Value of Laparoscopic Appendectomy in the Elderly

Acta Psychiatrica ScandinavicaVolume 121, Issue 2 p. 157-157 Reply M. Weiser, M. Weiser Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorN. Werbeloff, N. Werbeloff Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorD. Dalperin, D. Dalperin Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorE. Kravitz, E. Kravitz Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorR. Yoffe, R. Yoffe Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorM. Davidson, M. Davidson Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this author M. Weiser, M. Weiser Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorN. Werbeloff, N. Werbeloff Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorD. Dalperin, D. Dalperin Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorE. Kravitz, E. Kravitz Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorR. Yoffe, R. Yoffe Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this authorM. Davidson, M. Davidson Department Of Psychiatry, Sheba Medical Center, and Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Israel E-mail: mweiser@netvision.net.ilSearch for more papers by this author First published: 04 January 2010 https://doi.org/10.1111/j.1600-0447.2009.01499.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume121, Issue2February 2010Pages 157-157 RelatedInformation

Demographic changes associated with the aging population mean that surgeons increasingly have contact and make decisions about treating patients from the oldest age groups. The aim of the study was to review the literature concerning the treatment of acute appendicitis in patients over the age of 60 years old. A review of the literature published in the years 2000-2015 has been carried out using the PubMed database. The initial number of results corresponding to the query in English, "appendicitis (MeSH) AND elderly (MeSH)" was 260. Selection based on the titles, abstracts, and eventually whole articles, ultimately resulted in 11 papers concerning the treatment of appendicitis in patients above 60 years of age. Nine papers were retrospective and 2 were prospective. In total, the studies included 82,852 patients. Laparoscopic appendectomy was associated with a lower mortality rate, a smaller number of postoperative complications and a shorter length of hospital stay, which led to it being recommended by most authors. Four of the ten papers demonstrated that the patients who were qualified for laparoscopic surgery had less comorbidity and were in a lower ASA (American Society of Anaesthesiology) category. Antibiotic therapy as an independent method was assessed in one study in a group of elderly people, on a selected group of 26 patients, and its effectiveness was shown to be 70%. Most studies, however, are highly heterogeneous which significantly hindered comparisons. Currently, laparoscopic appendectomy seems to be the treatment of choice in the elderly with acute appendicitis. Antibiotic therapy, as an independent method of treatment of acute appendicitis, cannot currently be recommended. However, further, prospective, and better-designed studies are needed, involving a larger number of patients, and primarily dedicated to the elderly.

BackgroundLaparoscopic appendectomy is not yet unanimously considered the “gold standard” in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. This study aimed to compare outcomes and cost of laparoscopic and open appendectomy in a district hospital.MethodsA retrospective analysis of 230 patients who underwent appendectomy at the Division of General Surgery of the Civil Hospital of Ragusa, Italy, from May 2008 to May 2012 was performed. The variables analyzed included patients data (age, gender, previous abdominal surgery, preoperative WBC count, duration of symptoms, ASA risk score), rate of uncomplicated or complicated appendicitis, operative time, postoperative complications, length of hospital stay, and total costs. The patients were divided in two groups according to the surgical approach and compared for each variable. The results were analyzed using the t Student test for quantitative variables, and the Chi-square test with Yates correction and Fisher exact test for categorical.ResultsLaparoscopic appendectomy was performed in 139 patients, open appendectomy in 91. Two cases (1.4%) were converted to open procedure and included in the laparoscopic group data. Patient data and rate of complicated appendicitis were similar in the two study groups. There was no statistical difference (p = 0.476) in the mean operative time between the laparoscopic (52.2 min; range, 20–155) and open appendectomy (49.3 min; range, 20–110) groups. The overall incidence of minor and major complications was significantly lower (p = 0.006) after laparoscopic appendectomy (2.9%, 4 cases) than after open appendectomy (13.2%, 12 cases); rate of intra-abdominal abscess were similar. The length of hospital stay was significantly shorter (p = 0.001) in laparoscopic group (2.75 days; range, 1–8) than in open group (3.87 days; range, 1–19). The mean total cost was 2282 Euro in laparoscopic group and 2337 Euro in open group, with a no significant difference of 55 Euro (p = 0.812).ConclusionLaparoscopic appendectomy is associated with fewer complications, shorter hospital stay, and similar operative time, intra-abdominal abscess rate, and total costs, compared with open appendectomy. Therefore, laparoscopic appendectomy can be recommended as preferred approach in acute appendicitis.

