An audit of training in laparoscopic appendicectomy in the South Thames Region

2007 ◽  
Vol 89 (3) ◽  
pp. 102-104
Author(s):  
N Kukreja ◽  
C Bhan ◽  
A Schizas
Keyword(s):  
Acute Appendicitis ◽  
Operative Treatment ◽  
Lifetime Risk ◽  
Laparoscopic Appendicectomy ◽  
Open Appendicectomy ◽  
Surgical Trainee ◽  
Open Procedure ◽  
Abdominal Operation ◽  
The Uk ◽  
Huge Variation

Appendicitis is extremely common, with a lifetime risk of 8% in the UK. McBurney performed the first appendicectomy in 1889. Operative treatment remains the mainstay of treatment for acute appendicitis: this procedure has altered little since it was developed. Open appendicectomy is often the first abdominal operation undertaken by the surgical trainee and therefore forms an important part of training for the junior surgeon. Laparoscopic appendicectomy (LA) represents the biggest change in the management of acute appendicitis since the introduction of the open procedure. An increasing number of surgeons are performing LA. In spite of this, there remains huge variation in the ability of SpRs to perform this procedure.

scholarly journals Surgical site infection in Laparoscopic versus Open appendicectomy

2018 ◽  
Vol 7 (2) ◽  
pp. 39-43
Author(s):  
Ashok Koirala ◽  
Dipendra Thakur ◽  
Sunit Agrawal ◽  
Bhuwan Lal Chaudhary ◽  
Sagar Poudel
Keyword(s):  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Age Groups ◽  
Laparoscopic Appendicectomy ◽  
Surgical Removal ◽  
Age Group ◽  
Site Infection ◽  
Open Appendicectomy ◽  
Number Of Patients ◽  
The Mean

 Background: Acute appendicitis is very common surgical cause of acute abdomen and needs surgical removal either by laparoscopic or open appendicectomy. The aim of this study is to compare frequency of surgical site infection (SSI) in patients undergoing laparoscopic and open appendicectomy. Materials and Methods: The study was prospective study conducted in NMCTH, Biratnagar. Total 200 patients with diagnosis of acute appendicitis admitted through the emergency department of our hospital were included in the study. The patients were randomly allocated in two groups: Laparoscopic appendicectomy group (LA) and Open appendicectomy group (OA). Both groups underwent successful emergency appendicectomy. Wound infections in terms of surgical site infection (SSI) if present were recorded. All age groups and both sexes were included.  Results: Two hundred patients underwent appendicectomy, one hundred Laparoscopic appendicectomy (LA) and another hundred open appendicectomy (OA). The mean age of patients with acute appendicitis was 30.63±16.14 years with minimum of 6 years and maximum of 77 years. The highest number of patients were in age group of 10 to 20 years (29.5%). In LA group SSI noted in 3 patients (3%) whereas in OA group it was found in 12 patients (12%). Conclusion: Laparoscopic appendicectomy is better and offers great advantages in terms of SSI as compared to Open appendicectomy.  

scholarly journals P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
H Pringle ◽  
U Donigiewicz ◽  
M Bennett ◽  
G F Fowler ◽  
E Walker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Medical Records ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management ◽  
Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals 1073 Synchronous Cholecystitis and Appendicitis: A Case Report Highlighting Learning Points on Medical Imaging and Consent

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
B David ◽  
M Issa ◽  
A Gallucci
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Medical Imaging ◽  
Acute Appendicitis ◽  
Laparoscopic Appendicectomy ◽  
Consent Process ◽  
Surgical Interventions ◽  
The Uk ◽  
Us Scan ◽  
Learning Points

