Laparoscopic Appendectomy For Complicated Appendicitis Research Articles

Rethinking hospital postoperative resource use: A national analysis of pediatric appendectomy patients admitted to children’s hospitals

BackgroundThe increased use of remote monitoring and telemedicine support may help alleviate the need for some of the postoperative inpatient hospital care and reduce health care costs, but little is known about current postoperative hospital resource use patterns. We aim to describe hospital resources use patterns in pediatric patients postappendectomy for complicated appendicitis and to evaluate the potential of earlier discharge with remote monitoring. MethodsThis was a retrospective cohort study using the Pediatric Health Information System database for patients who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Health care use/costs (antibiotics, intravenous fluids [proxy for diet], analgesics, laboratory studies, and imaging tests) were determined using administrative billing data. Potentially avoidable days were defined as nondischarge days without codes for intravenous opioid pain medication or intravenous fluids. Descriptive statistics and logistic regression were used. ResultsIn total, 24,165 patients were included: 8,300 patients (34.3%) had at least 1 potentially avoidable hospitalization day, totaling 13,970 days or 14.2% of all hospitalization days. Median hospitalization cost was $19,434 [$15,658–$25,157], with accommodation and operating room being the greatest contributors. Public insurance and minority races and ethnicities were associated with greater odds of potentially avoidable days. More than 80% of hospitalized patients had intravenous antibiotics through 10 days postoperatively. More than 20% received opioids daily. ConclusionsMore than one third of the patients who underwent laparoscopic appendectomy for complicated appendicitis could have had at least 1 potentially avoidable hospitalization day. Remote monitoring and telemedicine support should be explored and could help with earlier discharge and lower costs.

The Intraperitoneal Use of Cephazolin: A Novelty in the Prevention of Intra-abdominal Abscess after Laparoscopic Appendectomy in Children.

Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients. A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intra-abdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results. One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess (p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision. Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses.

The Impact of Redosing Antibiotics for Pediatric Patients Undergoing Appendectomy for Complicated Appendicitis.

Currently, there is no universally accepted, standardized protocol for pre-operative antibiotic administration in the setting of appendectomy for complicated appendicitis among pediatric patients. Strategies to mitigate surgical site infections (SSIs) must be balanced with optimal antibiotic use and exposure. We conducted a retrospective chart review to compare outcomes between patients treated pre-operatively with a single pre-operative dose of antibiotics with those who received additional antibiotics prior to laparoscopic appendectomy for complicated appendicitis between 2020 and 2022. Of 124 pediatric patients, 18% received an additional dose of pre-operative antibiotics after initial treatment dose. Surgical site infection rates between the two groups were not statistically significant (P-value = .352), thereby suggesting that redosing antibiotics closer to the time of incision may not impact SSI rates. Additional studies are necessary to make clinical recommendations.

Using Consumer Wearable Devices to Profile Postoperative Complications After Pediatric Appendectomy

IntroductionMarkers of postoperative recovery in pediatric patients are difficult for parents to evaluate after hospital discharge, who use subjective proxies to assess recovery and the onset of complications. Consumer-grade wearable devices (e.g., Fitbit) generate objective recovery data in near real time and thus may provide an opportunity to remotely monitor postoperative patients and identify complications beyond the initial hospitalization. The aim of this study was to use daily step counts from a Fitbit to compare recovery in patients with complications to those without complications after undergoing appendectomy for complicated appendicitis. MethodsChildren ages 3-17 years old undergoing laparoscopic appendectomy for complicated appendicitis were recruited. Patients wore a Fitbit device for 21 d after operation. After collection, patient data were included in the analysis if minimum wear-time criteria were achieved. Postoperative complications were identified through chart review, and step count trajectories for patients recovering with and without complications were compared. Additionally, to account for the patients experiencing a complication on different postoperative days, median daily step count for pre- and post-complication were analyzed. ResultsEighty-six patients with complicated appendicitis were enrolled in the study, and fourteen children developed a postoperative complication. Three patients were excluded because they did not meet the minimum wear time requirements. Complications were divided into abscesses (n = 7, 64%), surgical site infections (n = 2, 18%), and other, which included small bowel obstruction and Clostridioides difficile infection (n = 2, 18%). Patients presented with a complication on mean postoperative day 8, while deviation from the normative recovery trajectory was evident 4 d prior. When compared to children with normative recovery, the patients with surgical complications experienced a slower increase in step count postoperatively, but the recovery trajectory was specific to each complication type. When corrected for day of presentation with complication, step count remained low prior to the discovery of the complication and increased after treatment resembling the normative recovery trajectory. ConclusionsThis study profiled variations from the normative recovery trajectory in patients with complication after appendectomy for complicated appendicitis, with distinct trajectory patterns by complication type. Our findings have potentially profound clinical implications for monitoring pediatric patients postoperatively, particularly in the outpatient setting, thus providing objective data for potentially earlier identification of complications after hospital discharge.

