A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies. Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive). Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis. Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1) Laparoscopic Robotic Complications N = 49,800 N = 50 P Value Odds ratio Any Complication 5302 (10.6%) 5 (10%) 1 1.06 Superficial surgical site infection 423 (0.8%) 0 >0.9 Organ Space SSI 1,355 (2.7%) 0 >0.9 Postoperative Intra-abdominal Abscess 1353 (2.7%) 0 >0.9 Sepsis 1,696 (3.4%) 1 (2%) >0.9 1.7 Table 1. Complications for Laparoscopic versus Robotic appendectomy. Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.

Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

Background Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. Methods According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. Results Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75–2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73–3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04–2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64–2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14–11.12); no statistical significance was found for hospital stay (MD − 0.39, 95% CI − 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56–2.38; I2 = 71%). Conclusions This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group.

346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases

Aim To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases Method We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p &lt; 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups. Conclusions Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.