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1.
Rev. cir. (Impr.) ; 73(2)abr. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388806

ABSTRACT

Resumen Objetivo: En este estudio se comparan los desenlaces clínicos de cuatro técnicas de apendicectomía laparoscópica utilizadas en una institución colombiana para el manejo de la apendicitis aguda tras la adopción de políticas de reúso y reprocesamiento de dispositivos médicos para la Región de las Américas (2014). Materiales y Método: Mediante el análisis de varianza de una vía (ANOVA) y la prueba de Kruskal Wallis, se compararon las tasas de infección de sitio operatorio (ISO), reoperación no planeada, readmisión y mortalidad (en los primeros 30 días del postoperatorio) de las siguientes técnicas: Técnica 1: Ligadura del muñón apendicular con endonudo y disección del mesenterio apendicular con electrocoagulación bipolar convencional; Técnica 2: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación bipolar convencional; Técnica 3: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación monopolar; Técnica 4: Clipaje del muñón y disección roma y ligadura del mesenterio con endoclip de polímero. Resultados: Se incluyeron 551 pacientes. No se encontraron diferencias en los ANOVAs en cuanto a las características demográficas de los pacientes por cada técnica. Los desenlaces globales fueron: ISO (5,44%), reoperación no planeada (3,08%), readmisión (15,97%) y mortalidad (0,18%). Se encontraron diferencias significativas (p < 0,05) en estos desenlaces explicados por mayores tasas de ISO y reoperación con la Técnica-1. Conclusiones: Los desenlaces globales de la apendicectomía laparoscópica tras la adopción de políticas de reúso de dispositivos médicos se encuentran dentro de los aceptados globalmente cuando se utilizan las Técnicas 2-3-4 en poblaciones equivalentes de pacientes con apendicitis aguda. En este contexto, nuestros resultados invitan a utilizar con precaución la Técnica-1.


Aim: The present study sought to compare the clinical outcomes between four operative techniques for laparoscopic appendectomy in a Colombian institution, following the adoption of reuse and reprocessing policies for medical devices in the Region of Americas (2014). Materials and Methods: One-way analysis of variance (ANOVA) and Kruskal Wallis tests were used to compare the rates of Surgical Site Infection (SSI), unplanned reoperation, readmission and mortality (confined to 30 days after surgery) of these operative techniques: Technique 1: Ligature of appendiceal stump with endo stitch plus mesenteric dissection with conventional bipolar electrocoagulation; Technique 2: Clipping of stump with polymer endoclip plus mesenteric dissection with conventional bipolar electrocoagulation; Technique 3: Clipping of stump with polymer endoclip plus mesenteric dissection with monopolar electrocoagulation; Technique 4: Clipping of stump plus mesenteric dissection with polymer endoclip. Results: A total of 551 patients were included. No differences were found in the demographic characteristics of the patients between techniques during ANOVAs. The global outcomes were SSI (5.44%), unplanned reoperation (3.08%), readmission (15.97%) and mortality (0.18%). Significant differences were found (p < 0.05) in these outcomes explained by higher rates of SSI and unplanned reoperation with Technique 1. Conclusions: The overall outcomes of laparoscopic appendectomy, after the adoption of policies for the reuse and reprocessing of medical devices, are similar to those accepted globally when using operative techniques 2-3-4 in equivalent populations of patients with acute appendicitis. In this context, our results invite to use with caution technique-1.

