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

2020 ◽  
Vol 7 (8) ◽  
pp. 2499
Author(s):  
Harsha B. Kodliwadmath ◽  
B. Srinivas Pai ◽  
K. Sphurti Kamath
Keyword(s):  
Laparoscopic Appendectomy ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Total Leucocyte Count ◽  
Conversion To Open Surgery ◽  
Male Preponderance ◽  
The Mean ◽  
One Year ◽  
Open Surgical Approach

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. 

scholarly journals Laparoscopic appendectomy for acute appendicitis: an observational study from a peripheral hospital with limited facilities in Kashmir, India

2020 ◽  
Vol 7 (3) ◽  
pp. 717
Author(s):  
Hakeem Vaqar Ahmed ◽  
Majid Mushtaque
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Low Cost ◽  
Laparoscopic Approach ◽  
Suture Materials ◽  
Conversion To Open Surgery ◽  
Peripheral Hospital ◽  
Operative Complications ◽  
The Mean ◽  
Level Hospital

Background: Appendectomy is one of the most commonly performed procedures in abdominal surgery and the laparoscopic approach is gradually replacing the conventional laparotomy for acute appendicitis.Methods: A total of 108 patients with acute appendicitis who underwent laparoscopic appendectomy at JLNM Hospital Srinagar over a period of five years were evaluated in terms of feasibility and safety of the procedure at the District level hospital. It was an observational study.Results: The age of the patient ranged between 16 and 43 years, with 68 males and 40 females. Most (76.85%) of the patients had un-ruptured inflamed appendix. The mean operative time was 43 minutes with no intra-operative complications. Two patients required conversion to open surgery. Mean duration of hospital stay was 1.7 days. Eight patients had post-operative complications which were managed conservatively.Conclusions: Laparoscopic appendectomy is safe and feasible in expert hands, and can be done using low cost, readily available basic laparoscopic instruments and suture materials at hospitals with limited facilities.

MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

2021 ◽  
pp. 87-89
Author(s):  
Yamen Jabri ◽  
Md Mahfooz Buksh ◽  
Alicia Skrervin
Keyword(s):  
Operative Treatment ◽  
Open Surgery ◽  
Ct Scanning ◽  
Disease Recurrence ◽  
Diagnostic Value ◽  
Complicated Appendicitis ◽  
Risk Patients ◽  
Risk Of Disease ◽  
One Year

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

scholarly journals Laparoscopic Urological Surgery: Our Initial Experiences

2020 ◽  
Vol 23 (1) ◽  
pp. 17-23
Author(s):  
Shiba Prasad Nandy ◽  
AKM Akramul Bari ◽  
Anirban Ghose ◽  
Hasmot Ali Mia ◽  
Md Alamgir ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Radical Nephrectomy ◽  
Open Surgery ◽  
Renal Cyst ◽  
Conversion To Open Surgery ◽  
Cyst Excision ◽  
Excellent Outcome ◽  
Duration Of Surgery ◽  
The Mean

Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

A Nationwide Cohort Study of Outcome after Pediatric Appendicitis

2020 ◽  
Author(s):  
Erik Omling ◽  
Martin Salö ◽  
Saurabh Saluja ◽  
Sanna Bergbrant ◽  
Louise Olsson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Laparoscopic Approach ◽  
Surgical Site Infections ◽  
Complicated Appendicitis ◽  
Increased Risk ◽  
Short And Long Term ◽  
Trends Over Time

Abstract Introduction Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. Materials and Methods A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. Results Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18–3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08–5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61–5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62–0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11–0.63], p = 0.002). Conclusion Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.

