA) and laparoscopic (LA)methods as no other technique is formulated. In this study, weaimed to compare the laparoscopic procedure and thestandard technique in the treatment of acute appendicitis.Methods: Retrospectively collected data from 60 consecutivepatients with acute appendicitis were studied. These comprised30 patients who underwent conventional appendectomy and 30patients treated laparoscopically. The two groups werecompared for Intra operative parameters like duration ofsurgery, conversion, complications, and post-operativeparameters like pain, requirement of pain medications, woundcomplications, hospital stay, any other complications, andcosmetic outcome.Results: In our study Laparoscopic Appendectomy have ashorter hospital stay (Mean duration of hospital stay aftersurgery was 3.1 & 1.9 day in OA & LA group respectively),Operative time was significantly less in the open group (Meanduration of surgery was 71.2 minutes in OA group and 48.8minutes in LA group). Total number of complications werefewer in the LA group with a significantly less incidence ofwound infection (5 Vs 11, P <0.04).Conclusion: The laparoscopic method is a safe andcompetent operative method in appendicectomy. Postoperativepain in our study is notably lesser in laparoscopic group ascompared to open appendectomy, also post-operativecomplication especially wound infections are less frequent inlaparoscopic group of patients. Patient’s recovery fromoperation is also better in laparoscopic appendicectomy groupwhich includes early bowel activity, minimum hospital stay andearly return to work. Overall cosmetic outcome is preferable inlaparoscopic group of patients.

Comparative Study Of Two Port Laparoscope Assisted Open Appendectomy Vs There Port Laparoscopic Appendectomy

We have done a randomised prospective observational study to compare the efficiency of two port laparoscope assisted open appendectomy versus three port laparoscopic appendectomy. Total 50 patients have been participated in the study (25 cases with two port and 25 cases with three ports). In this study two port laparoscope assisted appendectomy found simpler than three port laparoscopic appendectomy and requires less expertise and equipments, less operative time with shorter hospital stay. So it can be interpreted that the two port laparoscopic assisted open appendectomy is cost effective.

To Review The Outcome Of Laparoscopic Appendicectomy Versus Open Appendicectomy

Proponents of laparoscopic appendectomy emphasize the advantages of laparoscopic operation decreased hospitalization, less operating time and minimal complication. this study includes comparison between laparoscopic vs open appendectomy. 50 patients in each group were included in the study during the period of November 2015 to June 2017.There were 60 male patients while female patients were 40. Of the 60 male patients, 34 patients underwent LA while 26 patients underwent OA. 16 female patients underwent LA, while 24 female patients underwent OA. All patients presented with complaint pain. Nausea was present in 54% of the patients and vomiting in 81%. Fever was present in 58%. Per-operative diagnosis were slightly different than USG findings . 19% patients had enlarged appendix with dilated bowel loop, 4% patients had adhesions of bowel, 61% patients had acute appendicitis with omental adhesion, 8 % patients had RIF collection, 2% patients had only inflamed appendix, 3%patients had gangrenous perforated appendix with flakes, 3% patients had enlarged dilated appendix with dilated bowel loop. In our study most common anatomical position was retrocaecal 72%, 24% had pelvic postion,1% had preileal and 3% had subcaecalposition. Operating time was longer in the OA group compared to LA group and was statistically significant. The median operation time for the LA was 20-30 minutes while that of OA was 40-50 minutes. Patients who underwent LA had a shorter hospital stay compared to OA group. The average duration of hospital stay for LA group in the study was 3-4 days while for the OA group was 5-6 days. In the LA group, only 1 patient (2%) developed caecal perforation, while 3 (6%) patients developed port site infections . For those undergoing OA, 16% had complications. The most common being wound sepsis, which occurred, in 14% of the patients. One patient had developed small bowel obstruction which was diagnosed 7 days after the surgery.

Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis

PURPOSE: A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy. METHODS: A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review. RESULTS: Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases. CONCLUSION: Patients older than 45 years old with a CT radiologist's read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.

Single Incision Laparoscopic Appendectomy for Management of Complicated Appendicitis: Comparison between Single-Incision and Conventional

PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.