Abstract Laparoscopic appendicectomy and laparoscopic cholecystectomy are separately two of the most common emergency surgical procedures carried out in the UK. Only a small number of synchronous presentations of acute appendicitis and acute cholecystitis have been reported in surgical literature and this rare co-existent pathology gives rise to several valuable learning points with regards to laparoscopy, medical imaging interpretation and the consent process. Our case report involves a 58-year-old female patient presenting with both RUQ and RIF pain and positive Murphy’s sign on clinical examination. US scan demonstrated several gallstones within a thin-walled gallbladder. Subsequent CT scan reported acute appendicitis which was treated definitively with laparoscopic surgery. Intraoperatively a perforated gangrenous gallbladder containing multiple calculi was discovered, and the decision was made to perform a double procedure of laparoscopic appendicectomy and cholecystectomy. Histopathology confirmed synchronous pathology of appendicitis with faecolith and calculus cholecystitis. This case demonstrates the importance of considering multiple pathologies when assessing a patient with ambiguous and migratory abdominal pain. It reinforces the importance of diagnostic laparoscopy to rule out multiple pathologies. This acts as a cautionary case against over-reliance on medical imaging and reminds surgeons of their obligation to maintain competence in CT interpretation plus correlation of imaging with clinical assessment of the patient. Readers should also be reminded that the consent process for surgical interventions should be undertaken meticulously in patients with ambiguous abdominal pain.

scholarly journals 904 Can Patients with Acute Appendicitis be Ambulated Safely?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S O'Brien ◽  
L Armstrong
Keyword(s):  
Acute Appendicitis ◽  
Significant Proportion ◽  
Initial Assessment ◽  
Efficacy And Safety ◽  
Oral Antibiotics ◽  
Surgical Service ◽  
Open Appendicectomy ◽  
Suspected Appendicitis ◽  
Uncomplicated Appendicitis ◽  
The Uk

Abstract Introduction During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis. Method Data was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded. Results 190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy. Conclusions Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.

scholarly journals APPENDECTOMY

2011 ◽  
Vol 18 (01) ◽  
pp. 97-101
Author(s):  
ZULFIQAR ALI ◽  
TANVEER AHMAD ◽  
IRSHAD AHMAD ◽  
Muhammad Suhail Amir ◽  
AG Rehan
Keyword(s):  
Acute Appendicitis ◽  
Statistical Significance ◽  
Operating Time ◽  
Laparoscopic Appendicectomy ◽  
P Value ◽  
Continuous Variables ◽  
Open Appendicectomy ◽  
Chi Square ◽  
Student’S T ◽  
Study Setting

Objective: The aim of this study was to compare the outcomes and morbidities of laparoscopic appendicectomy (LA) and open appendicectomy (OA) in patients with acute appendicitis. Design: Interventional study. Setting: The study was conducted at Madina Teaching Hospital, University Medical & Dental College, Faisalabad. Period: From June 2007 to August 2009. Materials and Methods: The study group consisted of two hundred patients suffering from acute appendicitis. One hundred patients underwent LA and one hundred patients underwent OA. Comparison was based on operating time, complications, requirements for postoperative analgesia, time until resumption to regular diet, hospital stay, and return to full activity in days. Comparisons were made between continuous variables using Student’s t test of the means and were made between proportions using Fischer’s exact or chi-square testing where appropriate. Statistical significance was taken to be a p value of .05 or less. Results: Of the hundred patients, five patients (5%) had the procedure converted to open surgery. The rate of infection was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (2 days after LA, 5 days after OA, P < 0.05) than after OA. The operating time was shorter {OA: 25 min (median), LA: 30 min (median), P > .05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. Conclusion: LA is associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

scholarly journals Laparoscopic versus conventional open appendicectomy: a prospective comparative analytical study in a tertiary care set up

2019 ◽  
Vol 7 (7) ◽  
pp. 2536
Author(s):  
Anurag Shrivastava ◽  
Anurag Jain ◽  
Rajiv Jain
Keyword(s):  
Operative Time ◽  
Tertiary Care ◽  
Operating Time ◽  
Open Appendectomy ◽  
Laparoscopic Appendicectomy ◽  
Open Appendicectomy ◽  
Open Procedure ◽  
Diagnostic Potential ◽  
Operative Complications ◽  
Set Up