2.
Article in Chinese | WPRIM | ID: wpr-909269

ABSTRACT

Objective:To investigate the analgesic efficacy of dexmedetomidine combined with fentanyl citrate injection in patients undergoing laparoscopic appendectomy and its effects on inflammatory factor level.Methods:200 patients with appendicitis who underwent laparoscopic appendectomy in Hangzhou Dajiangdong Hospital from April 2017 to March 2019 were included in this study. They were randomly assigned to receive postoperative anesthesia either with fentanyl citrate injection alone (control group, n = 100) or fentanyl citrate injection combined with dexmedetomidine (observation group, n = 100). At different time points after surgery, Visual Analogue Scale (VAS) score was compared between the two groups. Inflammatory factors C-reactive protein, interleukin-6, and tumor necrosis factor-α levels before and after surgery, and the incidence of adverse reactions were compared between the two groups. Results:At 6, 12, 24 and 48 hours after surgery, VAS score in the observation group was significantly lower than that in the control group ( t = 4.671, 9.594, 10.877 and 12.358, all P < 0.001). Before surgery, there were significant differences in C-reactive protein, interleukin-6, and tumor necrosis factor-α levels between the two groups ( t = 0.224, 0.188, 0.421, all P > 0.05). At 24 hours after surgery, C-reactive protein, interleukin-6, and tumor necrosis factor-α levels in each group were significantly increased compared with before surgery, and C-reactive protein, interleukin-6, and tumor necrosis factor-α levels in the observation group were significantly lower than those in the control group ( t = 2.496, 2.209, 3.165, all P < 0.05). There was no significant difference in the incidence of adverse reactions between the control and observation groups [8.00% (8/100) vs. 10.00% (10/100), χ2 = 0.244, P > 0.05]. Conclusion:Dexmedetomidine combined with fentanyl citrate injection exhibits good and anesthesic and analgesic effects during laparoscopic appendectomy, helps inhibit the expression of inflammatory factors, reduces the level of inflammatory factors, leads to less adverse reactions, and is highly safe.

3.
Article | IMSEAR | ID: sea-213220

ABSTRACT

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.

4.
Article | IMSEAR | ID: sea-213114

ABSTRACT

Single incision laparoscopic surgery is an emerging branch of minimally assess surgery to reduce scar and post-operative pain. Appendicitis is a common general surgical problem encountered in day to day practice. Different methods of appendectomy have been described by different surgeons from open to laparoscopic and now single incision laparoscopic surgery has been practised. This is a prospective study carried out in our Department of General Surgery SCB Medical College, Cuttack from February 2019 to March 2020; 60 patients had undergone the procedure and the results are published noted under headings of post-operative pain at (6 hours, 12 hours, 24 hours and 48 hours), post-operative requirement of analgesia (diclofenac) at (6 hours, 12 hours, 24 hours and 48 hours), operative time, days to resume bowel activity, days of hospital stay, post-operative complication in accordance to Clavien-Dindo classification.

5.
Article | IMSEAR | ID: sea-213113

ABSTRACT

Minimally invasive techniques revolutionized surgery with severe reduction of access trauma, prompt mobilization, lessened hospital stays and better cosmesis.1 Laparoscopic appendectomy can be further categorized into three port and reduced port appendectomy. All the selected cases have been put in a tabulated form on the basis of their age, clinical features and signs, ultrasonography findings, intra op complications, duration of surgery, duration of post op pain, early post op complications, cosmetic outcome and trochar size. 20 patients fulfilling inclusion and exclusion criteria, who were admitted in our hospital (SMIMER Surat) from 1st December, 2019 to 1st April 2020 and were included in the study and underwent single sight two port laparoscopic appendectomy (SSTPLA) after their consent. We have covered the entire procedure of single sight two port appendectomy, its technique, feasibility, advantages, and disadvantages. From our study, we conclude that this new technique of SSTPLA is technically safe and feasible. Our experience of this innovative surgical technique is suggestive of the fact that SSTPLA has better patient satisfaction with respect to cosmesis, decreased post-operative pain, decreased hospital stay, decreased operative time, fewer intra operative and post-operative complications and surgeon satisfaction with respect to ergonomics and decreased chances of collision of laparoscope with only single working instrument.

6.
Article | IMSEAR | ID: sea-213156

ABSTRACT

Background: Acute appendicitis in children is the most common surgical emergency. Good outcomes have been reported with laparoscopic appendectomy (LA) in children for uncomplicated appendicitis. But the use of laparoscopy for complicated appendicitis in children is more controversial. Higher incidences of postoperative abdominal and wound infections have been reported. The purpose of this study was to retrospectively compare LA and open appendectomy (OA) for complicated appendicitis in children.Methods: The outcome of 73 patients with complicated appendicitis was retrospectively analyzed. There were 36 children in the LA group and 37 in the OA group. Data collection included demographics, duration of symptoms, type of complicated appendicitis, operative time, resumption of diet, early and late complication, length of hospitalization and duration of antibiotic use.Results: No significant difference was found with respect to age, duration of symptoms and total leucocyte count between two groups.  The operative time for LA (55.83±4.81 minutes for LA versus 67.16±4.27 minutes for OA; p=0.0001) was shorter. Patients in the LA group returned to oral intake earlier (2.83±0.31 days for LA versus 3.84±0.33 days for OA; p=0.001) and had a shorter length of hospital stay (5.11±0.55 days for LA versus 7.92±1.06 days for OA; p=0.0001).  The incidence of wound infection in group LA was 5.5% compared to 18.9% in OA group.Conclusions: The laparoscopic technique for complicated appendicitis in children is feasible, safe. Laparoscopic appendectomy should be the initial procedure of choice for most cases of complicated appendicitis in children.