BackgroundAppendectomy is one of the most common operations. Laparoscopic appendectomy (LA) is considered first-line treatment, but the use of LA for treatment of complicated appendicitis remains controversial. Here, we performed a retrospective analysis to compare clinical outcomes between patients treated with LA and those who underwent open appendectomy (OA).MethodsData for 179 patients who underwent an operation for the treatment of complicated appendicitis at our hospital between 2011 and 2017 were retrospectively analyzed. The selection included 89 patients who underwent a conventional appendectomy and 90 patients who were treated laparoscopically. Outcome measures such as mean operative time, blood loss, time until oral intake duration of hospital stay, and postoperative complications were analyzed. Logistic regression analysis was performed to determine the concurrent effects of the examined factors on the rate of postoperative complications.ResultsThe mean ages of patients in the OA and LA groups were 50.17 ± 22.77 and 50.13 ± 25.84 year. Mean operative times were longer in the LA group than OA (10.2.56 ± 44.4 versus 85.4 ± 43.11 min; p = 0.009). The duration of hospital stay was shorter for the LA group (9.61 ± 5.57 versus 12.19 ± 8.4; p = 0.016). There were no significant differences in return to consumption of oral intake between the LA and OA groups (2.03 ± 1.66 versus 2.48 ± 2.17; p = 0.123). Multivariable analysis found that the rate of postoperative complications was significantly reduced for the LA group, in comparison with the postoperative-complication rate of the OA group (16.7% versus 27%; odds ratio 0.376; 95% CI 0.153–0.923; p = 0.0327).ConclusionsThese results suggest that LA is a safe and efficient operative procedure that provides clinically beneficial advantages in comparison with OA. Thus, when possible, appendectomy for complicated appendicitis should be attempted using a laparoscopic approach.Trial registrationRetrospectively registered.

Acute appendicitis is one of the most common urgent abdominal interventions.Open appendectomy has been a standard procedure for acute appendicitis for more than 100 years.However, in the last 20 years, after many studies, laparoscopic appendectomy has become a gold standard in solving acute appendicitis.The main goal of our study was to compare results of open and laparoscopic appendectomies with regard to in-hospital stay, time of operation, postoperative complications and postoperative pain.All patients underwent open or laparoscopic appendectomy in the Center of Minimally Invasive Surgery and Emergency Center of the University Clinical Center Ni, Serbia in the period of one year.A total of 126 patients were enrolled and submitted to retrospective analysis.One hundred and twenty-six patients who underwent laparoscopic or open appendectomy surgery were retrospectively analysed.A laparoscopic appendectomy was performed in 58 patients, while 68 patients underwent an open appendectomy.Groups were demographically similar and there was no significant difference between the age structure and gender distribution (t = 0.927; p = 0.057).Average height (p = 0.123), weight (p = 0.200) and BMI (p = 0.425) were mostly similar.Previous surgical operations were more common in patients with open appendectomy, but with no statistical significance (p = 0.141).Percentage of patients with WBC > 10 were the same in both groups (p = 0.927).Diabetes mellitus was more common in patients with open appendectomy, but with no statistical significance (p = 0.563).Acute and perforated appendicitis were similar in both groups (p = 0.490).Average time of operation was the same in both groups (p = 0.751).Number of days of in-hospital stay was shorter in patients who underwent laparoscopic appendectomy (p < 0.001).The analysis of administration of parenteral and oral analgesics showed that postoperative pain was less in the group of patients who underwent laparoscopic appendectomy than in the group of patients with open appendectomy.There was no statistically significant difference with respect to postoperative complications between two groups (p < 0.001).The treatment of appendicitis by using laparoscopic surgery in comparison to open approach provides a better result in terms of duration of hospital stay, recovering time, postoperative complications and postoperative pain.