Video-Endoscopic Mobilization of the Gracilis Muscle for Rectourinary Fistula Repair

2021 ◽  
pp. 1-5
Author(s):  
Cesar Britto ◽  
Daniel Pfalzgraf ◽  
Ronnie Lima ◽  
Paulo Medeiros ◽  
Rafael Rebouças ◽  
...  
Keyword(s):  
Open Surgery ◽  
Gracilis Muscle ◽  
Rectourethral Fistula ◽  
Reconstructive Procedures ◽  
Conversion To Open Surgery ◽  
Perineal Region ◽  
The Mean ◽  
Minimally Invasive Access ◽  
Rectourinary Fistula ◽  
Mean Time

<b><i>Introduction:</i></b> Transposition of the gracilis has been used in a large number of reconstructive procedures. Its advantage is its proximity to these defects and a good blood supply. Traditionally, the gracilis mobilization is performed by open surgery with one or more incisions. We describe our initial experience with the video-endoscopic mobilization of gracilis. <b><i>Method:</i></b> We described a retrospective review of all patients who underwent gracilis muscle mobilization for treatment of rectourethral fistula, performed by video-endoscopy, between March 2013 and September 2017, for treatment of rectourethral fistula. Also, our surgical technique is described in detail. <b><i>Results:</i></b> Three patients, with a mean age of 66.6 years, underwent the procedures. The mean time for mobilization of the gracilis was 107 min (range 60–145). There was no case of donor area infection, no change in the sensitivity of the medial aspect of the thigh or chronic pain. Conversion to open surgery was not necessary in any case. The hospital discharge occurred in average after 4 days. The bladder catheter was removed after 4 weeks after cystography was performed without evidence of leakage. One patient had a recurrence of the fistula. <b><i>Discussion:</i></b> The gracilis is an excellent choice of tissue to be interposed in reconstructive procedures of the perineal region, especially in the treatment of rectourinary fistulas. However, endoscopic harvest of the gracilis muscle has not yet found its way into everyday practice. The results in the treatment of rectourinary fistulas are excellent, with a success rate of 87.7%. Our rate of 67% is below, probably due to the small number of cases. In open surgery, complications are uncommon; however, approximately half of the patients expressed concern about the painful scar, which can be reduced by minimally invasive access. <b><i>Conclusion:</i></b> Video-endoscopic mobilization of gracilis muscle for the treatment of rectourethral fistula is feasible and safe. Studies comparing this technique with the conventional mobilization are required.

scholarly journals LAPAROSCOPIC LIVER RESECTION VIA LAPAROSCOPY: EXPERIENCE IN OUR CENTRE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
P del Val Ruiz ◽  
S Sanz Navarro ◽  
B Carrasco Aguilera ◽  
C García Bernardo ◽  
A Miyar de Leon ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Surgery ◽  
Open Surgery ◽  
Cancer Metastasis ◽  
Initial Experience ◽  
Specific Training ◽  
Laparoscopic Liver Surgery ◽  
Conversion To Open Surgery ◽  
Colon Cancer Metastasis ◽  
The Mean

Abstract INTRODUCTION Laparoscopic liver surgery has undergone a great evolution in recent years, allowing increasingly complex resections without increasing complications and with evident postoperative benefits. Our purpose is to analyze our initial experience in this type of resection. MATERIAL AND METHODS We performed a retrospective observational study analyzing 41 patients who underwent liver resections by laparoscopy in our centre from March 2019 to January 2020. RESULTS The mean age of the patients was 64.5 years (SD 11) with a mean BMI of 27.56 (from 4.59). The most common surgical indication was colon cancer metastasis (41.4%), followed by hepatocarcinoma (36.6%) and usually single lesions (75.6%). The procedure passed without complications except in the case of 5 patients who required conversion to open surgery (12.5%) and 3 patients (7.5%) who required intraoperative transfusion. During the postoperative period 4 patients (9.8%) presented complications and all of them were classified as Clavien-Dindo II. We only reported 1 death (2.4%) in &gt; 90 days, which was not related to the reason for surgery. No reinterventions were necessary during admission and there were no readmissions in the first 30 days after discharge, CONCLUSIONS Laparoscopic liver surgery is technically demanding and requires previous experience in open surgery, as well as specific training, which makes a regulated implementation of the technique necessary.

scholarly journals Efficacy and Safety of Laparoscopic Appendectomy for Complicated Appendicitis in Children in Tertiary Care Hospital

2018 ◽  
Vol 28 (Number 1) ◽  
pp. 21-26
Author(s):  
Md. Anisuzzaman ◽  
ASM A Kabir ◽  
Md. A R l Sadiq ◽  
Md. A Matin ◽  
I Ahmed ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Complicated Appendicitis ◽  
Safe Procedure ◽  
Care Hospital ◽  
Efficacy And Safety ◽  
The Mean

