Clinical outcome of appendectomy: laparoscopic vs open technique

Background: Acute appendicitis is a common abdominal surgical emergency. Appendectomy has been proven to be the standard care for the treatment of acute appendicitis. Objective of the study was to compare laparoscopic and open appendectomy in terms of clinical outcome and complication rates.Methods: This was a single centric, retrospective study conducted at SKIMS, Soura from May 2018 to April 2021. Open and laparoscopic appendectomy patients were compared in terms of operative times, conversion rate, complication rates and duration of hospital stay.Results: Total 120 patients were included in this study with 40 in laparoscopic group while 80 patients in the open group. Increased operative time in laparoscopic group (p=0.033) and longer duration of hospital stay (p=0.021) with open group while as comparable complication rate in both procedures were observed. Higher rates of intra-abdominal collection in laparoscopic group as compared to open groupConclusions: Both laparoscopic and open appendectomy procedures can be performed routinely for acute appendicitis without the additional risks of complications.

P-OGC81 The learning curve for robotic assisted abdominal phase in two stage oesophagectomy

Background Robotic assisted oesophagectomy (RAO) is increasingly being utilised in the management of oesophageal cancer. RAO implementation into practice has an inevitable learning curve. As oesophagectomy usually involves at least 2 stages, a staggered approach to training and introduction of RAO can be done. A major advantage of this is that the surgeon can concentrate on overcoming the learning curve in one phase of the procedure at a time, whilst the remaining phase can be completed by an established technique. This study looks at the learning curve of a robotic assisted abdominal phase for two-stage oesophagectomy compared to an open abdominal phase to achieve parity. Methods This study uses a prospectively maintained database to retrospectively analyse the abdominal phase of the first 17 RAO compared to the previous 20 open abdominal phase procedures. The cases are sequential, done by a single surgeon at a large UK oesophagogastric referral centre. Operating time, nodal count, and R0 rate were reviewed to determine the number of cases on the learning curve to reach parity with the open procedure. Results The open abdominal phase group had a similar age (65.6 vs 65.7), pre-op anaerobic threshold (13.9 vs 14.6 p = 0.3) but a higher BMI (mean 30.6 vs 24.6 p < 0.05) then the RAO group. All cases were T3 adenocarcinoma except for 2 cases in the robotic group (one HGD and one T2 adenocarcinoma). No RAO cases were converted to open. The mean time for the abdominal phase in the open group was 175.4 minutes with an average nodal count of 32.9. After 8 robotic assisted cases the mean operating time decreased from 267 minutes to 197 minutes, which was when a non-significant difference to the open group (p = 0.094) became apparent. The mean nodal count in the first 8 robotic assisted cases was 29.5 and increased to 38.4 in the subsequent cases. All patients had a R0 resection. Conclusions The multi-phase nature of oesophagectomy allows for modular implementation of a robotic programme. We have found that the learning curve for robotic assisted abdominal is around 8 cases. This allows for parity to open abdominal phase to be achieved regarding operative time, nodal count and R0 resection.

Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study

Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

Outcomes After Management of Subspine and Femoroacetabular Impingement Using a Direct Anterior Mini-Open Approach

Background: Subspine impingement (SSI) has been commonly managed with arthroscopic decompression. However, arthroscopic decompression is a demanding technique, as under- or over-resection of the anterior inferior iliac spine (AIIS) could lead to inferior outcomes. An anterior mini-open approach has also been used in the management of femoroacetabular impingement (FAI), and it could provide adequate visualization of the anterior hip joint without a long learning curve. Purpose/Hypothesis: The objective of the current study was to compare the outcomes of SSI patients with FAI who underwent arthroscopic subspine decompression and osteoplasty with a group undergoing subspine decompression and osteoplasty using a modified direct anterior mini-open approach. It was hypothesized that there would be no significant difference in outcomes between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of SSI patients who underwent decompression surgery (arthroscopic or mini-open) at our institution from June 1, 2015 to December 31, 2016. Both groups underwent the same postoperative rehabilitation protocol. Preoperative and 2-year postoperative patient-reported outcomes were compared using the modified Harris Hip Score (mHHS), International Hip Outcome Tool–33 (iHOT–33), and Hip Outcome Score—Activities of Daily Living (HOS–ADL). Major and minor complications as well as reoperation rates were recorded. Results: Included were 47 patients (49 hips) who underwent subspine decompression using an anterior mini-open approach and 35 patients (35 hips) who underwent arthroscopic subspine decompression. There were no differences in demographic and radiological parameters between the groups, and patients in both groups showed significant improvement in all outcome scores at follow-up. The pre- to postoperative improvement in outcome scores was also similar between groups (mini-open vs arthroscopy: mHHS, 26.30 vs 27.04 [ P = .783]; iHOT–33, 35.76 vs 31.77 [ P = .064]; HOS–ADL, 26.09 vs 22.77 [ P = .146]). In the mini-open group, 10 of the 47 patients had temporary meralgia paresthetica, and fat liquefaction was found in 1 female patient. There were no reoperations in the mini-open group. Conclusion: Subspine decompression using the anterior mini-open approach had similar outcomes to arthroscopic decompression in the management of SSI. The lateral femoral cutaneous nerve should be protected carefully during use of the anterior mini-open approach.