7.
Article | IMSEAR | ID: sea-212838

ABSTRACT

Stump appendicitis is one of the rare delayed complications post appendectomy with a reported incidence of 1 in 50,000 cases. Stump appendicitis can present as a diagnostic dilemma if the treating clinician is unfamiliar with this rare clinical entity. The purpose of this paper is to review current data on stump appendicitis and analyse published cases.

8.
Article | IMSEAR | ID: sea-212868

ABSTRACT

Background: A laparoscopic appendectomy (LA) was performed mostly on uncomplicated appendicitis due to opinions about its safety when it was first introduced. Nevertheless, there are still concerns about surgical difficulties in managing complicated appendicitis with laparoscopy, possible post-op complications and conversion to an open appendectomy (OA) during the surgery.Methods: The study consists of 30 patients who underwent laparoscopic appendectomy in department of General Surgery at Assiut University hospitals. The study population was enrolled after fulfilling the selection criteria from department of General Surgery. Informed consent was taken from all the patients who are involved in this study. Patients diagnosis was based on clinical findings, complete blood counts, and abdominal sonography.Results: Thirty patients underwent laparoscopic appendectomy for complicated appendicitis. Of the 30 patients, perforated appendix cases are 27, gangrenous appendix are 1, appendicular abscess only one case. Post operation wound infection, conversion rate and hospital stay rate very less.Conclusions: The present study proved that laparoscopic appendectomy is the best approach in complicated appendicitis.

9.
Article | IMSEAR | ID: sea-212848

ABSTRACT

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.

10.
Article | IMSEAR | ID: sea-212782

ABSTRACT

Background: Laparoscopic cholecystectomy and laparoscopic appendectomy is gold standard treatment modality for symptomatic cholelithiasis and appendicitis. Laparoscopy in paediatric patient have many limitations and  factors restricting its use in paediatric patient are smaller surface area for access, compliant abdominal wall,  the liver margin  below the rib cage, the bladder being  an intra-abdominal structure, the viscera close to  anterior abdominal wall and small sized abdominal cavity and conventional instruments too long for paediatrics use.  The so-called obliterated structures like umbilical vein, umbilical artery and urachus remain relatively large and partially patent in infants further restricting use of therapeutic laparoscopy.Methods: The present study was carried out in Department of General Surgery, MDM Hospital, Dr. S. N. Medical College, Jodhpur, Rajasthan. Total 50 patients were included in the present study of laparoscopic surgery in paediatric patients below 14 years of age and were studied in terms of, duration of surgery, postoperative pain, analgesic requirement, postoperative hospital stay, intraoperative and postoperative complication and factors necessitating conversion of laparoscopic procedure to open method.Results: As per the present study inguinal hernia was most common diagnosis (48%) followed by hydrocele (22%) and acute appendicitis (22%).Conclusions: It is concluded from the present study that laparoscopic surgery in paediatric patients is safe, complication free, had less analgesic requirement, shorter duration of surgery, short postoperative hospital and total hospital stay and better cosmetic results.

11.
Article | IMSEAR | ID: sea-212703

ABSTRACT

Background: Obstruction of appendiceal lumen resulting in acute appendicitis is diagnosed by clinical examination, supported by raised neutrophil count, computed tomography and/or ultrasonography.Appendectomy one of the most commonly done surgeries is the standard line of management for acute appendicitis. Trend is towards greater utilization of laparoscopic appendectomy despite lack of consensus on superiority of laparoscopic procedure, hence imperative to prove scientifically the effectiveness of the two methods. The aim of the present study was a comparative study of laparoscopic appendectomy versus open appendectomy.Methods: A prospective cohort study of 100 cases of acute appendicitis above 16 years of age with no co morbidities was carried out in Dr. D. Y. Patil Medical College, Hospital and Research Centre from July 2017 to September 2019.Results: Mean age was 28.82 years, 64 (64%) males and 36 (36%) females, pain in abdomen (100%) being most common complaint followed by fever (77%) with positive correlation with severity of appendicitis (Alvarado score) and with total leukocyte count. Mean duration of surgery and hospital stay in laparoscopic appendectomy was lesser than open and difference was statistically highly significant (p=0.000). No difference in pain score observed. Retrocaecal (58%) was the most common position, slightly higher rate of complications in open appendectomy, no conversion of laparoscopic to open. Subjective level of satisfaction score (0-10) in laparoscopic appendectomy was higher than in open and difference was statistically highly significant (p=0.000).Conclusions: Laparoscopic appendectomy had advantages like better cosmesis, shorter duration of procedure and hospital stay, fewer post-operative complications and early return to work with disadvantage of steep learning curve, while open appendectomy, does not require special instruments, and is performed under direct three-dimensional vision.

