Conventional Appendectomy Research Articles

Conventional appendectomy: which is the best incision?

Conventional appendectomy: which is the best incision?

Laparoscope-Assisted Appendectomy in Children: The Two-Trocar Technique

The conventional cannulae position in laparoscopic appendectomy does not permit good visualization of the appendix, especially if it is in a retrocaecal or pelvic position. In children, the smaller dimension of the peritoneal cavity aggravates this problem. In order to optimize appendix visualization, we propose a modification of the cannulae position associated with extraabdominal appendectomy. Two trocars are inserted, one in the umbilicus under direct vision and one in the midline above the pubic symphysis. The telescope is inserted in the second cannula. The appendix is delivered via the umbilical trocar incision and a conventional appendectomy is performed. During a one-year period, 38 appendectomies were performed. In 29 cases (76.3 %) the technique was successful. In 9 patients (4 with peritonitis, 4 with a retrocaecal and one with a pelvic appendix) a third trocar was necessary to complete the operation. We had two conversions (5.2 %), one to open surgery and one to intraabdominal laparoscopic appendectomy. Mean operation time was 19 min. There were two infectious complications (one parietal and one intraabdominal). The excellent visualization permitted considerable time gain. Infectious complications were also low. This method is suggested as an alternative procedure for appendectomy, especially in children, because of their favorable anatomy.

Results of laparoscopic vs. conventional appendectomy in complicated appendicitis.

Although many trials show some advantages of laparoscopic appendectomy over open appendectomy, the value of laparoscopic appendectomy is still controversial. Specifically the question of whether there are benefits of laparoscopic appendectomy over open appendectomy in complicated appendicitis remains to be answered. Of 1,106 consecutive appendectomies (717 laparoscopic appendectomies, 330 open appendectomies, and 59 conversions) between 1989 and 1999, the results of 299 patients with complicated appendicitis (defined by perforation, abscess, or peritonitis) were analyzed retrospectively to compare the complications of laparoscopic appendectomy and conversion (intention-to-treat group) with those of open appendectomy. Complicated appendicitis (n = 299) was treated by laparoscopic appendectomy in 171 patients, by open appendectomy in 82 patients, and by conversion in 46 patients. Laparoscopic appendectomy and conversion showed fewer abdominal wall complications than open appendectomy (13/217; 6 percent vs. 15/82; 18.3 percent; P < 0.003), which led to a decrease of the total complication rate in the intention-to-treat group (21/217; 9.7 percent vs. 19/82; 23.1 percent; P = 0.004). The rate of intra-abdominal abscess formation was nearly the same after laparoscopic appendectomy (4.1 percent) and open appendectomy (4.9 percent). The total complication rate was higher in complicated appendicitis than in acute appendicitis (P < 0.005) but was independent of the laparoscopic technique. The conversion rate was higher in complicated appendicitis than in acute appendicitis (21.2 vs. 2.3 percent; P < 0.001). In comparison with open appendectomy, laparoscopic appendectomy (by itself and in an intention-to-treat view) leads to a significant reduction of early postoperative complications in complicated appendicitis and therefore should be considered as the procedure of choice.

A comparison of an open and laparoscopic appendectomy for patients with liver cirrhosis.

Liver cirrhosis is a critical factor contributing to morbidity and mortality in abdominal surgery, because patients with cirrhosis have a particularly high risk of developing bleeding, infection, and ascites. Laparoscopic appendectomy (LA) recently has gained a lot of attention around the world; however, comparisons between the benefits of LA and those of conventional open appendectomy (OA) for patients with liver cirrhosis have yet to be sufficiently compiled. In the present retrospective study, 40 patients with liver cirrhosis who were diagnosed with acute appendicitis before surgery underwent an appendectomy (OA in 25 patients and LA in 15 patients). This study focused on the operative time, amount of postoperative pain, use of analgesics, the restart of a normal diet, number of complications, length of hospital stay, and cost-effectiveness of the procedure in such patients. The amount of postoperative pain and the length of hospital stay were significantly smaller in the LA group. The mean values of the serum C-reactive protein on postoperative days 1, 3, and 7 were significantly less in the LA group. The number of wound infections and wound bleeding was also less in the LA group. The difference in the total cost of hospitalization was not significant. The cost of the operation was greater in the LA group than in the OA group, whereas the hospitalization cost in the LA group was less than that in the OA group. The results of this study suggest that LA may be superior to OA for the treatment of postoperative pain and postoperative complications for patients with liver cirrhosis. Long-term follow-up studies are still necessary, however, to determine any possible decrease in the number of late complications.

Port-exteriorization appendectomy (PEA): a preliminary report.