Apendicectomía laparoscópica versus cirugía abierta para la apendicitis complicada / Laparoscopic versus open appendectomy for complicated appendicitis

INTRODUCCIÓN El tratamiento de la apendicitis aguda por vía laparoscópica reduce el riesgo de infección de la herida operatoria, disminuye el tiempo de hospitalización y acelera el retorno a las actividades. Sin embargo, aumenta el riesgo de infecciones intraabdominales, lo cual constituye uno de las principales riesgos del tratamiento quirúrgico laparoscópico de la apendicitis complicada. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos seis revisiones sistemáticas que en conjunto incluyen 55 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que la laparoscopía, en comparación con la cirugía abierta, probablemente disminuye el tiempo de estadía hospitalaria, y podría disminuir el riesgo de infección de la herida operatoria, pero no está claro si existen diferencias en la incidencia de absceso intraabdominal porque la certeza de la evidencia es muy baja.

INTRODUCTION The treatment of acute appendicitis using laparoscopy reduces the risk of wound infection, hospitalization time and return to normal activity. However, it increases the risk of intra-abdominal abscess, which is one the main complications of complicated appendicitis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified six systematic reviews including 55 studies overall, of which four were randomized trials. We concluded that the used of laparoscopy, compared to open appendectomy, probably reduces the time of hospital stay, and may reduce the risk of wound infection, but there's no clarity regarding the incidence of intra-abdominal abscess due to the very low certainty of the evidence available.

Laparoscopic appendectomy versus open appendectomy: A randomized prospective comparative study.

Introduction: Laparoscopic Appendectomy confers advantages to the patient in terms of fewer wound infections, less pain, faster recovery and earlier return to work. The aim of this study was to evaluate and compare advantages and disadvantages between laparoscopic Appendectomy and open Appendectomy in general surgical practices. Materials and methods: A two year randomized, prospective comparative study of Laparoscopic Appendectomy versus Open Appendectomy was done in the Department of Surgery, M.G.M medical college & L.S.K. hospital, Kishanganj, Bihar. SPSS software was used for data analysis. Chisquare test was applied. Results: Wound infections in LA group was 9% and OA group was 20%. Intra- abdominal abscess in LA group was 9% and OA group 1.8%. Adhesive ileus in LA group was 4.5% and OA group was 1.7%. Caecal leak was seen only in LA group. Pneumonia was not reported in both the groups. Operation time in LA group was 60 mins and OA group was 30mins. Duration of Hospital stay in LA group was 3 days and OA group was 5 days. Mean duration of return to normal activity in LA group was 5.4 days and OA group was 7.1 days. Mean duration of return to heavy work was 12.2 days in LA group and OA group was 16.8 days. Conclusion: Laparoscopic Appendectomy was found to be both feasible and safe in comparison with open Appendectomy.

Comparative Analysis of Laparoscopic Versus Open Appendectomy for Perforated Appendicitis in Children Under 12 Years Old at a Single Institute

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.

Éxito y complicaciones de la apendicectomía laparoscópica versus abierta en el paciente pediátrico, Instituto Nacional de Salud del Niño 2006-2007 / Success and complications of laparoscopic appendectomy versus open in pediatric patients, National Institute of Child Health 2006-2007

Objetivo: Determinar las diferencias en cuanto a tasas de éxito y complicaciones entre las apendicetomías abiertas (AA) y laparoscópicas (AL), practicadas en niños con apendicitis aguda (aa) en el Instituto Nacional de Salud del Niño (INSN) durante el periodo 2006-2007. Material y métodos: Se revisaron todas las historias clínicas de los pacientes con aa, sometidos a una apendicectomía en el INSN del 2006 al 2007, para comparar las tasas de éxito y complicaciones entre las AA y AL. Resultados: Un total de 1005 apendicectomías se analizaron, incluyendo 814 AA y 191 AL. Se encontraron diferencias en cuanto a la distribución de aa complicadas con peritonitis, siendo la mayoría de estos casos sometidos a una AA (55 por ciento vs 32 por ciento). Las AA registraron un tiempo quirúrgico significativamente menor que las AL (72 ± 31 min. vs. 95 ± 36 min.), asociándose con una mayor frecuencia de estancias hospitalarias mayores o iguales de una semana (36 por ciento vs 22 por ciento). La tasa de éxito y complicaciones fue estimada en 54.5 por ciento y 42.5 por ciento para las AA, y en 77.5 por ciento y 21.5 por ciento para las AL. La tasa de conversiones fue 3.7 por ciento. Se encontró que tanto la presencia de peritonitis (ORa, 3.86) como el tiempo quirúrgico (ORa, 1.01) se asociaban a una mayor incidencia de complicaciones, mientras que el abordaje laparoscópico (ORa, 0.34) y la edad del paciente (ORa, 0.95) actuaban como factores protectores. Conclusiones: Las AL constituirían una alternativa más eficaz y segura que las AA en el manejo de las aa en el paciente pediátrico. La incidencia de complicaciones se incrementa significativamente cuando el paciente padece de peritonitis o cuando el tiempo quirúrgico se prolonga, y disminuye significativamente si el paciente es sometido a una AL o su edad aumenta.