Comparison of Laparoscopic and Open Emergency Surgery for Colorectal Perforation: A Retrospective Study

Background This study aimed to clarify the safety and efficacy of laparoscopic surgery for colorectal perforation by comparing the clinical outcomes between laparoscopic and open emergency surgery for colorectal perforation. Methods We retrospectively reviewed the data of 100 patients who underwent surgery for colorectal perforation. The patients were categorized into two groups: the open group included patients who underwent laparotomy, and the laparoscopic group included those who underwent laparoscopic surgery. Clinical and operative characteristics and postoperative outcomes were evaluated. Results The open and laparoscopic groups included 58 and 42 patients, respectively. More than half of the patients in both groups developed perforation in the sigmoid colon (open, 55.2%; laparoscopic, 59.5%). The most common cause of perforation was diverticulum, followed by colorectal cancer. The mean intraoperative blood loss tended to be lower in the laparoscopic group than in the open group (78.8 mL versus 160.1 mL; P=0.0756). Hospital stay tended to be shorter in the laparoscopic group than in the open group (42.5 versus 55.7 days; P=0.0965). There were no significant differences in either the short- or long-term outcomes between the two groups. Univariate and multivariate analyses showed that the choice of surgical approach (open versus laparoscopic) did not affect overall survival in patients with colorectal perforation. Conclusions The laparoscopic approach for colorectal perforation in an emergency setting is a safe procedure compared with the open approach. The laparoscopic approach was associated with a decrease in intraoperative blood loss and a shorter length of hospital stay.

Comparison Between Microendoscopic Laminectomy and Open Posterior Decompression Surgery for Single-Level Lumbar Spinal Stenosis: A Multicenter Retrospective Cohort Study

BackgroundMicroendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy.MethodsThis is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. ResultsOf the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). ConclusionsMEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR

Aim Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center. Material and Methods Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach. Results 385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group. In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years. Conclusions Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.

Comparison of adjacent segment disease after minimally invasive versus open lumbar fusion: a minimum 10-year follow-up

OBJECTIVE The object of this study was to compare, after a long-term follow-up, the incidence and features of adjacent segment disease (ASDis) following lumbar fusion surgery performed via an open technique using conventional interbody fusion plus transpedicular screw fixation or a minimally invasive surgery (MIS) using a tubular retractor together with percutaneous pedicle screw fixation. METHODS The authors conducted a retrospective chart review of patients with a follow-up period > 10 years who had undergone instrumented lumbar fusion at the L4–5 level between January 2004 and December 2010. The patients were divided into an open surgery group and MIS group based on the surgical method performed. Baseline characteristics and radiological findings, including factors related to ASDis, were compared between the two groups. Additionally, the incidence of ASDis and related details, including diagnosis, time to diagnosis, and treatment, were analyzed. RESULTS Among 119 patients who had undergone lumbar fusion at the L4–5 level in the study period, 32 were excluded according to the exclusion criteria. The remaining 87 patients were included as the final study cohort and were divided into an open group (n = 44) and MIS group (n = 43). The mean follow-up period was 10.50 (range 10.0–14.0) years in the open group and 10.16 (range 10.0–13.0) years in the MIS group. The overall facet joint violation rate was significantly higher in the open group than in the MIS group (54.5% vs 30.2%, p = 0.022). However, in terms of adjacent segment degeneration, there were no significant differences in corrected disc height, segmental angle, range of motion, or degree of listhesis of the adjacent segments between the two groups during follow-up. The overall incidence of ASDis was 33.3%, with incidences of 31.8% in the open group and 34.9% in the MIS group, showing no significant difference between the two groups (p = 0.822). Additionally, detailed diagnosis and treatment factors were not different between the two groups. CONCLUSIONS After a minimum 10-year follow-up, the incidence of ASDis did not differ significantly between patients who had undergone open fusion and those who had undergone MIS fusion at the L4–5 level.

