scholarly journals Endoscopic retrograde appendicitis therapy vs. Laparoscopic appendectomy for uncomplicated acute appendicitis

Endoscopy ◽  
2022 ◽  
Author(s):  
Baohong Yang ◽  
Lingjian Kong ◽  
Ullah Saif ◽  
Lixia Zhao ◽  
Dan Liu ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Hospital Length Of Stay ◽  
Adverse Event Rate ◽  
Recurrence Time ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
One Year ◽  
Uncomplicated Acute Appendicitis ◽  
Matching Criteria

Background and study aims: To assess the efficacy and clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT) versus laparoscopic appendectomy (LA) for patients with uncomplicated acute appendicitis (AA). Patients and methods: We adopted propensity score matching (1:1) to compare ERAT and LA patients with uncomplicated AA from April 2017 to March 2020. We reviewed a total of 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated AA met the matching criteria (ERAT, 79; LA, 343), yielding 78 pairs of patients. Results: The rate of curative treatment within one year after ERAT was 92.1%; 95% CI, [83.8% - 96.3%]. The percentage of Visual Analog Scale (VAS) ≤ 3 at six hours after treatment was 94.7%; 95% CI [87.2% - 97.9%] in the ERAT group, and significantly higher than that in the LA group 83.3%; 95% CI [73.5% - 90.0%]. Median operative/procedure time and median hospital length of stay in the ERAT group were significantly lower compared to the LA group. At one year, the median recurrence time was 50 days (IQRs, 25-127) in the ERAT group. The overall adverse event rate was 24.3%; 95% CI [14.8% - 33.9%] in the LA group and 18.4%; 95% CI [9.7% - 27.1%] in the ERAT group, with no significant difference between the two groups. Conclusions: ERAT is a technically feasible method to treat uncomplicated AA compared to LA.

scholarly journals Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

2020 ◽  
Vol 36 (1) ◽  
pp. 30-34
Author(s):  
Tae Gyeong Lee ◽  
Soomin Nam ◽  
Hyung Soon Lee ◽  
Jin Ho Lee ◽  
Young Ki Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Postoperative Complication ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Multiple Logistic Regression Analysis ◽  
Operation Time ◽  
Site Infection ◽  
Uncomplicated Acute Appendicitis

Purpose: To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis.Methods: Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic.Results: A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis.Conclusion: There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Outpatient Laparoscopic Appendectomy for Acute Appendicitis

2012 ◽  
Vol 78 (2) ◽  
pp. 213-215 ◽  
Author(s):  
Cassadra L. Cash ◽  
Richard C. Frazee ◽  
Randall W. Smith ◽  
Matthew L. Davis ◽  
John C. Hendricks ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Clinical Course ◽  
Wound Infections ◽  
Outpatient Management ◽  
Abdominal Bleeding ◽  
Superficial Wound ◽  
Uncomplicated Acute Appendicitis

Laparoscopic appendectomy is the widely accepted treatment for acute appendicitis. This approach offers the potential of less pain, shorter hospital stay, and quicker return to activities. Traditionally, patients are hospitalized for 24 hours after laparoscopic appendectomy. This practice can be questioned due to the good results of other outpatient laparoscopic surgery. A retrospective review of 119 patients undergoing laparoscopic appendectomy for uncomplicated acute appendicitis was undertaken from January through September 2009; outpatient and in-patient laparoscopic appendectomies were compared. Patients were selected for outpatient management based upon physician discretion and their clinical course in operation and recovery rooms. Forty-two patients were dismissed on the day of surgery and 77 were admitted for 1 to 5 days postoperatively. No significant differences in age, gender, and preoperative comorbidities between outpatient and inpatient groups were found. Postoperative complications occurred in 2.4 per cent of outpatients and 11.7 per cent of inpatients ( P = 0.16). Complications included superficial wound infections, urinary retention, urinary tract infection, intra-abdominal bleeding, pneumonia, and infected hematoma. Based upon this study, outpatient laparoscopic appendectomy can be performed safely in selected patients. This study provides the background for the present prospective protocol for routine outpatient laparoscopic appendectomy at our institution.