Background: Present study outlines the outcomes of laparoscopic appendicectomy compared to open conventional appendicectomy in a tertiary care set up with aim to validate advantages and shortcomings of both procedures.Methods: A series of 80 cases above 18 years of age with clinical diagnosis of appendicitis having Alvarado score of seven and above were studied prospectively under the two groups after proper written consent: Open appendectomy-40 cases, Laparoscopic appendectomy-40 cases. Both groups were compared on grounds of intra-operative complications, additional diagnostic potential, operative time, postoperative analgesia, post-operative complications, length of hospital stay, subjective cosmesis, and return to routine normal activities. Values obtained were statistically analyzed.Results: The median operative time in Laparoscopic Appendicectomy was 58.22 minutes (range 32.68-85.46 min) as compared to open procedure which took 43.65 minutes (30.36-65.48min) (P<0.05). Conversion to open procedure was done in 10% (n=4) of laparoscopic cases. Mean value of postoperative pain by visual analogue scale was low in Laparoscopic Appendicectomy (LA) compared to Open Appendicectomy (OA) (P<0.05). Mean post-operative stay (3.2±0.34 days versus 2.3±0.24 days) and surgical site infection was recorded in 10 patients (25%) in OA group and 5 (13.9%) in LA group (P<0.05).Conclusions: It can be concluded that laparoscopic surgery is safe with greater diagnostic potential for additional pathologies and better Subjective cosmesis . But all these merits were at the price of longer operating time and a specialized set up needed for laparoscopy.

scholarly journals SP4.1.14 Single centre experience in managing acute appendicitis during COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Valdone Kolaityte ◽  
Ishani Mukhopadhyay ◽  
Daniel Newport ◽  
Imran Aslam
Keyword(s):  
Retrospective Study ◽  
Acute Appendicitis ◽  
Patient Outcomes ◽  
Treatment Strategies ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Single Centre Experience ◽  
Significant Difference ◽  
Management Approaches ◽  
The Uk

Abstract Background Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it. Methods This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods. Results 190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = &lt;0.001), open appendicectomy (34.7% vs 3.4% P = &lt;0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p &gt; 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%. Conclusions Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.

scholarly journals Management and early outcomes of children with appendicitis in the UK and Ireland during the COVID-19 pandemic: a survey of surgeons and observational study

2020 ◽  
Vol 4 (1) ◽  
pp. e000831
Author(s):  
George S Bethell ◽  
Clare M Rees ◽  
Jonathan R Sutcliffe ◽  
Nigel J Hall
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Imaging ◽  
Hospital Admission ◽  
Patient Outcomes ◽  
Operative Treatment ◽  
Treatment Strategy ◽  
Hospital Readmissions ◽  
Operative Management ◽  
Study Cohort ◽  
The Uk

