Elective Laparoscopic Appendectomy Research Articles

A magnet foreign body in the vermiform process in a child aged two years and eight months

BACKGROUND: Foreign bodies in the gastrointestinal tract is a fairly common pathology in pediatric surgery. The proportion of all cases is about 80%; in 20% of cases, foreign bodies can stuck in the physiological colon narrowings and in 0.005% — in the appendix. It is thought that magnetic foreign bodies pose a danger, if they are two or more because they can be attracted to each other at different parts of the gastrointestinal tract. A foreign body can get into the vermiform process, if its mass exceeds the mass of caecum content. Under the gravity mechanism, the foreign body penetrates into the dilated appendix lumen, but lumen peristalsis may not be strong enough to push it back into the large intestine. Swallowed foreign bodies may be asymptomatic in the vermiform process, and can manifest clinically as the inflammation either after few hours or after many years. CLINICAL CASE DESCRIPTION: In patient X., aged 2 years and 8 months, a magnet foreign body (a piece of magnetic pen) got into the vermiform process. The independent discharge of this object was under control, but no results. Patient's general state was satisfactory. No pathologies were observed in organs and systems. After a series of X-ray examinations of the abdominal organs, suspicion appeared that this foreign body was in the appendix. Diagnostic laparoscopy with intraoperative radiography and then laparoscopic appendectomy were performed. Macropreparation: unchanged vermiform process 6 cm long. The appendix lumen was opened, a foreign body was found — a magnetic rod with size 0.5 cm x 0.2 cm. CONCLUSION: The postoperative period was uneventful. The child was discharged from the hospital in the recovering state after the performed surgical intervention — an elective laparoscopic appendectomy.

A randomised controlled trial to study the analgesic efficacy of transversus abdominis plane block for adult undergoing elective laparoscopic appendectomy

Background: Laparoscopic appendectomy has evolved over the years as a minimally invasive approach for appendicitis. Routinely opioids are used for pain control postoperatively, however, its widespread use has numerous side effects and delays postoperative recovery. More recent studies have shown that transversus abdominis plane block reduces postoperative pain and analgesic drug usage. This study aims to evaluate the impact of transversus abdominis plane block in managing postoperative pain following elective laparoscopic appendectomy. Methods: A prospective, randomized, double-blind trial was performed on patients undergoing elective laparoscopic appendectomy. Patients were randomized to receive a TAP block with 0.25% bupivacaine and a control group receiving a TAP block with normal saline infusion. Laparoscopic port sites were infiltrated with bupivacaine in the control group and normal saline in the TAP block intervention group before starting the surgery. Postoperative pain scores were recorded using the visual analog scale scores at dedicated time points. Results: A total of 20 patients were included in the control group and 19 in the TAP block group. Visual analog scale scores were significantly reduced in the TAP block group at 6 hours, 12 hours, and 18 hours (p<0.001 in each). However, there was no significant reduction in the visual analog scale score at 24 hours (p=0.015). There was no significant difference between postoperative nausea (p=0.18), and length of postoperative hospital stay (p=0.93) between the two groups. Consumption of rescue analgesics and antiemetics in the first 24 hours postoperatively between both groups was statistically significant (p=0.005). Conclusions: Bilateral TAP block is safe and effective in reducing the need for analgesics and antiemetics in patients undergoing laparoscopic appendectomy in the postoperative period. In addition, there is a significant improvement in visual analog scale scores in patients after TAP block.

A rare case of appendiceal tip complete attachment to a sigmoid diverticulum: An appendiceal phlegmon case report.

IntroductionAppendiceal phlegmon is defined as an inflammatory mass, consisting of the inflamed appendix, enclosed by adjacent viscera and the greater omentum in 2 % to 10 % of patients with acute appendicitis.Case presentationA 24-year-old female presented to the hospital with chief complaints of fever, nausea, vomiting, and pain over the right lower quadrant of the abdomen for two days. In the local examination, tenderness and rebound tenderness were detected. Ultrasonography and abdominal CT scan indicated appendiceal phlegmon. After seven weeks of receiving a course of antibiotics with complete resolution of her symptoms, she underwent elective laparoscopic appendectomy. During surgery, the appendiceal tip was completely attached and fused to a sigmoid diverticulum, which has not been reported elsewhere. The appendix was completely removed, and the patient was discharged from the hospital in a good general condition after two days.DiscussionAcute appendicitis can cause serious complications, such as ruptured appendix, abscess, or phlegmon. In most cases, inflammation and infection resolve by antibiotic administration. In some cases perforation of the inflamed appendix and local abscess or diffuse peritonitis formation, which requires immediate percutaneous drainage or surgery as indicated. Theoretically, the inflamed appendix can cause adhesive damage to the adjacent organs; however, there is no particular report on this type of damage.ConclusionThis rare case suggests that during phlegmon formation and related inflammation, other complications such as fistula formation, are theoretically expected.

