Subject(s)
Appendectomy , Appendicitis , Laparoscopy , Postoperative Complications , Humans , Appendectomy/methods , Appendectomy/adverse effects , Laparoscopy/methods , Laparoscopy/adverse effects , Child , Female , Male , Retrospective Studies , Appendicitis/surgery , Adolescent , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Length of Stay/statistics & numerical data , Child, Preschool , Treatment OutcomeABSTRACT
INTRODUCTION: The most common surgical intervention in childhood is inguinal hernioplasty. OBJECTIVE: The aim of the authors was to evaluate the learning curve of PIRS (percutaneous internal ring suturing). METHOD: A prospective observational cohort was studied including patients under the age of 18 years with planned PIRS between 2018 and 2019. Patients with urgent intervention (incarceration) or other surgical procedures performed simultaneously were excluded. The incidence of metachronous hernia, surgical time, number of conversions and complications were analyzed. The postoperative follow-up time was 1-4 weeks. A phone call check-up was performed in 2022. RESULTS: PIRS was performed in 126 patients (57 boys, 69 girls) with an average age of 4.6 years. The average surgical time was 26.5 min, in the case of experts it was reduced to 22.9 min. The surgeries were longer in boys than in girls (30.5 vs. 23 min). Unilateral surgeries were faster than bilateral ones (23.7 vs. 33.6 min). Initially, girls were operated with PIRS, the surgical time decreased. When trainees started to learn the procedure, the surgical time increased, then decreased again. The same trend was observed in boys. 28 metachronous hernias were found. 3 conversions and 3 intraoperative complications were observed. During the postoperative follow-up, 1 recurrence, 4 postoperative complications were observed. The phone call check-up with 92/126 patients revealed 1 more recurrence and 6 chronic complaints. DISCUSSION: PIRS is a good laparoscopic "teaching" procedure during the training, but the open procedure has still place in the treatment. CONCLUSION: PIRS is a safe procedure in childhood and can be easily learned. It is an excellent method in basic laparoscopic training by use of which metachronous hernia can be recognized. Orv Hetil. 2023; 164(7): 260-264.
Subject(s)
Herniorrhaphy , Laparoscopy , Male , Female , Humans , Child , Child, Preschool , Adolescent , Learning Curve , Intraoperative Complications , HerniaABSTRACT
Severe abdominal pain and vomiting are common symptoms in children with pediatric multisystem inflammatory syndrome (PIMS). Mesenteric lymphadenitis and aseptic peritonitis are predominantly reported in cases where acute surgical abdomen was suspected and laparotomy was performed at the early stage of the pandemic. These reports generally discouraged surgeons to perform exploration in COVID-19-related cases and medical management was prioritized. Only a few COVID-19-specific surgical cases with intestinal ischemia were published. Here, we report another case of COVID-19-related intestinal ischemia complicated with Meckel's diverticulitis in a non-immunocompromised child who clearly required surgical intervention. In our case, the combination of COVID-19-related vasculitis and low blood pressure episodes may have contributed to this severe outcome.
ABSTRACT
Introduction: The advantages of laparoscopic against open appendectomy were observed both in adults and children. Objective: The aim of the authors was to study the learning period when they switched from open to laparoscopic appendectomy. Methods: Retrospective, observational study was performed. Children (018 years) between 2016 and 2017 were included, who underwent acute appendectomy. Exclusion criteria were other surgical procedure performed at the same time (Meckel's diverticulum, ovarian pathology), converted laparoscopic procedure and malignancies. Patients were divided to open appendectomy (OA) and laparoscopic appendectomy (LA) groups. Duration of the procedures, length of hospital stay, postoperative complications were reviewed. For statistical analysis MannWhitney, Fisher's exact and chi2 tests were used. Results: During the study period, 297 appendectomies were performed (open: 149, laparoscopic: 148). In 2017, reaching the end of the learning curve, laparoscopy was the faster procedure (p = 0.0003). The length of stay was shorter in laparoscopic than in open appendectomy (p<0.0001). There was no difference in the number of postoperative complications between the OA and the LA groups (p = 0.2409). Discussion: Our study supports the international studies in English literature which showed that the results of a laparoscopic operation in childhood after the "learning phase" do not differ, and may be better, than those of an open one. Conclusion: LA is a safe and fast procedure in childhood. Even paediatric surgeons who did previously only open procedures, can switch to the laparoscopic technique following a short learning curve.