12.
Article | IMSEAR | ID: sea-203553

ABSTRACT

Background: Appendectomy is the most common surgicalprocedure performed in emergency surgery. Appendectomy isstill being performed by both open (OA) and laparoscopic (LA)methods as no other technique is formulated. In this study, weaimed to compare the laparoscopic procedure and thestandard technique in the treatment of acute appendicitis.Methods: Retrospectively collected data from 60 consecutivepatients with acute appendicitis were studied. These comprised30 patients who underwent conventional appendectomy and 30patients treated laparoscopically. The two groups werecompared for Intra operative parameters like duration ofsurgery, conversion, complications, and post-operativeparameters like pain, requirement of pain medications, woundcomplications, hospital stay, any other complications, andcosmetic outcome.Results: In our study Laparoscopic Appendectomy have ashorter hospital stay (Mean duration of hospital stay aftersurgery was 3.1 & 1.9 day in OA & LA group respectively),Operative time was significantly less in the open group (Meanduration of surgery was 71.2 minutes in OA group and 48.8minutes in LA group). Total number of complications werefewer in the LA group with a significantly less incidence ofwound infection (5 Vs 11, P <0.04).Conclusion: The laparoscopic method is a safe andcompetent operative method in appendicectomy. Postoperativepain in our study is notably lesser in laparoscopic group ascompared to open appendectomy, also post-operativecomplication especially wound infections are less frequent inlaparoscopic group of patients. Patient’s recovery fromoperation is also better in laparoscopic appendicectomy groupwhich includes early bowel activity, minimum hospital stay andearly return to work. Overall cosmetic outcome is preferable inlaparoscopic group of patients.

13.
VozAndes ; 31(2): 79-83, 2020.
Article in Spanish | LILACS | ID: biblio-1146656

ABSTRACT

La apendicitis del muñón es una rara entidad, de la cual se desconoce su incidencia, con alrededor de 100 casos reportados en la literatura médica. Requiere un alto grado de sospecha clínica para su correcta identificación. El tratamiento recomendado es quirúrgico. Se presenta el caso de un paciente de 26 años, con antecedente de apendicectomía hace 17 años, con cuadro de dolor abdominal en fosa iliaca derecha y signos apendiculares positivos en el examen físico. La Tomografía Axial Computarizada demostró una colección con gas y fecalitos en su interior, localizada en fosa iliaca derecha, planteándose un diagnóstico de apendicitis del muñón. Se realizó una laparotomía exploratoria, evidenciándose un muñón apendicular perforado en su tercio proximal, por lo que se completó la apendicectomía del muñón. El informe histopatológico reportó un muñón apendicular con infiltrado mono y polimorfo nuclear, que compromete el espesor de la pared. El paciente fue dado de alta con evolución dentro de parámetros esperados y fue remitido a control y seguimiento por Consulta Externa.


Stump appendicitis is a rare entity, of which its incidence is unknown, with about 100 cases reported in the medical literature, which requires a high degree of clinical suspicion for proper identification. The recommended treatment is surgical. The case of a 26-year-old patient with an appendectomy antecedent 17 years ago, with abdominal pain in right lower quadrant and positive appendicular signs on the physical exam is presented. Computerized Axial Tomography demonstrated a collection of gas and fecalites inside, located in right lower quadrant, considering a diagnosis of stump appendicitis. An exploratory laparotomy was performed, with an appendicular stump perforated in its proximal third, and the stump appendectomy was completed. The histopathological report reported an appendicular stump with mono and polymorph nuclear infiltrate, which compromises the thickness of the wall. The patient is discharged with evolution within expected parameters and is referred to control and follow-up by External Consultation.