Laparoscopic appendectomy protocol expedites management of uncomplicated acute appendicitis

2015 ◽  
Vol 221 (4) ◽  
pp. e86-e87
Author(s):  
Joseph A. Ibrahim ◽  
Alvaro M. Bada ◽  
Andrew C. Gratzon ◽  
Karen Safcsak ◽  
Chadwick P. Smith ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Uncomplicated Acute Appendicitis

Financial Impact of Surgical Technique in the Treatment of Acute Appendicitis in Children

2013 ◽  
Vol 79 (9) ◽  
pp. 857-860 ◽  
Author(s):  
Cristen Litz ◽  
Paul D. Danielson ◽  
Jay Gould ◽  
Nicole M. Chandler
Keyword(s):  
Surgical Technique ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Single Incision ◽  
Open Appendectomy ◽  
Direct Costs ◽  
Financial Impact ◽  
Invasive Approach ◽  
Significant Difference ◽  
Supply Costs

Appendicitis is the most common emergent problem encountered by pediatric surgeons. Driven by improved cosmetic outcomes, many surgeons are offering pediatric patients single-incision laparoscopic appendectomy. We sought to investigate the financial impact of different surgical approaches to appendectomy. A retrospective study of patients with acute appendicitis undergoing appendectomy from February 2010 to September 2011 was conducted. Based on surgeon preference, patients underwent open appendectomy (OA), laparoscopic appendectomy (LA), or single-incision laparoscopic appendectomy (SILA). Demographic information, surgical outcomes, surgical supply costs, and total direct costs were recorded. A total of 465 patients underwent appendectomy during the study. The mean age of all patients was 11.2 years (range, 1 to 18 years). There were no conversions in the LA or SILA groups. There was a significant difference among surgical technique in regard to surgical supply costs (OA $159 vs LA $650 vs SILA $814, P < 0.01) and total direct costs (OA $2129 vs LA $2624 vs SILA $2991, P < 0.01). In our institution, both multiport laparoscopic and SILA carry higher costs when compared with OA, largely as a result of the cost of disposable instrumentation. Cost efficiency should be considered by surgeons when undertaking a minimally invasive approach to appendectomy.

scholarly journals TWO-PORT LAPAROSCOPIC APPENDECTOMY IS MORE BENEFECIAL THAN OPEN APPENDECTOMY IN EARLY ACUTE APPENDICITIS

2017 ◽  
Vol 52 (2) ◽  
pp. 131
Author(s):  
Vicky S Budipramana
Keyword(s):  
Acute Appendicitis ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Operation Time ◽  
T Test ◽  
Small Incision ◽  
Post Operative Pain ◽  
Significant Difference

Open appendectomy has already commonly been performed to treat acute appendicitis, but the relatively more painful and longer incision scar becomes a cosmetical problem. Two port laparoscopic appendectomy can be performed safely, less painful and leaving only two small incision scars. The aim of the study was to evaluate the benefit of two-port laparoscopic appendectomy and that of with open appendectomy in the case of early acute appendicitis. An observational study was conducted from 2012 to 2014; to compare the operating time, post operative pain and wound infection in early acute appendicitis, performed with two-port laparoscopic appendectomy and with open appendectomy. The statistical analysis in this study uses t-test. There were 114 patients (73 men and 41 women) divided into two groups based on the choice made by the patients themselves. The number of samples performed with two-port laparoscopic appendectomy was 64 and that with open appendectomy was 46. Four patients were excluded from this study. In analysis using t-test, we found that the two-port laparoscopic appendectomy was more beneficial than open appendectomy. There was a significant difference between the two groups, the length of operation time was 37.22 minute in two-port laparoscopic appendectomy and 43.83 minute in open appendectomy (p=0.00), VAS pain score was 1.58 in two-port laparoscopic appendectomy and 2.30 in open appendectomy (p=0.00) and no post operative wound infection in both two groups. The conclusion is two-port laparoscopic appendectomy technique is faster and less painful and the same risk of wound infection than open appendectomy in early acute appendicitis.

scholarly journals Comparative study of single incision versus conventional three port laparoscopic appendectomy

2018 ◽  
Vol 5 (12) ◽  
pp. 3852 ◽  
Author(s):  
Sahil Rometra ◽  
Rahil Rometra ◽  
Neeraj Koul ◽  
R. K. Chrungoo
Keyword(s):  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Single Incision ◽  
Open Appendectomy ◽  
Single Incision Laparoscopic Surgery ◽  
Abdominal Incision ◽  
Significant Difference