IntroductionDespite the increase in use of laparoscopic appendectomy (LA) in recent years, until now no nationwide survey on this issue has been performed in Poland.AimTo determine current surgical practice patterns among Polish pediatric surgeons in the treatment of appendicitis in children.Material and methodsThe nationwide survey was conducted in the form of an internet questionnaire asking for information concerning treatment of children suspected of having acute appendicitis in the years 2007–2011. Twenty-seven major pediatric surgical departments in Poland were invited to participate in the study.ResultsThe overall survey response rate was 70.37%. Laparoscopic appendectomy was offered in all departments except one. Laparoscopy was used in 33% of cases and was the standard procedure in 4 departments. In 1 center 100% of appendectomies were performed laparoscopically. The 3-port technique was used in all departments. Five centers offered transumbilical laparoscopic extracorporeal appendectomy and 2 centers single-port appendectomy. In LA the mesoappendix was mostly divided using bipolar or monopolar coagulation and the appendix was ligated using endoloops or was clipped. The mean hospitalization time was 3.31 days after laparoscopy and 5.47 days after open appendectomy.ConclusionsDespite an apparent consensus on some aspects of pediatric appendicitis among Polish pediatric surgeons, significant inconsistency exists in the operative approach. The low rate of LA suggests that LA still remains far from being a standard. Personal experience and preference have a major influence on the choice of operative approach. It is recommended that national guidelines be set up, which could standardize the care for children and training of pediatric surgery residents.

BackgroundSeveral systematic reviews (SRs) of randomised controlled trials (RCTs) comparing laparoscopic versus open appendectomy have been published, but there has been no overview of SRs of these two interventions. This overview (review of review) aims to summarise the results of such SRs in order to provide the most up to date evidence, and to highlight discordant results.MethodsMedline, Embase, Cinahl, the Cochrane Database of Systematic Reviews and the Database of s of Reviews of Effects were searched for SRs published up to August 2014. Study selection and quality assessment using the AMSTAR tool were carried out independently by two reviewers. We used standardised forms to extract data that were analysed descriptively.ResultsNine SRs met the inclusion criteria. All were of moderate to high quality. The number of randomized controlled trials (RCTs) they included ranged from eight to 67. The duration of surgery pooled by eight reviews was 7.6 to 18.3 minutes shorter using the open approach. Pain scores on the first postoperative day were lower after laparoscopic appendectomy in two out of three reviews. The risk of abdominal abscesses was higher for laparoscopic surgery in half of six meta-analyses. The occurrence of wound infections pooled by all reviews was lower after laparoscopic appendectomy. One review showed no difference in mortality. The laparoscopic approach shortened hospital stay from 0.16 to 1.13 days in seven out of eight meta-analyses, though the strength of the evidence was affected by strong heterogeneity.ConclusionLaparoscopic and open appendectomy are both safe and effective procedures for the treatment of acute appendicitis. This overview shows discordant results with respect to the magnitude of the effect but not to the direction of the effect. The evidence from this overview may prove useful for the development of clinical guidelines and protocols.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-015-0277-3) contains supplementary material, which is available to authorized users.