РОЗРОБЛЕННЯ КОМП’ЮТЕРНОЇ ГРИ З ГОЛОСОВИМ ІНТЕРФЕЙСОМ ДЛЯ ВИВЧЕННЯ АНГЛІЙСЬКОЇ МОВИ ДІТЬМИ ДОШКІЛЬНОГО ВІКУ

Стаття присвячена питанням гейміфікації дошкільної освіти, а саме застосуванню комп’ютерних ігор для вивчення іноземної мови. Більшість застосунків для вивчення англійської мови, що існують на цей час, орієнтовані на дітей більш старшого віку та мають стандартний інтерфейс взаємодії з користувачем. Авторами запропоновано використання інтелектуального інтерфейсу, який базується на методах розпізнання голосу, а саме на методах розпізнавання мовлення на основі обмеженого словника та граматики запитів. У статті наведено повний цикл розробки комп’ютерної гри: спочатку було проведено аналіз та визначення вимог до гри, далі була побудована архітектура, після чого розроблено програмне забезпечення та проведено його тестування. Для проєктування гри було використано сучасний архітектурний фреймворк TOGAF (The Open Group Archіtecture Framework) та відповідний інструмент візуального моделювання Archimate. Такий підхід дозволив авторам визначити вимоги до гри, що базуються на основних цілях та проблемах стейкхолдерів; провести аналіз основних бізнес-процесів гри, зокрема процес роботи з голосовим інтерфейсом, як з точки зору розробника, так і гравця; спроєктувати архітектуру комп’ютерної гри. Для програмної реалізації гри авторами було обрано платформу Unity, а для реалізації голосового інтерфейсу один з класів модулю UnityEngine.Windows.Speech. Наведено приклад роботи одного з рівнів гри, який призначено для вивчення назв фруктів та закріплення знання назв кольорів англійською мовою. Останнім етапом проєктування будь-якої інформаційної системи є тестування, авторами розроблено тест-кейс для тестування одного з рівнів комп’ютерної гри. Даний тест-кейс охоплює усі кроки, які робить гравець під час гри, та доводить коректність роботи як програмного застосунку в цілому, так і окремо голосового інтерфейсу. Розроблена авторами гра дозволить підвищити ефективність та якість вивчення англійської мови дітьми дошкільного віку шляхом збільшення їх зацікавленості та спрощення процесу навчання.

Comparison between Laparoscopic and Open Repair of Umbilical and Paraumbilical Hernia: A Randomized Controlled Trial Study

Background: Laparoscopic repair of umbilical and paraumbilical hernia has largely replaced conventional (Open) repair. The purpose of the study was to compare the effectiveness of laparoscopic vs. open repair of umbilical & para umbilical hernia in a tertiary care government hospital. Methods: A total 50 patients of age >18 years diagnosed with umbilical and paraumbilical hernia who underwent laparoscopic and open hernia repair from May2018 to Nov 2020 were enrolled and divided into two groups of 25 patients in each. The patients were followed up in the post-operative period in the wards during daily rounds till the time of discharge; 1 and 6 months after discharge and yearly. Results: The mean age for open group was 44.24±7.68years while the mean age for laparoscopic group was 50.0±11.82years. Operative time was more in laparoscopic repair (81.68±18.37min) as compared to open (55.44±16.54min). Post-operative pain (VAS score) was greatest in the open group in comparison to lap group at 6 hr, 24 hr, day 8 and at 1month. Postoperative overall complication rate (Infection, seroma and recurrence) was 12% in the laparoscopic group and 28% in the open group. Recovery was faster with laparoscopic repair with a mean postoperative hospital stay of 3.28days as compared to 5.88days for open mesh repair. Patients treated with laparoscopic repair were early return to routine activity and work. Conclusion: The laparoscopic approach appears to be safe, effective and acceptable. It is a complex but very efficient method in experienced hands and it offered a significant advantage over open repair.