Goblet cell adenocarcinoma of the appendix: An incidental finding of a rare tumor which was recently renamed in 2019 World Health Organization classification update

Abstract Introduction/Objective Goblet cell adenocarcinoma (formerly goblet cell carcinoid) is a rare tumor almost exclusively involving the appendix. It is an amphicrine tumor consisting of both epithelial and neuroendocrine elements containing goblet cells. In the 2019 WHO classification update, GCC was reclassified as goblet cell adenocarcinoma of the appendix as it is recognized to have predominantly mucin secreting cells and a minor neuroendocrine component. Methods/Case Report A 72 year old,morbidly obese male presented with a 2 week history of abdominal pain and bilious vomiting. Imaging revealed a peri-appendiceal abscess. Due to the chronicity of his symptoms, he was treated conservatively with drainage of the abscess and intravenous antibiotics. He responded well and underwent elective laparoscopic appendectomy; at which time, the appendix appeared grossly unremarkable, measuring 5.1 x 0.9 x 0.3 cm with a wall thickness of 0.5 cm. Microscopically small nests and clusters of goblet cells circumferentially invaded dense collagenous stroma in the appendiceal wall. The neoplastic cells had large mucin vacuoles and small basally located nuclei. The cells were positive for CK20, CDX2, CD56, synaptophysin and focally positive for chromogranin. Ki-67 was 10%. CK7 was negative. These tumors are now graded and staged similar to colonic adenocarcinomas according to the 5 th edition of the World Health Organization Classification of Tumors - Digestive System Tumors. Results (if a Case Study enter NA) NA Conclusion This case demonstrates that this rare tumor may be an incidental finding in an elderly patient presenting with appendicitis; accurate diagnosis of this rare tumor may require submission of the entire appendix for microscopic evaluation.

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in children undergoing laparoscopic appendectomy: a randomized controlled study

Context Ultrasound (US)-guided quadratus lumborum block (QLB) is a new abdominal truncal block used for perioperative pain management of both upper and lower abdominal surgeries. Aims To compare the analgesic efficacy of US-guided QLB with transversus abdominis plane (TAP) block. Settings Approval of Zagazig Institutional Review Board (IRB) was obtained (ZU-IRB # 5504/16-9-2018) before the study, and patient’s informed written consent was also obtained. Our clinical study was registered with ClinicalTrials.gov (NCT04031196). A total of 34 pediatric patients scheduled for elective laparoscopic appendectomy were randomly allocated in two equal groups: QLB and TAP block groups. Patients and methods All patients received general anesthesia using intravenous 2 mg/kg propofol, 1 µg/kg fentanyl, and atracurium 0.5 mg/kg. After induction of anesthesia, QLB group received bilateral US-guided QLB type 2, using 0.5 ml/kg of 0.25% levobupivacaine, whereas TAP block group received bilateral US-guided TAP block using 0.5 ml/kg of 0.25% levobupivacaine. The primary outcomes were changes of intraoperative hemodynamics and postoperative pain assessment. Secondary outcomes were total intraoperative fentanyl consumption, the first time of rescue analgesics, total rescue analgesic consumption in the first postoperative 24 h, and degree of parent satisfaction. Results QLB group had statistically significant lower hemodynamic changes 15 min after performing the block to the end of surgery (P Conclusion This study revealed that QLB provides longer and more effective postoperative analgesia compared with TAP block in pediatric patients undergoing laparoscopic appendectomy.