Between 1994 and 1999, 121 patients with the clinical diagnosis of acute appendicitis were operated upon at our institute, 70 by conventional appendectomy and 51 by laparoscopic procedures. There were no significant differences in the demographic data, but the percentage of complicated appendicitis operated upon laparoscopically (47%) was higher than in those operated upon conventionally (35.6%). In 13 children a new laparoscopy-assisted technique was used, which entails exteriorization of the inflamed appendix via a right-iliac-fossa port and a complete appendectomy outside the abdominal cavity. The new technique proved to be useful in all types of appendiceal pathology; there were shorter operative times and hospital stays and it avoids the drawbacks associated with operating in complicated appendicitis.

Prospective Multicenter Study of Antibiotic Prophylaxis in Operative Treatment of Appendicitis

Background/Aims: A prospective, multicenter observation study was conducted to investigate the effectiveness of antibiotic prophylaxis in the operative treatment of appendicitis. Methods: Between June 1996 and May 1997, a total of 4,968 patients underwent an operation for appendicitis at 34 East German hospitals. 41.4% (n = 2,424) received perioperative antibiotic prophylaxis whereas in 58.9% of the cases this was not given. The patients who received antibiotic prophylaxis constituted a negative selection, both with regard to risk factors and to the stage of inflammation. Results: In the total test group, the rate for septic disorders of wound healing amounted to 2.5% (n = 120). The use of antibiotic prophylaxis makes it possible to significant lower the incidence of postoperative septic disorders of wound healing (p < 0.001). In both conventional (0.7% with prophylaxis vs. 3.8% without) and in laparoscopic appendectomy (0 vs. 1.0%) the rate for septic disorders of wound healing can be reduced (p < 0.001). The global comparison irrespective of possible antibiotic prophylaxis shows a significant advantage for appendectomies which started with laparoscopy (p = 0.008), but in the subgroups with prophylaxis this advantage is completely neutralized (p = 0.78). Conclusion: From this one can deduce that conventional appendectomy with antibiotic prophylaxis comprises no higher risk of wound infection than laparoscopy, since the risk of conversion exists for every operation begun by laparoscopy. These results would lead to the conclusion that antibiotic prophylaxis should be given before every appendectomy, whether by laparoscopy or conventional methods.

The Introduction of Laparoscopic Appendectomy in a Teaching Hospital

Objectives: A retrospective study of laparoscopic appendectomy (LA) versus open appendectomy (OA) was performed on patients with suspected acute appendicitis. Patients were selected for OA or LA according to the clinical evaluation, and preference of the surgeon. Methods: Over a 2-year period 180 patients were included, of whom 94 patients underwent OA, and 86 patients underwent LA. Results: LA was successfully completed in 76 patients (88.3%). The mean hospital stay in OA was 3.2 days versus 2.7 days in LA. The mean operative time was shorter in OA than in LA (51.6 versus 59.8 min). There was no significant difference in convalescence between both the groups, however, there was a tendency towards less narcotic requirement among the LA group. Postoperative complications in patients who underwent OA included: chest infection (3 patients), wound infection (4 patients), thrombophlebitis (1 patient). Complications after LA included: pelvic collection (1 patient), chest infection (1 patient), ileus (1 patient). There was no wound infection in the LA group. There was no death in either groups. Conclusion: LA is a safe procedure comparable to OA, however, it requires skills in laparoscopy and prospective randomized trials are needed to confirm its advantages over conventional appendectomy.

Laparoscopic versus conventional appendectomy in children: S.A. Hay. Pediatr Surg Int 13:21–23, (January), 1998

Laparoscopic versus conventional appendectomy in children: S.A. Hay. Pediatr Surg Int 13:21–23, (January), 1998

Randomized controlled trial with sequential design of laparoscopic versus conventional appendicectomy

A prospective study including 272 patients with suspected appendicitis was performed. The aims were to evaluate the representativity of the study group and to compare diagnostic and therapeutic laparoscopy with conventional appendicectomy. The study was an open, randomized, single-centre trial with sequential design. One hundred and eight patients were randomized between laparoscopy or conventional appendicectomy, of whom 84 had acute appendicitis. Duration of postoperative convalescence was the major endpoint. The study patients were representative of the eligible population regarding age and stage of appendicitis. The risk of unnecessary appendicectomy was significantly (P = 0.03) lower after laparoscopy. The mean difference in duration of postoperative convalescence was 4.7 days in favour of of laparoscopic appendicectomy (P = 0.07), and 26 min in duration of operation in favour of conventional appendicectomy (P < 0.01). No differences were detected in postoperative hospital stay, pain assessment or complications. The laparoscopic procedure is at least as good as conventional appendicectomy. Initial laparoscopy reduces the rate of misdiagnosis.

Randomized controlled trial with sequential design of laparoscopicversus conventional appendicectomy

Randomized controlled trial with sequential design of laparoscopicversus conventional appendicectomy

Mechanical small-bowel obstruction after conventional appendectomy in children.