Aim: To determine whether there were differences in the success and complication rates between open appendectomies (OA) versus laparoscopic appendectomies (LA) practiced in children with acute appendicitis (aa) at the National Institute of Child Health (NICH) during years 2006-2007. Material and methods: We reviewed the medical records of all patients with aa, treated with an appendectomy at the NICH during the years 2006-2007, in order to compare success rates and complications due to OA versus LA. Results: A total of 1005 appendectomies could be analyzed, including 814 OA and 191 LA. We found differences in the distribution of complicated appendicitis with peritonitis, the majority of these cases underwent OP (55 per cent vs. 32 per cent). Also we found that OA showed a significantly lower surgical time than the LA (72 ± 31 min vs. 95 ± 36 min), this in turn being associated with an increased frequency of hospital stays of more or equal to one week (36 per cent vs. 22 per cent). The success and complication rate was estimated at 54.5 per cent and 42.5 per cent for OA, and 77.5 per cent and 21.5 per cent for LA, respectively. Furthermore, the rate of conversion from LA was estimated at 3.7 per cent. We found that LA showed significantly higher success rate and a lower complication rate that the OA. Finally, after modeling the incidence of complications we found that both the presence of peritonitis (OR, 3.86) and operative time (OR, 1.01) were associated with greater incidence of complications, whereas the laparoscopic approach (aOR, 0.34) and age (aOR, 0.95) acted as potential protective factors. Conclusions: LA will be an effective and safe alternative to OA in the management of aa in the pediatric patient. The incidence of complications increases significantly when the patient has peritonitis or prolonged surgical time, and decreases significantly if the patient undergoes a LA or if your age increases.

A Clinical Comparison of Laparoscopic versus Open Appendectomy for Complicated Appendicitis

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.

Laparoscopic Versus Open Appendectomy for Simple and Perforated Appendicitis in Children / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy is a popular surgical treatment of choice for children with appendicitis. This study compared laparoscopic appendectomy (LA) with an open appendectomy (OA) in children with simple appendicitis (SA) and perforated appendicitis (PA) to confirm the safety and effectiveness of the laparoscopic procedure. METHODS: A retrospective medical record review was performed on 193 patients who underwent an appendectomy at our institution from January, 2008 to August, 2011. The demographic properties and postoperative factors including complications were assessed. RESULTS: Among 140 SA, there were 81 and 59 cases of OA and LA, respectively. In SA, the time to bowel movement in LA was shorter than OA (0.9 vs. 1.2 days, p=0.0005) and the number of times analgesics were used in LA were significantly lower than OA (1.8 vs. 2.5, p=0.027). Of 53 PA, 30 cases received OA whereas 23 cases underwent LA. In patients with PA, the LA group were older (124.0 vs. 98.8 months, p=0.027) with a longer operative time (93.5 vs. 68.2 minutes, p=0.02). On the other hand, the time to diet was faster in LA (1.8 vs. 3.2 days, p=0.02). In both SA and PA, there were no significant differences between OA and LA with respect to gender, hospital stay, drain insertion, duration of antibiotics usage, and complications. In SA, the LA group had fewer complications than the OA group with borderline significance. CONCLUSION: LA is a safe and effective way to treat SA and PA in children.

Laparoscopic versus Open Appendectomy in Pregnancy / 대한내시경복강경외과학회지

PURPOSE: Although laparoscopic appendectomy is a safe and effective procedure for the management of acute appendicitis, laparoscopic appendectomy in pregnancy has not been considered the preferred procedure until recently. The aim of this study was to evaluate the safety of laparoscopic appendectomy (LA) during pregnancy as compared with the control group that underwent open appendectomy (OA) during pregnancy. METHODS: The clinical data of all the patients who underwent appendectomy during pregnancy at our hospital between 2006 and 2009 was collected and retrospectively analyzed. Nineteen patients underwent LA and 11 patients underwent OA. The general features of the cases, the outcomes and the fetal status were evaluated. RESULTS: There were no significant differences in the length of the procedure, the hospital stay and the complication rate between the LA and OA groups. All the laparoscopic procedures were completed without conversion to an open operation. There were no significant differences between the two groups for premature delivery, the delivery type and the birth weight. There were no fetal losses or abortions. CONCLUSION: Our results demonstrate that LA was not inferior to OA in terms of the operative outcomes, the complication and both the fetal and maternal safety during 1st and 2nd trimesters of pregnancy. LA could be safely performed even in the 1st and 2nd trimesters of pregnancy using careful patient selection, safe operative techniques and the appropriate application of instruments.