De Garengeot Hernia Complicated by Acute Appendicitis in a Patient Who Simultaneously Underwent Elective Laparoscopic Appendectomy and Femoral Hernia Repair by Transabdominal Preperitoneal Repair

De Garengeot Hernia Complicated by Acute Appendicitis in a Patient Who Simultaneously Underwent Elective Laparoscopic Appendectomy and Femoral Hernia Repair by Transabdominal Preperitoneal Repair

Role of elective laparoscopic appendicectomy in chronic right lower quadrant pain: a prospective and interventional study

Background: Chronic pain occurring in the Right Lower Quadrant (RLQ) region is a common clinical entity and has many differential diagnoses. Chronic/Recurrent appendicitis is an important cause. We evaluate here whether undiagnosed chronic RLQ pain can be relieved after elective laparoscopic appendectomy. Methods: 30 patients, 5-65 years of age, with undiagnosed chronic RLQ pain underwent laparoscopic appendectomy between 2012 and 2014. Inclusion criteria was pain of more than 3 months’ duration. Exclusion criteria was patients who had previously been treated conservatively for appendicitis or appendicular lump, previous abdominal surgery, diagnosed cases of specific urological, gynecological or gastrointestinal diseases. Patients were followed up for 6 months and their pain was graded in the following manner - grade 1 (pain worse than before), grade 2 (pain decreased, but not completely gone) and grade 3 (completely pain free). The histopathology of the appendices was also compared with the grades of pain. Results: Out of 30 patients, 26 were completely pain free at the end of 6 months. 4 patients had a pain grading of 2. Most of the patients had appendicular adhesions. There was 1 patient who had disseminated abdominal tuberculosis. Other intra-operative findings were ascites, free fluid in cul-de-sac, mesenteric lymphadenopathy and intussusception. There was no significant co-relation between pain relief and histopathology of the appendix. Conclusions: Laparoscopy is an invaluable tool in diagnosing other conditions existing concurrently. There is no correlation between the relief of chronic right lower quadrant pain and histopathology of the appendix. Chronic right lower quadrant pain is relieved by performing laparoscopic appendicectomy.

A bizarre foreign body in the appendix: A case report

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management option.

Combined spinal epidural anesthesia for laparoscopic appendectomy in adults: A case series

Background:Laparoscopy is one of the most common surgical procedures and is the procedure of choice for most of the elective abdominal surgeries performed preferably under endotracheal general anesthesia. Technical advances in the field of laparoscopy have helped to reduce surgical trauma and discomfort, reduce anesthetic requirement resulting in shortened hospital stay. Recently, regional anaesthetic techniques have been found beneficial, especially in patients at a high risk to receive general anesthesia. Herewith we present a case series of laparoscopic appendectomy in eight American Society of Anaesthesiologists (ASA) I and II patients performed under spinal-epidural anaesthesia.Methods:Eight ASA Grade I and II adult patients undergoing elective Laparoscopic appendectomy received Combined Spinal Epidural Anaesthesia. Spinal Anaesthesia was performed at L2-L3 interspace using 2 ml of 0.5% (10 mg) hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms) of Fentanyl. Epidural catheter was inserted at T10-T11 interspace for inadequate spinal anaesthesia and postoperative pain relief. Perioperative events and operative difficulty were studied. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension.Results:Spinal anaesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and received Fentanyl, one patient was given Midazolam for anxiety and two were given Ephedrine for hypotension. The postoperative period was uneventful.Conclusion:Spinal anaesthesia with Hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients but careful evaluation of the method is needed particularly in compromised cardio respiratory conditions.

Elective laparoscopic appendectomy in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet available. One of its main clinical features is recurrent acute episodes of peritonitis. During such an episode, physical examination and laboratory findings may be similar to those for acute appendicitis. Therefore up to two-thirds of FMF patients undergo emergency appendectomy, with the appendix being normal in most cases. As laparoscopic appendectomy has proved to be safe and advantageous, and to prevent misdiagnosis and unnecessary emergency surgery, we performed elective laparoscopic appendectomy in 13 FMF patients ranging in age from 8 to 32 years. They had been suffering from the disease for 1 to 12 years (mean 3.8) and had had an average of 3.5 yearly episodes of FMF peritonitis. All procedures were concluded by laparoscopy without conversion to open surgery. The average postoperative hospital stay was 3.07 days. The only complication was superficial wound infection in one patient (7.6%), and the mean time to regain full normal activity was 8.5 days. We conclude that elective laparoscopic appendectomy in FMF patients is safe. It helps to exclude appendicitis as a cause for peritonitis in these patients and may prevent unnecessary emergency surgery.