Laparoscopic appendectomy in complicated appendicitis with compromised appendix base: a retrospective cohort study

Laparoscopic appendectomy in complicated appendicitis with compromised appendix base: a retrospective cohort study

Safety of Laparoscopic Appendectomy in Complicated Appendicitis in children

ABSTRACT&#x0D; INTRODUCTION: Acute appendicitis is one of the most common surgical emergency in pediatric age group. Laparoscopic Appendectomy (LA) is no more a new procedure in pediatric surgery. The idea behind laparoscopy is short hospital stay, minimal complications and better cosmesis especially in overweight and obese patients. Laparoscopy offers detailed and magnified visualization and better access into the whole abdominal cavity. In many pediatric surgery centers, laparoscopic management of acute appendicitis is practiced but we have observed that most of them performed laparoscopic appendectomy for simple straight forward appendicitis. It is generally considered that complicated appendicitis is better managed by open procedure. We have performed laparoscopy in 42 patients of Complicated Appendicitis (CA) and observed that the rate of complication is comparable to the known reported studies.&#x0D; OBJECTIVE: The objective of this study was to establish safety of laparoscopic appendectomy in complicated appendicitis in children&#x0D; STUDY DESIGN: It was a retrospective study.&#x0D; SETTING: Research was conducted at Department of Pediatric Surgery, Shifa International Hospital Islamabad.&#x0D; DURATION: Duration of study was 3 years after due approval from ethical and research review board.&#x0D; MATERIAL AND METHODS: The present study is a retrospective analytical review of 42 patients who were operated for complicated appendicitis laparoscopically at Shifa International Hospital, Islamabad from January 2018 to December 2020.&#x0D; All patients were enrolled from emergency department. Clinical assessment of the patients were done in the routine way by history and physical examination. Investigations included complete blood count, C reactive protein and ultrasound abdomen and pelvis. Those patients were excluded from the study who had simple non-complicated appendicitis, open appendectomy, those who had laparotomy for other reasons and interval appendectomy. Similarly those patients who were COVID positive were excluded from the study.&#x0D; All those patients who had complicated appendix like perforation, abscess, mass or gangrene were included in the study.&#x0D; Variables observed in this study were age, sex, operative findings, operative time, hospital stay and post op complications.&#x0D; RESULTS: From January 2018 to December 2020, total 42 patients were included in this study who underwent laparoscopic appendectomy for complicated appendicitis. Complicated appendicitis includes perforated appendicitis, abscess, mass or gangrene. Mean age of the patients was 9.95 with standard deviation of 3.22. Of 42 patients in total, 32 (76%) patients were male and 10 (24%) were female. Mean operative time was 42.5min with standard deviation of 20.03. Mean hospital stay time was 2.23 days with standard deviation of 1.55 (table 1).&#x0D; Out of total 42 patients, 20 (48%) had perforated appendicitis, 9 (21%) patients had appendicular mass, 12 (29%) patients had appendicular abscess and 1 (2%) patient had gangrenous appendicitis. Postoperatively, one patient of perforated appendicitis had trocar site infection. One patient had mass formation with partial obstruction and post-operatively developed urinary retention with peri-orbital puffiness. Two patients of appendicular mass had transaction of appendicular base due to perforated and sloughed appendicular base. One patient of appendicular abscess had large collection in right paracolic gutter. One patient of appendicular abscess developed peritonitis with abscess formation secondary to cecal perforation.&#x0D; CONCLUSION: Our experience with laparoscopy in appendicitis revealed that for complicated appendix laparoscopy is very safe in children with only fewer complications. Although our sample size is small but in our 3 last year experience we learned that laparoscopy may safely be done as a first choice in all patients with appendicitis, whether simple or complicated. Our experience indicates that the apprehension amongst the treating surgeons is not very justified as we routinely do laparoscopy in all appendicitis.&#x0D; KEY WORDS: Laparoscopic appendectomy, complicated appendicitis.