Comparison of Clinical Outcomes between Laparoscopic and Open Appendectomy: A Retrospective Analysis of 2,745 Patients

PURPOSE: Despite the reported advantages of laparoscopic appendectomy (LA), there is debate about the postoperative complication rates. Our study attempts to determine if laparoscopic appendectomy is safe and feasible compared with open appendectomy (OA). METHODS: A retrospective review was conducted of all patients who underwent open appendectomy (OA, 2,109 cases) and laparoscopic appendectomy (LA, 500 cases) at our hospital between 1997 and 2007. Incidental and interval appendectomies were excluded from this study. Demographic data, pathology, operation time, length of hospital stay, days to regular diet, and in hospital complication rate were identified. RESULTS: The peak age was 27 years. Seven of the 500 were converted to OA, yielding a conversion rate of 1.2%. The presence of non-visualized appendix, adhesion and technical failures were reasons for conversion. The distribution of histological stages of inflammation was comparable in both groups. The mean operating time was longer for the laparoscopic (64 min) than for the open procedure (58 min) (P<0.001). The complication rate after OA (7%) was significantly higher than that following LA (2.8%) (P=0.001). Hospital stay and frequency of analgesic administration were significantly lower in LA group than in OA group. CONCLUSION: Laparoscopic appendectomy is a safe and clinically beneficial operating procedure even in patients with appendicitis with peritonitis, perforation and abscess, resulting in shorter hospital stays and lower complication rates.

Apendicectomia laparascópica versus aberta: análise retrospectiva / Laparascopic versus open appendectomy: retrospective analises

Introdução: As técnicas de apendicectomia convencional (aberta) e videolaparoscópica (VLP) vêm sendo amplamente estudadas com o objetivo de definir uma técnica padrão-ouro. No entanto, os estudos até hoje realizados não foram capazes de uniformizar a indicação cirúrgica mais adequada. Objetivo: Este estudo tem como objetivo analisar a casuística do Hospital de Clínicas de Porto Alegre (HCPA) e comparar os resultados de apendicectomias obtidos através da técnica convencional com aqueles encontrados através do uso da videolaparoscopia. Métodos: Estudo descritivo de uma coorte histórica de 348 pacientes maiores de 12 anos submetidos à apendicectomia no HCPA no período de 01/01/2004 a 31/12/2005. Resultados: O tempo cirúrgico, tempo de internação hospitalar e taxa de abscesso intra-abdominal não apresentam diferença estatisticamente significativa. A técnica VLP foi superior à convencional quando comparada a taxas de infecção de ferida operatória (p < 0,001). A videolaparoscopia foi mais indicada em mulheres e mais realizada por profissionais com maior experiência (p < 0,001). Conclusão: A cirurgia aberta mostrou significativas desvantagens em comparação à videolaparoscopia, como uma maior taxa de infecção em ferida posoperatória. Entretanto, ainda são necessários estudos prospectivos complementares para melhor comparar as duas técnicas. Portanto, a definição da técnica cirúrgica deve ser baseada principalmente na experiência do cirurgião e nas características clínicas de cada paciente.

Background: Conventional (open) and laparoscopic appendectomies are being widely studied in order to define a gold standard technique. Nevertheless, the studies until now could not be able to standardize the most adequate surgical indication. Objective: To analyze our hospital’s case series and compare the results obtained using open appendectomy with the results found with laparoscopic technique. Methods: Descriptive historical cohort study of 348 patients older than 12 years-old that underwent either open or laparoscopic appendectomies from 01/01/2004 to 12/31/2005 Results: Operative time, length of stay in hospital and intra-abdominal abscess rate were not statistically significant. Laparoscopic technique was superior to open procedure when wound infection (p < 0.001) was compared. Also, laparoscopy was more indicated among women and it was more performed by experienced professionals (p < 0.001). Conclusion: Open appendectomy showed significant disadvantages when compared to laparoscopic surgery, like a higher post-operatory wound infection rate. However, additional prospective studies are needed to better compare the two procedures. Therefore, surgical technique must be defined based on the experience of the surgeon and the clinical condition of the patient.