Subject(s)
Humans , Male , Female , Adult , Appendectomy , Appendicitis , Laparoscopy , Gastric Stump , Digestive System
14.
Article | IMSEAR | ID: sea-189015

ABSTRACT

Background: Laparoscopic appendectomy is preferred because of increasing popularity and certain benefits over open method. Laparoscopic surgeries are conventionally done under general anaesthesia with positive pressure ventilation to avoid shoulder pain, respiratory embarrassment and abdominal discomfort caused by pneumoperitoneum. The data regarding use of spinal anaesthesia for laparoscopic appendectomy is limited. This study was designed to evaluate laparoscopic appendectomy under spinal anaesthesia along with the use of intravenous injection ketamine and intravenous injection dexmedetomidine. Objectives of this study were to observe efficacy of both drugs in reducing shoulder pain, need of rescue analgesia, need of conversion to open method due patient discomfort, changes in hemodynamic parameters, postoperative nausea and vomiting. Methods: After approval of ethical committee of institute , 100 patients of age group between 18-60 years with ASA grade I or II undergoing laparoscopic appendectomy with written informed consent were included in this study .All patients were informed about standard spinal anaesthesia technique in detail and also about the risk of conversion to general anaesthesia.Spinal anaesthesia procedure was carried out with hyperbaric injection bupivacaine 0.5% . Patients were randomized in two groups. One is Group K (n=50) patients who received injection Ketamine and other is Group D (n=50) patients who received injection Dexmedetomidine intravenously.Intraoperative hemodynamic parameters,shoulder pain,abdominal discomfort,need of rescue analgesia ,postoperative recovery were monitored and recorded. Results: No patients during study required conversion to general anaesthesia or open method. VDS(verbal descriptive scale) score for referred shoulder pain was statistically lower in group K compared to group D.Group D was associated with statistically significant lower heart rate and blood pressure than Group K. Conclusion:Injection ketamine and injection dexmedetomidine, both drugs are efficacious for reduction of referred shoulder pain with more hemodynamic stability in ketamine group during laparoscopic appendectomy.

15.
Article | IMSEAR | ID: sea-185368

ABSTRACT

We have done a randomised prospective observational study to compare the efficiency of two port laparoscope assisted open appendectomy versus three port laparoscopic appendectomy. Total 50 patients have been participated in the study (25 cases with two port and 25 cases with three ports). In this study two port laparoscope assisted appendectomy found simpler than three port laparoscopic appendectomy and requires less expertise and equipments, less operative time with shorter hospital stay. So it can be interpreted that the two port laparoscopic assisted open appendectomy is cost effective.

16.
Univ. med ; 60(2): 1-10, 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-988600

ABSTRACT

Introducción: La cirugía laparoscópica ha revolucionado el manejo quirúrgico de los pacientes y ha generado una necesidad de capacitación en el área. El rendimiento en la vida real es lo que permite una determinación global de las competencias en un procedimiento y establece un método de formación. El objetivo de este estudio es describir la evolución en la experiencia quirúrgica de un grupo de residentes de cirugía general. Metodología: Estudio observacional analítico de cohorte retrospectiva en el Hospital Universitario San Ignacio. Incluyó 4191 procedimientos realizados, divididos en 1045 apendicectomías laparoscópicas (AL) y 3146 colecistectomías laparoscópicas (CL), realizadas por un total de 52 residentes entre enero de 2008 y diciembre de 2014. Resultados: Tanto en AL como en CL se observó un aumento en el número de procedimientos anuales. Al comparar los tiempos promedios de AL por año de residencia, se observó una tendencia a la disminución en la mediana a medida que el residente era mayor. Las complicaciones intraoperatorias fueron del 0,77% para AL y del 1,9% para CL. La complicación postoperatoria más frecuente fue infección del sitio operatorio con una mortalidad menor al 0,5%. Conclusión: Los resultados evocan la necesidad de continuar con programas de residencia que proporcionen preparación adecuada en el abordaje laparoscópico, posiblemente con exposición cada vez más temprana a procedimientos mínimamente invasivos.


Introduction: Laparoscopic surgery has revolutionized the surgical management of patients, generating a need for training in the area. The performance in real life is what allows a global determination of the competences in a procedure and establishes a method of training. The objective of this study is to describe the evolution in the surgical experience of a group of residents of general surgery.Methodology: Observational analytical study of a retrospective cohort at the University Hospital San Ignacio. It included 4191 surgical procedures divided in 1045 laparoscopic appendectomies (LA) and 3146 laparoscopic cholecystectomies (LC) performed by a total of 52 residents between January 2008 and December 2014. Results: Both LA and LC showed an increase in the number of annual procedures. When comparing the average times of AL per year of residence, a tendency to decrease in the median was observed, as the resident was older. The intraoperative complications were 0.77% for LA and 1.9% for LC; being the most frequent postoperative complication ISO with mortality <0.5%. Conclusion: The results evoke the need to continue with residency programs that provide adequate preparation in the laparoscopic approach, possibly with increasingly early exposure to minimally invasive procedures.


