Author Correction: Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study.

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.

The significant impact of age on the clinical outcomes of laparoscopic appendectomy: Results from the Polish Laparoscopic Appendectomy multicenter large cohort study.

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1-<40 years old; Group 2-between 40 and 64 years old; Group 3-between 65 and 74 years old; and Group 4-75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2-4] vs 3 [IQR 3-5], vs 4 [IQR 3-5], vs 5 [IQR 3-6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.

[Early results of surgical treatment of haemorrhoids at use of harmonic scalpel]. / Wczesne wyniki operacji zylaków odbytu przy uzyciu noza harmonicznego.

AIM OF THE STUDY: To estimate the usefulness of harmonic scalpel during operation of haemorrhoids. MATERIAL AND METHODS: It presented material 37 patients, 23 women and 14 men, in average from 28 for 76 year, middling 53 year. Operated by harmonic scalpel in haemorrhoids dissease. During the study was evaluate pain scale (NRS), hospitalization time, consumption of analgesics, postoperation complications, time needed to resume regular professional activity. RESULTS: At the 1st, 2st, 1th postoperative mean intensity of pain was respectively: 2.3, 1.2, 1.0 Mean consumption of metamizole during the 1st postoperative day was 2.7 g/24, but to II day 1.1 g/24. Mean consumption of pethidine on the 1st postoperative day was 70.9 mg/24, but to II day 37.8 mg. Time of procedure evaluated from 10 for 44 minutes (median 26,9 minutes). Seven patients was bleeding from operation field. Postoperation complications has been appeared in 10 patient, including: bleeding (6 patients), leak from anal canal at 3 patients and anoderm mucosal oedema at one patient. CONCLUSIONS: Using of harmonic scalpel in hemoroidectomy procedure is technically simple and safe procedure.

[Long-term results of rectal tumors treatment by transanal endoscopic microsurgery (TEM)]. / Odlegle wyniki leczenia guzów odbytnicy sposobem przezodbytniczej mikrochirurgii endoskopowej (TEM).

UNLABELLED: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for excision of selected benign and malignant rectal neoplasmas. The aim of this study was to assess the long-term results after benign and malignant rectal lesions excision using TEM. MATERIAL AND METHODS: Between December 1998 and October 2005 37 patients were operated on using TEM. Median follow-up was 3.5 years (range 1-5 years). There were 9 (33.3%) women and 18 (66.7%) men with a median patient age of 75 years (range 38-83 years). 27 patients were included into this study. RESULTS: One patient has still incontinent. There have been two local recurrences and liver metastasis in one patient. Two patients have had stricture of the rectum. One patient died because of heart attack. 21 (77.7%) of patients were satisfied with treatment. CONCLUSION: TEM is a safe, effective treatment for selected cases of benign lesions and some cases of early stage rectal cancer. Long-term results and a prospective randomized trial are needed.

[Bilateral posterior thoracoscopic splanchnicectomy in a face-down position in the management of chronic pancreatic pain]. / Obustronna tylna torakoskopowa splanchnicektomia w uloieniu brzusznym w leczeniu przewleklego bólu trzustkowego.

UNLABELLED: Abdominal pain is the primary symptom in most patients with chronic pancreatic diseases. Many authors have reported that thoracoscopic splanchnicectomy is a effective and recognize method for relief of chronic pain due to pancreatic cancer and chronic pancreatitis. Time ago only few authors used bilateral toracoscopic splanchnicectomy in one session because they observed side effects as transient orthostatic hypotension and/or diarrhea. The aim of this study was retrospective analysis of two methods of the bilateral thoracoscopy splanchnicectomy at one session. We comparsion operation's time, intraoperative and postoperative complication, hospitalization and evaluate pain intensity in patients with intractable pain due to advanced pancreatic cancer and chronic pancreatitis. MATERIAL AND METHODS: The study group comprised 94 patients, aged 26-69 years operated with bilateral thoracosopic splanchnicectomy at one session approach between years 1997-2006. There were two groups. First (I group) for operated patients in thoracotomy position with changed the position of patients at the same procedure and second (II group) for posterior thoracoscopic approach with the patient in a face-down position. In all patients evaluated operation's time, intraoperative and postoperative complication and pain intensity before and for 6 months after the thoracoscopic splanchnicectomy. RESULTS: The mean operating time in the I group was 58.3 min. and the II group was 43.5 min. (p < 0.05). There were no intraoperative and postoperative complications, only 16 patients I group and 3 patients II group had intercostal neuralgia after operation. The mean hospitalization's time in all patients were 1.3 day. In all patients pain was reduced significantly after the operation and during postoperative follow-up. CONCLUSION: Posterior thoracoscopic splanchnicectomy approach with the patient in a face-down position is a save, minimally invasive and reduce operation time procedure.

[Late complication of endoscopic sphincterotomy]. / Odlegle powiklanie endoskopowej sfinkterotomii.

Endoscopic sphincterotomy and stone extraction has become method of choice in the treatment of residual lithiasis after cholecystectomy. Then safe endeavour and effective, yet despite many advantages possible complications are. The paper presents a rare case endoscopic sphincterotomy under form of gigantic abscess of extraperitoneal space from consequent sepsis and death of patient.