During the period May 1988 to August 1990, 871 children aged between 0 and 15 years were appendectomized by laparotomy because of suspected appendicitis at the department of pediatric surgery, St. Göran's Children's Hospital. The children were followed 4-6 years after appendectomy. 1.3 % (10/791) developed clinical symptoms consistent with mechanical small bowel obstruction (SBO) resulting in relaparotomy and confirmation of the diagnosis. The patients were divided into subgroups according to the degree of appendicitis. In the group with normal appendix 1.8% (3/170) developed mechanical SBO, simple appendicitis 0% (0/209), gangrenous appendicitis 0.4 % (1/236) and perforated appendicitis 3.4% (6/176). There was no mortality due to postoperative complications. Two patients died due to unrelated causes during the follow-up period.

Pilot Assessment of Interval Laparoscopic Appendectomy for Treatment of Perforated Appendicitis in Children

ABSTRACT Children with appendicitis often present with perforation. With the recent development of minimal access surgery and improved delivery of antibiotics, we postulated that hospitalization and postoperative morbidity for this problem could be reduced. We undertook this pilot study to determine the efficacy and safety of managing perforated appendicitis with intravenous antibiotics and performing an interval laparoscopic appendectomy at 6 weeks after presentation. Between June 1, 1995 and September 1, 1995, we admitted 29 patients with appendicitis. Of these, 13 (44%) were perforated. Ten patients with perforated appendicitis were treated by conventional operative appendectomy and antibiotics. Three patients with perforated appendicitis were started on intravenous antibiotics in the hospital and these were continued at home. These patients returned for an interval laparoscopic appendectomy at 6 weeks using all disposable instruments. Intravenous antibiotics were discontinued in both groups when, afte...

Laparoscopic versus open appendicectomy: prospective randomised trial

Randomised assessment of new laparoscopic surgical techniques is difficult. Surgeons need time to become experienced with the methods and tend, when they have experience, to favour one or other approach. We have carried out a prospective randomised comparison of laparoscopic and conventional appendicectomy done by surgeons of comparable experience in patients with suspected acute appendicitis. Postoperative management decisions were made by surgeons other than the operating surgeon. 140 patients were randomly assigned to open (OA) or laparoscopic (LA) appendicectomy (70 each). The age, sex ratio, duration of symptoms, and proportion of patients with histologically confirmed appendicitis was similar in the two groups. Operating time was longer for LA than for OA (mean 70·3 [SD 21·9] vs 46·5 [25·9] min; p<0·001). There were no major intraoperative complications in either group. 14 (20%) patients in the LA group required conversion to an open operation. No significant differences between the groups were found postoperatively for pain score, analgesic requirement, time to reintroduction of diet, or hospital stay. 46 LA patients and 42 OA patients attended follow-up 3 weeks after surgery. Similar proportions had returned to work (36 [79%] vs 31 [74%]). The frequency of wound complications and wound pain after leaving hospital was lower after LA but not significantly so. We conclude that the postoperative course after LA and conventional OA does not differ significantly.

Laparoscopic Appendectomy

To assess the feasibility of laparoscopic appendectomy, we reviewed hospital records and charge data for all patients older than age 15 years who underwent appendectomy between November 1990 and July 1992. Fifty-eight patients underwent laparoscopic appendectomy and 206 patients underwent conventional appendectomy. Intraoperative (1.9%) and postoperative (5.8%) complication rates were low. The rate of conversion to conventional appendectomy was 7.7%. Hospital stay and charge analysis was performed on a cohort of 52 patients undergoing laparoscopic appendectomy and 180 patients undergoing conventional appendectomy. Total costs were similar. The most notable difference between the two groups was the operating room supply charge; this negated any cost savings achieved by the reduced length of stay following laparoscopic appendectomy. Laparoscopic appendectomy is a safe alternative to conventional appendectomy; it shortens hospital stay and allows patients to resume normal activity more quickly than conventional appendectomy.

REMOVAL OF BULKY TISSUE AT LAPAROSCOPIC SURGERY

A technique for extraction of bulky tissue during laparoscopic surgery is presented. One laparoscopic cannula is replaced with a sigmoidoscope which acts as a wide-bore cannula. At laparoscopic cholecystectomy, 22 of 60 (38%) patients were found to require wound enlargement to remove a grossly diseased gall-bladder. Use of a sigmoidoscope as a cannula was associated with fewer technical complications than surgical wound extension. At laparoscopic appendicectomy, the appendix could not be removed through the standard laparoscopic cannula in 16 of 46 (31%) cases. The incidence of wound infection was significantly lower after laparoscopic appendicectomy than among a group of 98 patients having conventional appendicectomy (P = 0.024). It is concluded that a sigmoidoscope can be used as a replacement cannula allowing uncomplicated removal of bulky tissue and reducing wound contamination.