See Article on Page 192-197 Acute appendicitis is the most common indication for surgery in patients admitted to hospital due to an acute abdomen. Although most are uncomplicated, about 20% of all acute appendicitis cases are complicated, leading to local or diffuse peritonitis. An urgent appendectomy is the recommended treatment for both complicated and uncomplicated appendicitis. The appendectomy, which has been the first choice for the treatment of acute appendicitis for over 120 years, is a classic surgical procedure [1]. Nowadays, a laparoscopic appendectomy is widely practiced for its benefits, such as significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay [2]. Although an appendectomy is generally well tolerated, it is still considered a major surgical intervention and can be associated with postoperative morbidity in about 2%-23% of patients [3]. According to a study that followed patients for over a decade, 3% of the patients undergoing appendectomy were readmitted for intestinal obstruction related to postoperative adhesion [4,5]. Therefore, physicians are taking higher interest in noninvasive interventions, such as antibiotic therapy, as a primary treatment. Although the appendectomy remains the standard approach for treating appendicitis [6], several studies have already suggested that appendicitis can be treated with antibiotics [5]. Two well-studied appendicitis scoring systems based on clinical symptoms were used to diagnose appendicitis: the Alfredo Alvarado system for adults and the Madan Samuel system for children. The Alvarado score was developed in Philadelphia in the mid-1980s and has a sensitivity of 81% and a specificity of 74% [7]. The Pediatric Appendicitis Score was developed to diagnose appendicitis in children and has a high sensitivity of 100% and specificity of 92% [8]. Although these scoring systems were widely used to diagnose appendicitis in the past, they are no longer practically implicated. Recently, various diagnostic tools, such as computed tomography (CT) and ultrasound, have been developed to diagnose appendicitis. With the improvement of such radiologic tools, determining the severity of and diagnosing appendicitis have become more accurate. The development of radiologic tools has provided many advantages for diagnosing appendicitis and determining its severity. The increased use of CT has reduced the rate of negative (unnecessary) appendectomies [9]. A meta-analysis consisting of data from 31 studies revealed that both the sensitivity and the specificity of CT for appendicitis were as high as 94% [10]. The development of a precise scoring system based on CT to distinguish between complicated and uncomplicated appendicitis has led to an improvement in diagnostic accuracy [11]. This system provides the physician with the evidence needed to decide on a treatment strategy for appendicitis patients. A meta-analysis [12] of randomized controlled trials comparing antibiotics with appendectomies has shown that although antibiotic treatment alone can be successful in 77%-95% of the cases, patients should be made aware of the fact that the failure rate during the first year, with a need for readmission or surgery, is around 25%-30%. However, recently conducted research proposed the use of antibiotics as the single treatment for uncomplicated appendicitis. However, one should note that more accurate selection criteria, based on combinations of clinical risk scores and imaging, are required for patients or subgroups of patients in whom primary antibiotic treatment is more likely to succeed in the long-term, and CT could be of assistance in the process of selecting patients suitable for antibiotics therapy. Although the appendectomy is the best treatment for the appendicitis, studies on the use of antibiotics therapy to treat patients with uncomplicated appendicitis are still meaningful; thus, efforts for such research should be supported.

To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre. The data of patients who underwent appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale of pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded. Patients with surgery converted from laparoscopic appendectomy (LA) to mini-incision open appendectomy (MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physical examination, laboratory values, and radiological tests (abdominal ultrasound or computed tomography). All operations were performed with general anaesthesia. The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients. Of the 243 patients, 121 (49.9%) underwent MOA, while 122 (50.1%) had laparoscopic appendectomy. There were no significant differences in operation time between the two groups (P = 0.844), whereas the visual analog scale of pain was significantly higher in the open appendectomy group at the 1(st) hour (P = 0.001), 6(th) hour (P = 0.001), and 12(th) hour (P = 0.027). The need for analgesic medication was significantly higher in the MOA group (P = 0.001). There were no differences between the two groups in terms of morbidity rate (P = 0.599). The rate of total complications was similar between the two groups (6.5% in LA vs 7.4% in OA, P = 0.599). All wound infections were treated non-surgically. Six out of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient required surgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain. The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Background: Open appendicectomy has been safe and effective for acute appendicitis for more than a century. Recently, several authors proposed that the new technique of laparoscopic appendicectomy should be the treatment for acute appendicitis. Therefore, the aim of this study is to evaluate and compare laparoscopic appendicectomy with open appendicectomy in general surgical practice. Methods: This prospective randomized controlled study was carried out over a period from October 2012 to October 2015 in the department of general surgery K.P.C. Medical College and Hospital, Kolkata. Patients between 18 years and 60 years of age were candidates for randomization. The total population group included 144 patients with a mean age of 39 years. Results: Comparative studies of laparoscopic and open appendicectomy shows that hospital stay and wound infection rates are significantly lower after laparoscopic appendicectomy. As compared to laparoscopic appendicectomy prevalence of intra-abdominal abscess was less in open appendicectomy. Similarly, shorter operating time was found in patients randomized to open appendicectomy compared with laparoscopic appendicectomy. There were shorter period of convalescence and better cosmesis observed in the laparoscopic group. However, no single case of pneumonia was reported in the post-operative period in both appendicectomy. Conclusions: From the present study, we can conclude that laparoscopic appendicectomy has been shown to be both feasible and safe in comparison with open appendicectomy. However, because of the competition of laparoscopic and open appendicectomy, open appendicectomy has improved greatly. The benefit of laparoscopic appendicectomy over the open appendicectomy will be a question.