Background: Appendicitis is primarily a disease of adolescents and young adults with a peak incidence in the second and third decades of life. Appendectomy for appendicitis is the most commonly performed emergency operation in the world.For more than a century, open appendectomy remained the gold standard for the treatment of acute appendicitis.  Laparoscopic surgery has become popular universally during the last couple of decades.   Efforts are still being made to decrease abdominal incision and visible scars after laparoscopy.  Single incision laparoscopic surgery (SILS) is a new innovation allowing minimal access surgery to be performed through a single umbilical incision.Methods: It was a prospective study carried out on 50 patients diagnosed as acute appendicitis. They were divided into two groups of 25 each. One group underwent Conventional Laparoscopic Appendectomy (CLA) and other group underwent Single Incision Laparoscopic Surgery (SILS).  Results were compared with regard to mean operative time,   complications, post-operative pain and discomfort (vas score at 12 hours), post-operative morbidity, duration of hospital stay and condition at discharge and cosmesis.Results: There was no statistically significant difference between the two groups with respect to the parameters like postoperative pain, hospital stay and complication profile. However, operative time for SILS appendectomy were found to be significantly higher compared to conventional group.Conclusions: Single incision laparoscopic appendectomy using standard laparoscopic instruments is safe and effective, feasible surgery with better cosmetic results.

Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial

2018 ◽  
Vol 33 (2) ◽  
pp. 429-436 ◽  
Author(s):  
Mario E. Trejo-Ávila ◽  
Sujey Romero-Loera ◽  
Eduardo Cárdenas-Lailson ◽  
Miguel Blas-Franco ◽  
Roberto Delano-Alonso ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Randomized Trial ◽  
Laparoscopic Appendectomy ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Prospective Randomized Trial ◽  
Uncomplicated Acute Appendicitis

DOZ047.45: The effect of transanastomotic feeding tubes on anastomotic strictures following esophageal atresia repair

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
K LaRusso ◽  
R Lakabi ◽  
D Lévesque ◽  
J-M Laberge ◽  
S Emil
Keyword(s):  
Esophageal Atresia ◽  
Primary Repair ◽  
Hospital Length ◽  
Oral Feeding ◽  
Hospital Length Of Stay ◽  
Stricture Formation ◽  
Type D ◽  
Anastomotic Strictures ◽  
Significant Difference ◽  
One Year

Abstract Purpose Recent studies have identified the use of transanastomotic tubes (TATs) as an independent risk factor for the development of strictures after repair of esophageal atresia (EA). We retrospectively analyzed a 25-year cohort of EA patients (1993–2018) to investigate the effect of TAT use on stricture formation. Methods Following institutional approval (MP-37–2019-2991), a retrospective study of all Type C and Type D EA patients who underwent primary repair was examined. Infants were included if they had surgery within the first two weeks of life and had a least one year of follow-up. Stricture was defined as the presence of symptoms confirmed by imaging and/or endoscopy. A multiple logistic regression model was used to compare stricture in those with and without TATs. Poisson regression was used to evaluate differences in postoperative outcomes listed in Table 1. Results Strictures occurred in 35 of 85 patients (41%). Of those with strictures, 25 (71%) had transanastomotic tubes. There was no significant difference in stricture rates between those with TATs and without TATs (odd ratio (OR) = 1.94, 95% confidence interval (CI): 0.78–5.06, P = 0.161). However, those who had TATs had a significantly higher number of dilations overall (rate ratio (RR) = 1.47, 95% CI: 1.09–2.03, P = 0.014). In patients with TATs, the time to enteral feeding was significantly shorter (RR = 0.37, 95% CI: 0.28–0.49, P < 0.001), but the time to oral feeding was significantly longer (RR = 1.37, CI: 1.20–1.56, P < 0.001). The TAT group had a 34% lower mean hospital length of stay. On multivariate analysis, there remained no difference in stricture rates between the two groups. Conclusion Transanastomotic tubes do not seem to result in increased strictures rates in our cohort, but significantly decrease time to initiation of enteral feeds and reduce the duration of hospital stay.

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