Laparoscopic treatment of appendiceal peritonitis without drainage in children—A prospective randomized clinical trial

BackgroundRoutine placement of a drain for complicated appendicitis is one of the approaches to reduce postoperative complication. In a resource-limited hospital where radiologist-directed monitoring is not feasible, drainage is beneficial for complication follow-up. Nevertheless, emerging studies indicated drainage did not significantly impact on amelioration of patients’ outcomes. This study aimed to compare the postoperative results of pediatric patients with or without drainage after laparoscopic appendectomy for complicated appendicitis at a rural children's hospital. MethodsWe performed a quasi-randomized recruitment of pediatric patients who underwent laparoscopic treatment for complicated appendicitis with or without drainage. Several parameters, including operative time, lengths of stay, complication rate, duration of antibiotic administration, and hospital charges were monitored for assessment. ResultsFrom 05/2020 to 05/2022, there were 184 cases of recruited pediatric patients who underwent laparoscopic appendectomy for complicated appendicitis, with 91 patients in drain-placing group (49.5%). Demographic baseline and pre-surgery symptoms did not indicate any differences between two groups. Data of postoperative complications including intra-abdominal abscesses and wound infections showed no significance in discrepancy. Notably, patients of drainage group experienced longer length of stay than non-drainage group, with average of 8.5 days and 7.5 days, respectively (p<0.0001). Additionally, the significantly higher number of hospital charges was observed in the those with peritoneal drain (p<0.0001). ConclusionOur records showed that routine placement of a peritoneal drain after laparoscopic appendectomy in pediatric patients with complicated appendicitis did not impact on the outcomes, but prolonged hospital stay and caused more hospital charges.

OUTCOMES OF LAPAROSCOPY IN COMPLICATED APPENDICITIS AND CHANCES OF CONVERSION TO OPEN APPENDICECTOMY

Laparoscopic appendectomy (LA) was performed mostly on uncomplicated appendicitis due to opinions about its safety when it was first introduced. Nevertheless, there are still concerns about surgical difficulties in managing complicated appendicitis with laparoscopy, possible post-op complications and conversion to an open appendectomy (OA) during the surgery. Aims and Objectives: To study outcomes of laparoscopy in complicated appendicitis and chances of conversion to open appendicectomy. Methods:The study consists of 50 patients who underwent laparoscopic appendectomy in department of General Surgery at Navodaya Medical College hospital and research center, Raichur.. The study population was enrolled after fulfilling the selection criteria from department of General Surgery. Informed consent was taken from all the patients who are involved in this study. Patients diagnosis was based on clinical findings, complete blood counts, abdominal sonography and CT in selected cases. Result: Fifty patients underwent laparoscopic appendectomy for complicated appendicitis. Of the 50 patients, perforated appendix cases are 31, gangrenous appendix are 15, acute appendicitis with abscess were 4 cases.Three patients were converted to open appendicectomy. Post operation wound infection, conversion rate and hospital stay rate are very less. Conclusions: The present study proved that laparoscopic appendectomy is the best approach in complicated appendicitis. Most cases of complicated appendicitis can be treated laparoscopically. Laparoscopic appendicectomy is a useful method for reducing hospital stay, post operativepain,complications and return to normal activity.

Post-Operative Outcomes of Laparoscopic Appendectomy in Acute Complicated Appendicitis: A Single Center Study.

Acute appendicitis (AA) is a surgical emergency because of inflammation in the appendix leading to swelling, whereas acute complicated appendicitis is characterized by a gangrenous or perforated appendix with or without periappendicular abscess, peritonitis, and an appendicular mass. The laparoscopic approach in complicated acute appendicitis is a viable alternative method but is not practiced in all cases because of technical difficulties and unpredictable complications. Thus, the present study aimed to evaluate the primary and secondary outcome predictors of laparoscopic appendectomy in complicated appendicitis. A single-center prospective observational study was carried out after the approval of the Institutional Ethics Committee (IEC). A total of 87 complicated acute appendicitis patients were included in the study. Clinico-demographic features such as age, gender, duration of surgery, post-operative pain, and hospital stay were monitored in different age groups of <20, 20-39, and >40 years, and the primary and secondary outcomes of laparoscopic surgery in acute complicated appendicitis were measured. Acute complicated appendicitis cases were observed mostly in people older than 42 years in the total study population. Laparoscopic appendectomy was conducted in all 87 acute complicated appendicitis patients, and the major surgical outcome predictors were monitored, such as mean operating time (87.9 minutes), post-operative pain (3.9 scores), and post-operative stay (6.7 days). Post-operative complications such as drain site infection (1.14%), enterocutaneous fistula (2%), and intra-abdominal abscess (7%) were observed. Based on our observations, a laparoscopic appendectomy can be considered a viable alternative with an acceptable complication rate. Operative time varies from 84 to 94 minutes in different age groups and with the extent of the disease.

Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin/Tazobactam Versus Ceftriaxone with Metronidazole

Recent studies are discordant regarding postoperative use of piperacillin/tazobactam (PT) versus ceftriaxone/metronidazole (CM) for pediatric complicated appendicitis. Some argue that the broader spectrum PT decreases intraabdominal abscess formation; however, antibiotic stewardship, and once-a-day dosing favor CM. We aim to compare outcomes of postoperative antibiotic utilization using a large administrative database. We queried the Pediatric Health Information System for patients 2-18 years old who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Patients were grouped into PT, CM, or other using the first postoperative day antibiotics. Adverse events and antibiotic use trends were evaluated. We included 29,015 children from 45 hospitals. CM was used in 51.9% and 31.3% received PT. Wide variation was seen among hospitals with PT use decreasing over the years. Overall rate of abscess was 9.2%. On multivariable regression, PT was associated with higher risk for abscess formation (RR 1.35, 99% CI 1.04-1.75) and readmission (RR 1.38, 99% CI 1.13-1.68) compared to the CM group. However, following adjustment for hospitals with high CM prevalence, these associations were no longer significant. Postoperative use of PT for complicated appendicitis is associated with higher rates of readmissions and intraabdominal abscess when compared to CM. However, this effect is mitigated when adjusting for common practice patterns. Level III. Retrospective Comparative Study.

Clinical Outcomes of Laparoscopic Appendectomy in Complicated Appendicitis among Young Children

Background and Aim: Despite the good outcomes associated with laparoscopic appendectomy for uncomplicated appendicitis, the benefits of this procedure for complicated appendicitis are less obvious due to increased infection risk. The current study aims to assess the effectiveness of laparoscopic appendectomy in children with complicated appendicitis. Patients and Methods: This retrospective study was conducted on 92 complicated appendicitis cases among young children (&lt;8 years) in the department of Surgery, Lady Reading Hospital, Peshawar for the period from January 2022 to June 2022. Prior to study conduction, surgical consent was provided by each individual. Demographic details such as age and gender, operative time, hospital stay, operative finding, postoperative complications, bowel function return, and oral feed resumption were recorded. Results: Of the total 92 cases, 52 (56.5%) were male and 40 (43.5%) were females. The overall mean age was 5.9±0.8 years with an age range from 4.2 to 7.8 years. Among the total cases, 88 (95.7%) underwent complete laparoscopic appendectomy whereas 4 (4.3%) patients needed conversion to open appendectomy. The mean length of hospitalization was 4.8±3.3 days. The operation took 72.8±26.4 minutes. In terms of postoperative complications, the incidence of post-operative ileus, superficial wound infections, and intra-abdominal collections developed in 4 (4.3%), 2 (2.2%), and 6 (6.5%) respectively. There was no death recorded. Conclusion: The present study concluded that children with complicated appendicitis can benefit from laparoscopic appendectomy. In addition to its feasibility, safety, rapid recovery and good cosmetic results, this procedure is associated with minimal post-operative morbidity. Keywords: Complicated appendectomy, Laparoscopic appendectomy, Clinical outcomes

Operative Time Is Independently Associated With Morbidity in Pediatric Complicated Appendicitis.

Complicated appendicitis is a common cause of morbidity in children. Studies have analyzed the risk factors in the surgical treatment of this pathology, including obesity and disease severity, but not operative time (OT). We hypothesize that OT is independently associated with increased morbidity for children with complicated appendicitis. Data were extracted from the 2018 and 2019 National Surgical Quality Improvement Program-Pediatrics data sets. Patients aged 2-18y who underwent laparoscopic appendectomy for complicated appendicitis were identified. Patient demographics, disease severity, and operative details were evaluated. Surgical site infections (SSIs), hospital length of stay (LOS), ≤30-d readmissions and reoperations, interventional radiologic drain (IR-drain) placement, pneumonia, and death were analyzed. Logistic and linear regression analyses were performed. A total of 8168 patients were analyzed, with a mean age of 9.96±3.9y and a mean weight of 41.2±21.2kg. The mean OT was 55.8±24.9min, with a mean LOS of 5.15±3.37d. For every 1-min increase in OT, there was an independently associated increase in the likelihood of any SSI (odds ratio [OR]=1.01; 95% confidence interval [CI] 1.008-1.013), superficial SSI (OR=1.01; 95% CI 1.004-1.020), organ-space SSI (OR=1.01; 95% CI 1.008-1.013), IR-drain placement (OR=1.01; 95% CI 1.008-1.013), and readmission (OR=1.004; 95% CI 1.000-1.007). Prolonged OT is independently associated with greater likelihood of any SSI, superficial SSI, organ-space SSI, IR-drain placement, readmission and reoperation within 30d, and longer hospital LOS. There is a need to determine modifiable factors that prolong OT to aid in the optimization of routine operations to reduce patient morbidity.