Subject(s)
Humans , Cholecystectomy, Laparoscopic , Appendectomy , Learning Curve , Medical Staff, Hospital
17.
Article | IMSEAR | ID: sea-184758

ABSTRACT

Proponents of laparoscopic appendectomy emphasize the advantages of laparoscopic operation decreased hospitalization, less operating time and minimal complication. this study includes comparison between laparoscopic vs open appendectomy. 50 patients in each group were included in the study during the period of November 2015 to June 2017.There were 60 male patients while female patients were 40. Of the 60 male patients, 34 patients underwent LA while 26 patients underwent OA. 16 female patients underwent LA, while 24 female patients underwent OA. All patients presented with complaint pain. Nausea was present in 54% of the patients and vomiting in 81%. Fever was present in 58%. Per-operative diagnosis were slightly different than USG findings . 19% patients had enlarged appendix with dilated bowel loop, 4% patients had adhesions of bowel, 61% patients had acute appendicitis with omental adhesion, 8 % patients had RIF collection, 2% patients had only inflamed appendix, 3%patients had gangrenous perforated appendix with flakes, 3% patients had enlarged dilated appendix with dilated bowel loop. In our study most common anatomical position was retrocaecal 72%, 24% had pelvic postion,1% had preileal and 3% had subcaecalposition. Operating time was longer in the OA group compared to LA group and was statistically significant. The median operation time for the LA was 20-30 minutes while that of OA was 40-50 minutes. Patients who underwent LA had a shorter hospital stay compared to OA group. The average duration of hospital stay for LA group in the study was 3-4 days while for the OA group was 5-6 days. In the LA group, only 1 patient (2%) developed caecal perforation, while 3 (6%) patients developed port site infections . For those undergoing OA, 16% had complications. The most common being wound sepsis, which occurred, in 14% of the patients. One patient had developed small bowel obstruction which was diagnosed 7 days after the surgery.

18.
Article in English | WPRIM | ID: wpr-714796

ABSTRACT

PURPOSE: Laparoscopic appendectomy (LA) is a popular procedure for acute appendicitis. Its minimally invasive nature has made LA a commonly performed surgical technique for surgical residents. However, single incision laparoscopic surgery (SILS) poses a challenge to inexperienced surgical residents. We described our initial experience in teaching SILS for appendectomy in our medical center. METHODS: Twenty nine cases of SILA were performed by single surgical resident and 110 cases of LA were performed by four surgical residents and five board-certified surgeons. Data were reviewed retrospectively. RESULTS: The mean SILA and multi-port laparoscopic appendectomy (MLA) operative time was 44.5±14 min (range 25~85 min) and 74.8±26 min (range 20~125 min), respectively. The shorter time for SILA was significant (p<0.05). Postoperative hospital stay was 3.3±1.6 days (range 2~6 days) following SILA and 4.0±2.9 days (range 2~12 days) following MLA (p<0.05). Three cases of wound infection developed following SILA. Complications in the MLA patients included one cases each of operative bladder injury and postoperative ileus. CONCLUSION: SILA is a considerable training method for laparoscopic surgery for a surgical resident learning SILS.


Subject(s)
Appendectomy , Appendicitis , Humans , Ileus , Laparoscopy , Learning , Length of Stay , Methods , Operative Time , Retrospective Studies , Surgeons , Urinary Bladder , Wound Infection
19.
Article in English | WPRIM | ID: wpr-718661

ABSTRACT

PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.


Subject(s)
Appendectomy , Appendicitis , Body Mass Index , Demography , Humans , Length of Stay , Retrospective Studies , Surgeons , Surgical Instruments , Surgical Wound Infection
20.
Article in English | WPRIM | ID: wpr-717779

ABSTRACT

PURPOSE: A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy. METHODS: A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review. RESULTS: Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases. CONCLUSION: Patients older than 45 years old with a CT radiologist's read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.


Subject(s)
Appendectomy , Appendicitis , C-Reactive Protein , Conversion to Open Surgery , Humans , Laparoscopy , Laparotomy , Odds Ratio , Pathology , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
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