Timing of intervention does not affect outcome in acute appendicitis in a large community practice.

BACKGROUND: Surgical management of acute appendicitis remains one of the most frequent problems faced by gastrointestinal surgeons. Traditional management has emphasized urgent surgical care. Recent literature suggests delayed surgery for acute appendicitis does not affect outcome. The outcomes of patients undergoing urgent and delayed appendectomy in a large community surgical practice are compared. METHODS: All patients undergoing appendectomy between August 2002 and May 2007 were reviewed retrospectively. The data were gathered from a large community surgical practice. Patient demographics, treatment times, and surgical, pathologic, and postsurgical outcomes were documented. RESULTS: A total of 1,198 patients underwent appendectomy (575 female/623 male). The mean time to surgical intervention was 7.1 hours (range, 1-24 h). The percentage of patients undergoing laparoscopy versus open versus surgical conversion was 63%, 33%, and 4%, respectively. The percentage of patients with acute appendicitis versus perforated acute appendicitis versus negative exploration was 77%, 14%, and 8.5%, respectively. Postoperative wound or intra-abdominal septic complications were observed in 5.3% and 2.6% of patients, respectively. There was no correlation between the duration of symptoms or time to surgical intervention and surgical approach, pathologic outcome, length of stay, or postoperative septic complications. CONCLUSIONS: Outcome variables documented in this study were independent of duration of symptoms or time to surgical intervention. This would suggest that short delays in surgical intervention for acute appendicitis are well tolerated. Outcome is related more clearly to the severity of the acute appendicitis at presentation.

Outcomes of a laparoscopic approach for total abdominal colectomy and proctocolectomy.

BACKGROUND: The role of laparoscopy for total abdominal colectomy (TAC) and total proctocolectomy (TPC) has been controversial given its technical difficulty, high conversion rate, and complication rate. Recent studies have documented its efficacy for experienced laparoscopic surgeons. The outcomes of a prospective series of patients undergoing TAC and TPC are presented. METHODS: A consecutive series of patients undergoing TAC or TPC were identified from prospectively collected data during 2002 to 2005. The database reflects a single colon and rectal surgical specialty practice. Patient characteristics, surgical parameters, and patient outcomes were documented. RESULTS: From a total of 51 patients, 19 underwent TAC and 32 underwent TPC. There were 26 women and 35 men. The mean patient age was 40 years (range, 17-74 y). The mean body mass index was 25 (range, 19-38). Twelve patients underwent surgery for colonic inertia, 2 for familial adenomatous polyposis, and 37 for chronic ulcerative colitis. Of the ulcerative colitis patients, 8 patients had toxic colitis, 4 had dysplasia, and 25 had medically refractory disease. The overall mean surgical time was 163 minutes (range, 85-227 min): the mean surgical time for TAC was 131 minutes (range, 85-189 min) and for TPC was 197 minutes (range, 131-227 min). The overall mean blood loss was 200 mL (range, 75-500 mL). The mean length of stay was 4.8 days (range, 2-16 d). Open conversion was required in 5 patients: 3 with toxic colitis (38%), and 2 during elective colectomy (4.8%). Ten complications occurred (19.7%) with no mortality. CONCLUSIONS: A laparoscopic approach to TAC and TPC is efficacious and safe. It is a viable alternative to open surgery for surgeons experienced with the laparoscopic approach to colectomy. Patients with toxic colitis may undergo a laparoscopic approach but will have a higher open conversion rate.