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

scholarly journals COMPLICATED APPENDICITIS;

2017 ◽  
Vol 24 (01) ◽  
pp. 82-88
Author(s):  
Awais Shuja ◽  
Professor M Ramzan ◽  
Nadia Sharif
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Operating Time ◽  
Open Appendectomy ◽  
Complicated Appendicitis ◽  
Open Approach ◽  
Number Of Patients ◽  
Analgesia Requirement ◽  
Group A ◽  
The Mean

Appendectomy is the most common surgical procedure performed in surgicalemergency. The advent of minimal invasive surgery has massively influenced the field of surgery.Laparoscopic surgery might offer clinical benefits in perforated and complicated appendicitis.Objective: To compare laparoscopic appendectomy and open appendectomy as treatment ofcomplicated appendicitis in terms of mean requirement of post-operative analgesia, operativetime and hospital stay. Study design: Randomized control trial. Setting: All subjects for thestudy were recruited from Department of Surgery, Independent University Hospital, Faisalabad.Duration: The duration of study was of 6 months duration from February 2012 to august 2012.Results: In this study the divided into two groups, group A for open appendectomy (OA)and group B for Laparoscopic Appendectomy (LA). Both groups had 43 patients each. Theoperating time for open appendectomy group A had mean operating time 37.21 minutes .Thehospital stay in OA group was 2.63 days. The mean dosage of analgesia requirement was 258mg of diclofenac. The operating time for open appendectomy group A had mean operatingtime 39.16 minutes. The hospital stay in OA group was 2.95 days. The mean dosage of was258.14 mg of diclofenac. Conclusion: Our study concludes that both approaches laparoscopicand open approach have proved to be similar in terms of post-operative hospital stay, operatingtime and analgesia requirement. Where as LA is superior in terms of cosmesis and surgicalsite infection. Further studies with more number of patients are recommended to asscess thebenefits of laparoscopic approach in complicated appendicitis.

EVALUATION OUTCOMES OF THE LAPAROSCOPIC RETROPERITONEAL NEPHRECTOMY FOR BENIGN NONFUNCTIONING KIDNEYS

2017 ◽  
pp. 107-112
Author(s):  
Duc Minh Hoang ◽  
khoa Hung Nguyen ◽  
Vinh Quy Truong ◽  
Van Binh Nguyen ◽  
Hong Duong Nguyen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operating Time ◽  
Indications For Surgery ◽  
Conversion To Open Surgery ◽  
Multicystic Kidney ◽  
Post Operation ◽  
The Mean ◽  
Retroperitoneal Nephrectomy

Purpose: To assess results of retroperitoneoscopy nephrectomy for benign non-function kidneys from June 2013 to June 2017 at Quang Tri General Hospital. Materials and Methods: The study comprised 43 patients who underwent retroperitoneoscopic nephrectomy during a 4 years period beginning from June 2013. Results: Mean age of surgery was 52.6 years (28-72 years). 23 males and 20 females. 25 patients underwent left nephrectomy; 18 underwent right nephrectomy. Retroperitoneoscopic nephrectomy were completed successfully in 38 patients (88.4%). There was 5 patients required conversion to open surgery (11.6%), all cases by poor progression. The mean operating time was 112.7 minutes (range 70 to 210), mean blood loss was 45.7 ml (range 15 to 170 ml), and mean post-operation hospital stay was 4.3 days (range 3 to 9). A total of 21.1% complications (8/38 cases), no severe complications occurred. No re-intervention was needed. No case was mortality. The indications for surgery included hydronephrosis in 19/38 cases (50.0%), atrophic kidney in 13/38 cases (34.2%) and multicystic kidney in 6/38 cases (15.8%). Conclusions: Retroperitoneoscopic nephrectomy can be performed safely and successfully with obvious advantages for benign nonfunctioning kidneys regardless of the etiology or pathogenesis. Key words: nephrectomy, kidney, benign, retroperitoneoscopy

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