Introduction:Appendectomy remains the most frequently performed emergency abdominal surgical procedure. 1The lifetime risk of acute appendicitis for men and women is 8.6% and 6.7% respectively.[4] Laparoscopic appendicectomy was first described by Semm in 1983. 5ombining clinical history, physical examination and laboratory studies has led to the development of scoring systems and computer-aided algorithms to help clinicians with decision making in acute appendicitis. 6verall, the actual gain of scoring systems

Introduction: Laparoscopic appendectomy becomes a usual method in the treatment of acute appendicitis, although its advantage over open appendectomy has been proven. In Bosnia and Herzegovina, a few medical centers are introducing laparoscopic appendectomy as a method of treatment of acute appendicitis. In this study we want to compare different methods of treatment of acute appendicitis. Patients and Methods: During 20 months we have analyzed 498 patients operated due to acute appendicitis. We followed the duration of operation, total hospitalization stay, complications of surgical procedure and reasons of conversion in patients operated by laparoscopic approach. Results: The duration of operation was 96 minutes in the group operated by open approach and 107 minutes in the group operated by laparoscopic approach. Total hospitalization stay was 3.9. days in the group operated by open approach and 2.3. days in the group operated by laparoscopic approach. The most frequent complication in the group operated by open approach was infection of the operative wound (56/452) and ileus (5/452), and in the group operated by laparosocopic approach ileus (1/46) was the most frequent complication. Conclusion: The patients operated by laparoscopic approach have fewer risk of wound infection, and the hospital stay is shorter. With the increase of surgeon’s experience this method of treatment of acute appendicitis will become a method of choice.