ObjectivesAcute appendicitis is the most common surgical condition in children. In the UK, appendicectomy is the most common treatment with non-operative management unusual. Due to concerns about the risk of SARS-CoV-2 transmission during surgical procedures, surgeons were advised to consider non-operative treatment and avoid laparoscopy where possible. This study aims to report management and outcomes, to date, of children with appendicitis in the UK and Ireland during the COVID-19 pandemic.DesignSurvey of consultant surgeons who treat children with appendicitis that informed a prospective multicentre observational cohort study.SettingData were collected from centres in the UK and Ireland for cases admitted between 1 April and 31 May 2020 (first 2 months of the COVID-19 pandemic) at both general surgical and specialist paediatric surgical centres.ParticipantsThe study cohort includes 838 children with a clinical and/or radiological diagnosis of acute appendicitis of which 527 (63%) were male.Main outcomes measuredPrimary outcome was treatment strategy used for acute appendicitis. Other outcomes reported include change in treatment strategy over time, use of diagnostic imaging and important patient outcomes to 30 days following hospital admission.ResultsFrom very early in the pandemic surgeons experienced a change in their management of children with appendicitis and almost all surgeons who responded to the survey anticipated further changes during the pandemic. Overall, 326/838 (39%) were initially treated non-operatively of whom 81/326 (25%) proceeded to appendicectomy within the initial hospital admission. Of cases treated initially surgically 243/512 (48%) were performed laparoscopically. Diagnostic imaging was used in 445/838 (53%) children. Cases treated non-operatively had a shorter hospital stay than those treated surgically but hospital readmissions within 30 days were similar between groups. In cases treated surgically the negative appendicectomy rate was 4.5%. There was a trend towards increased use of surgical treatment and from open to laparoscopic appendicectomy as the pandemic progressed.ConclusionNon-operative treatment of appendicitis has been widely used for the first time in children in the UK and Ireland and is safe and effective in selected patients. Overall patient outcomes do not appear to have been adversely impacted by change in management during the pandemic thus far.

scholarly journals Is the laparoscopic approach superior to open approach for treatment of acute appendicitis? A hospital based experience

2017 ◽  
Vol 4 (5) ◽  
pp. 1726
Author(s):  
Anil Reddy Pinate ◽  
Mohammad Fazelul Rahman Shoeb ◽  
Shiva Kumar C. R.
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Group ◽  
Laparoscopic Appendicectomy ◽  
Open Group ◽  
Open Appendicectomy ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Laparoscopic appendicetomy remains controversial in Indian perspective. The objective was to compare the clinical outcome of open with laparoscopic appendicectomy.Methods: Prospectively collected data from 150 consecutive patients with acute appendicitis was studied. Patients undergoing surgery for acute appendicitis were alternately assigned into one of the two groups (Group-A patients underwent open appendicectomy and in Group B laparoscopic appendicectomy). The two groups were compared with respect to operative time, length of hospital stay, postoperative pain & wound complications.Results: The mean operative time in the open group was 84.40 minutes; for laparoscopic group, 95.20 minutes (p-0.001). Duration of paralytic ileus, tolerance to oral feeds, resumption of daily routine activity and ambulation of patients were started earlier in laparoscopic group than open group. Group A (OA) patients had pain at the mean of 2.66 days as compared group B (LA), in which patients had pain at the mean of 1.66 days.  Study also showed that the hospital stay for laparoscopic group was almost half of that for open group. Laparoscopic appendicectomy was safe as compared to open surgery in context to post-operative complications.Conclusions: Provided surgical experience and equipment are available, Laparoscopic appendicectomy is as safe and efficient than open appendicectomy.

scholarly journals Laparoscopic Versus Open Appendicectomy for Treatment of Acute Appendicitis

2019 ◽  
Vol 20 (1) ◽  
pp. 24-25
Author(s):  
Mohammad Ali ◽  
Kazi Lsrat Jahan
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Gold Standard ◽  
Operative Time ◽  
The Other ◽  
Laparoscopic Appendicectomy ◽  
Abdominal Abscess ◽  
Open Appendicectomy ◽  
Laparoscopic Skills ◽  
Operative Complications

Laparoscopic appendicectomy is not yet considered the "gold standard" in the treatment of acuteappendicitis because of its higher operative time, intra-abdominal abscess risk, and costscompared to open appendicectomy. On the other hand laparoscopic appendicectomy is associatedwith fewer post operative complications, shorter hospital stay, and nearly similar operative time,intra-abdominal abscess rate, and total costs, compared with open appendicectomy. With increasein the experience of the surgeon in laparoscopic skills pit falls will be much lower. Therefore, laparoscopicappendectomy can be recommended as preferred approach in acute appendicitis Journal of Surgical Sciences (2016) Vol. 20 (1) : 24-25

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