Subject(s)
Appendicitis , Laparoscopy , Adult , Appendectomy/adverse effects , Appendicitis/complications , Appendicitis/surgery , Child , Humans , Laparoscopy/methods , Length of Stay , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
Összefoglaló. Bevezetés: A COVID-19-pandémia miatt a gyermekkori appendicitisek kezelésében számos változás történt (laparoszkópia helyett nyílt mutét, antibiotikumkezelés). Világszerte emelkedett a szövodményes appendicitisek aránya. Célkituzés: Munkánk során a COVID-19-járványnak a gyermekkori akut appendicitisekre kifejtett hatását szerettük volna vizsgálni: lett-e több perforált eset? Módszerek: A 2012 és 2020 között akut vakbélgyulladás miatt operált gyermekeket vizsgáltuk, külön, havi bontásban a 2020-as eseteket. A szövettani diagnózis alapján perforált és nem perforált appendicitis csoportokat alkottunk. A 2020-ban operált betegek COVID-19-statusát is rögzítettük. Statisztikai analízisre a khi2-próbát ('chi2 test for trend') és a Fisher-féle egzakt tesztet alkalmaztuk. Eredmények: A vizsgált idoszakban 1343 appendectomia történt, többségében nem perforált akut appendicitis miatt (1166/1343). 2015-tol kezdodoen a perforált esetek aránya szignifikáns emelkedést mutat (p = 0,0002). Az igazoltan COVID-19-pozitív betegek között magasabb volt a perforáltak aránya (5/8), mint az igazoltan negatív betegek között (15/92) (p = 0,0075). Megbeszélés: A nemzetközi trendeknek megfeleloen 2020-ban osztályunkon is magasabb volt a perforált appendicitisek aránya, mint a korábbi években. Ez az emelkedés 2015-tol tart, a pandémiával nem mutat szoros összefüggést. A perforált appendicitisek COVID-19-pozitív betegek között észlelt magas arányának okát nem ismerjük. Következtetés: További vizsgálat indokolt annak feltárására, hogy mi okozza a perforált appendicitisek COVID-19-pozitív betegek között észlelt magas, illetve 2015 óta emelkedo rátáját. Orv Hetil. 2021; 162(16): 608-610. INTRODUCTION: As a result of the COVID-19 pandemic, the management of paediatric appendicitis has changed (open instead of laparoscopic appendectomy, antibiotic treatment). The number of complicated appendicitis cases increased worldwide. OBJECTIVE: Our aim was to study the effect of the COVID-19 pandemic on paediatric acute appendicitis: has there been more perforated cases? METHODS: Children operated because of acute appendicitis between 2012 and 2020 were studied. Cases from the year 2020 were analysed monthly. Patients were divided into perforated and non-perforated appendicitis groups according to their histological findings. COVID-19 status of patients in 2020 was studied. Chi2 test for trend and Fisher's exact test were used for statistical analysis. RESULTS: In the study period, 1343 appendectomies were performed. The majority of our cases were non-perforated (1166/1343). The rate of perforated appendicitis cases has been increasing from 2015 (p = 0.0002). The number of perforated cases was higher in COVID-19 positive patients (5/8) then in negative ones (15/92) (p = 0.0075). DISCUSSION: In line with the international trend, more perforated appendicitis cases were treated in our departement in 2020. However, this increase started in 2015, and there is no correlation with the COVID-19 pandemic. The cause of the increased number of perforated cases in COVID-19 positive appendicitis patients is unknown. CONCLUSION: The causes of the high proportion of perforated cases in COVID-19 positive patients and the rising rate of perforated appendicitis cases since 2015 need further studies. Orv Hetil. 2021; 162(16): 608-610.