Киришүү. Кыргыз Республикасынын улуттук статистикалык комитетинин маалыматына таянсак жалпы өлкөнүн жарандарынын арасында улгайган жана кары адамдардын саны жылдан жылга карай өсүүдө.Ал эми ошол адамдырдын 12ден 18 пайызга чейинкиси курч аппендицит дарты менен хирургиялык бөлүмдөргө жаткырылат жана дарыланышат. Курч аппендицит кечиктирилгис хирургияда кеңири таралган жа на жакшы изилденген оорулардын бири экенине карабастан улгайган жана кары адамдарда курч аппендицитти аныктоо жана даарылоо толук изилденбеген бойдон калууда. Изилдөөнүн максаты. Улгайган жана кары адамдардагы курч аппендицит дартында лапароскопиялык жол менен жана ачык түрдө жасалган операциялардын жыйынтыктарын баалоо. Материалдар жана методдор. Изилдөө Кыргыз Республикасынын Саламаттык сактоо министрлигинин Академик М. М. Мамакеев атындагы Улуттук хирургиялык борборунда дарыланган улгайган жана кары адамдардын арасында жургүзүлдү. 01.01.2022 жылдан баштап 01.01.2024 жылга чейин академик М. М. Мамакеев атындагы Улуттук хирургия борборуна курч аппендицит дарты аныкталып, операция болуп дарыланган 60 жаштан 90 жашка чейинки бейтаптардын оору баяндарына ретроспективдүү изилдөө жүргүзүлдү. Изилдөөгө жалпысынан 166 бейтап катышты, алардын 58 бейтап негизги топко, ал эми 108 бейтап контролдук топко бөлүндү. Натыйжалар жана талкуулоо. Операциялардын узактыгын эсептегенде ачык жол менен жасалган аппендэктомиянын узактыгы лапароскопиялык операциянын узактыгынан бир топ эле узак болгон. Ачык аппендэктомия 50±20 минут. Лапароскопиялык аппендэктомия - 30±5 минут. Бейтаптардын операциядан кийинки ооруканада жаткан убактысын карап көргөнүбүздө лапароскопиялык жол менен операция болгон бейтаптардын убактысы 4,0±2,0 күндү түзсө, ачык жол менен операция болгондордун убактысы 7,0±4,0 күндү түзгөн. Улгайган жана кары адамдарда курч аппендицитти дарылоодо видеолапароскопиялык технологияларды колдонуу экономикалык жагынан да алганда натыйжалуу болуп эсептелет. Ал лапароскопиялык операциянын узактыгы аз экени жана бейтаптардын операциядан кийинки убакта ооруканада жатуусунун кыска убакытка созулганы менен түшүндүрүлөт. Жыйынтыгы. Лапароскопиялык аппендэктомия улгайган жана кары адамдардагы курч аппендицитти дарылоодо тандалып алына турган операциянын түрү болуп саналат. Введение. По данным Национального статистического комитета Кыргызской Республики, количество пожилых людей среди граждан страны в целом увеличивается из года в год. От 12 до 18 % из числа этих людей госпитализируются и лечатся по поводу острого аппендицита. Несмотря на то, что острый аппендицит является одним из наиболее распространенных и хорошо изученных воспалительных сос тояний, требующих экстренного хирургического вмешательства, его диагностика и лечение у лиц пожилого и старческого возраста остаю тся малоизученными. Цель исследования. Оценка результатов лапароскопических и открытых операций при остром аппендиците у лиц пожилого и старческого возраста. Материалы и методы. Исследование проводилось среди пациентов пожилого и старческого возраста Национального хирургического центра имени академика Мамакеева М. М. Министерства здравоохранения Кыргызской Республики. Проведено ретроспективное исследование историй болезни пациентов в возрасте от 60 до 90 лет с диаг нозом «острый аппендицит», пролеченных хирургическим путем в Национальном хирургическом центре имени М. М. Мамакеева в период с 01.01.2022 по 01.01.2024 годы. Всего в исследовании приняли участие 166 пациентов, из них 58 человек были распределены в основную группу, а 108 - в контрольную. Результаты и обсуждение. При расчете продолжительности операции открытая аппендэктомия проводилась достоверно дольше, чем лапароскопическая операция. Открытая аппендэктомия длилась 50±20 минут, лапароскопическая аппендэктомия - 30±5 минут. Время пребывания пациентов в стационаре после лапароскопической операции составило 4,0±2,0 дня, а после открытой операции - 7,0±4,0 дня. Использование видеолапароскопической технологии при лечении острого аппендицита у лиц пожилого и старческого возраста считается экономически целесообразным. Это объясняется тем, что данные операции характеризуются более низкой длительностью оперативного пособия и меньшей продолжительностью стационарного лечения. Заключение. Лапароскопическая аппендэктомия является более эффективным методом оперативного лечения больных пожилого и старческого возраста с диагнозом «острый аппендицит». Introduction. According to the National Statistical Committee of the Kyrgyz Republic, the number of elderly people among the country's citizens as a whole is increasing from year to year. Between 12 and 18 percent of these people are hospitalized and treated for acute appendicitis. Despite the fact that acute appendicitis is one of the most common and well-studied diseases requiring emergency surgical intervention, the diagnosis and treatment of acute appendicitis in elderly and senile people remains poorly studied. Operations for acute appendicitis occupy first place among general surgical operations. Currently, appendectomy is performed through an open incision (Volkovich-Dyakanov incision) and laparoscopically. The purpose of the study. Evaluation of the results of laparoscopic and open operations for acute appendicitis in elderly and senile people. Materials and methods. The study was conducted among elderly and senile patients of the National Surgical Center named after Academician M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic. A retrospective study of the case histories of patients aged 60 to 90 years with a diagnosis of acute appendicitis, treated surgically at the National Surgical Center named after Mamakeev from 01.01.2022 to 01.01.2024, was conducted. A total of 166 patients took part in the study, of which 58 patients were assigned to the main group, and 108 patients to the control group. Results and discussion. When calculating the duration of the operation, the duration of open appendectomy was significantly longer than the duration of laparoscopic surgery. Open appendectomy 50±20 minutes. Laparoscopic appendectomy - 30±5 minutes. When considering the time of stay of patients in the hospital after surgery, the stay after laparoscopic surgery was 4.0±2.0 days, and the stay after open surgery was 7.0±4.0 days. The use of video laparoscopic technology in the treatment of acute appendicitis in elderly and senile patients is considered cost-effective. This is explained by the fact that laparoscopic operations are characterized by a shorter duration of surgery and a shorter duration of inpatient treatment. Conclusion. Laparoscopic appendectomy is the method of choice for surgical treatment of elderly and senile patients diagnosed with acute appendicitis.

Aim: Video-assisted transumbilical appendectomy (VATA) is a combination of laparoscopic appendectomy (LA) and open appendectomy (OA) that has the potential advantages of both techniques. In this study we report our recent experience with VATA and compare it to our experience with OA and LA. Methods: The charts of all the children who underwent VATA between March 2006 and July 2008 were retrospectively reviewed and compared to those who had OA or LA between from July 2002 and October 2003 in our department. Children who present with a preoperative diagnosis of acute appendicitis and children who electively admitted for an interval appendectomy were candidates. One 12-mm trocar was inserted transumbilical. An operating laparoscope was used to mobilize the appendix, which was delivered through the umbilicus, and a standard extracorporeal appendectomy was performed. The results in VATA were compared to our results with OA and LA that was published in 2007. Results: Of 129 children who underwent appendectomy, 58 had VATA, 52 OA and 19 LA. Of the 58 children who had VATA, 42 were performed for treating acute appendicitis and 16 as an interval appendectomy after conservative treatment of complicated appendicitis. The operating time was significantly longer for LA than for VATA and OA. The length of stay (LOS) was significantly shorter after VATA or LA than after OA. A lower percentage of children who underwent VATA needed MO than after LA and OA and children after VATA had to be statistically significant fewer days on NPO. There were no death or severe complications during or after any of the operations and there were no statistically significant differences regarding the complications between the groups. Conclusions: Video-assisted transumbilical appendectomy is a safe, fast and inexpensive technique which combines the advantages of both OA and LA. The use of one trocar and extracorporeal Appendectomy make VATA, Less invasive, Easer, Faster and Cheaper.

Although laparoscopic appendectomy is becoming the procedure of choice over open appendectomy in the treatment of appendicitis, its role in the elderly has not been widely studied. The objective of this study was to compare the 30-day outcomes after laparoscopic versus open for appendicitis in the elderly patients. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS/NSQIP) databases for years 2005-2009, 3,674 patients (age >65 years) who underwent an appendectomy for appendicitis were identified. Seventy-two percent of the procedures were performed laparoscopically. In addition to aggregate cohort analysis, propensity score 1:1 matching was used to minimize the treatment selection bias. The association between surgical approach and morbidity, mortality, and length of stay (LOS) were analyzed. In the aggregate cohort analysis, patients who underwent an open appendectomy had a higher rate of minor morbidity (9.3% vs. 4.5%; p < 0.001), overall morbidity (13.4% vs. 8.2%, p < 0.001), and mortality (2% vs. 0.9%, p = 0.003). However, in the matched cohort analysis, open appendectomy was only associated with a higher rate of minor morbidity (9.3% vs. 5.7%; p = 0.002) and overall morbidity (13.4% vs. 10.1%; p = 0.02) but similar mortality rates (2% vs. 1.5%; p = 0.313). In matched cohort analysis, open appendectomy also was associated with a higher rate of superficial surgical site infection (SSI) (3.8% vs. 1.4%; p < 0.001) and a lower rate of organ/space SSI (1.3% vs. 2.9%; p = 0.009). Laparoscopic appendectomy was associated with a shorter LOS in both aggregate and matched cohorts compared with open appendectomy (p < 0.001). Within ACS NSQIP hospitals, elderly patients benefited from a laparoscopic approach to appendicitis with regards to a shorter LOS and a lower minor and overall morbidity. Laparoscopic appendectomy was associated with lower superficial SSI and higher organ/space SSI rates.