Laparoscopic appendectomy for complicated appendicitis in children: does the post-operative peritoneal drain make any difference? A pilot prospective randomised controlled trial

PurposeThis was a pilot randomised, prospective study, which aimed to determine and compare the post-operative complications of paediatric patients undergoing laparoscopic appendectomy (LA) for complicated appendicitis, with and without a peritoneal drain.MethodsPatients younger than 13 years, undergoing LA for complicated appendicitis at the Dr George Mukhari Academic Hospital (DGMAH), over a 15-month period during 2019–2020 were enrolled. Randomisation was achieved by a blocked randomisation plan. Patients were randomised in a 1:1 ratio into the “drain” (D) and “no drain” (ND) groups.ResultsThirty-four patients were included in this study; seventeen in each group. The complication rate was 26%. Intra-abdominal collection accounted for 89% of the complications. The complication rate in the “D” group was 18% and 35% in the “ND” group, with no statistically significant difference. Complication rates were higher (38%) in patients with generalised pus when compared to localised pus (7%), although not statistically significant. The mean theatre time, hospital stay, and duration of antibiotic use did not differ significantly between the groups.ConclusionFrom our study, the post-operative peritoneal drain did not make any statistically significant difference in patient outcome. The amount of intra-abdominal contamination is more likely to contribute in the development of complications.Trial registration numberSMUREC/M/15/2019: PG.

A Prospective Study Comparing Laparoscopic with Open Appendectomy in Children with Complicated Appendicitis

Background: Due to the difficulty of performing minimally invasive surgery in a region of distorted anatomy and significant inflammation, the decision to do laparoscopic appendectomy in pediatric patients with complicated appendicitis has been controversial. The main advantages of laparoscopic appendectomy in complicated appendicitis, according to several studies, are wound infection avoidance and shorter hospital stays. The study’s goal is to investigate and compare various clinical outcomes in children with complicated appendicitis who were treated with laparoscopic appendectomy versus those treated with open appendectomy to determine the value of laparoscopic appendectomy in pediatric patients. Methods: A prospective randomized controlled clinical trial was done at a single center in TAIF, Saudi Arabia. The study included children aged 14 years or less who were diagnosed with complicated appendicitis. All collected preoperative findings, investigations, type of surgery, operative findings and time, postoperative complications, antibiotic course, length of hospital stay, time to start oral intake, and histopathology report were analyzed. Results: Operative time was significantly longer in the Laparoscopic Appendectomy (LA) group (73.1 min) than in the Open Appendectomy (OA) group (63.4min) (p=0.0344), while the total hospitalization duration was significantly shorter in the LA group (4.51days) in comparison with the OA group (5.94 days) (p=0.0001). In addition, a statistically significant difference was noted in the resumption of oral intake which was significantly faster in the LA vs OA group (2.1 days) vs (3.4 days) (p=0.0001). We observed that patients in the OA group had a higher rate of incidence of surgical site infection (SSI), which is statistically significant (p= 0.0389). Conclusions: Our study shows that laparoscopic appendectomy in the expert hands for the management of complicated appendicitis in the pediatric population is considered safe and feasible and should be considered a first choice. Keywords: Children, complicated appendicitis, open appendectomy, Laparoscopic Appendectomy.

Closure of the Appendiceal Stump in Laparoscopic Appendectomy: A Comparison of Approaches to Complicated Appendicitis

Background: Various techniques can be used for the closure of the appendiceal stump in laparoscopic appendectomy, although no consensus exists on the optimum approach. Objectives: The present study was conducted to compare three different stump closure techniques in cases of complicated appendicitis. Methods: A total of 172 patients who underwent laparoscopic appendectomy for complicated appendicitis were selected for conducting the present retrospective cohort study. The patients were divided into three groups according to the appendiceal stump closure technique: Hem-o-lok clips; extracorporeal knots which were pushed into the abdomen; and laparoscopic knots which were tied manually within the abdomen. The three groups of patients were compared for demographic and clinical characteristics as well as follow-up data. Results: A total of 85 patients were in Group 1, 43 patients in Group 2, and 44 patients in Group 3. The most common surgical finding was a necrotic appendix in all three groups (67.1% vs. 81.4% vs. 68.2%; p: 0.448). The rate of drain use (42.4% vs. 34.9% vs. 31.8%; p: 0.455) and the readmission rates (10.6% vs. 14% vs. 11.4%; p: 0.178) were also similar in all groups. The median postoperative hospital stay was 2 days in all groups. Conclusion: No superiority was identified in any of the approaches to stump closure for the laparoscopic treatment of complicated appendicitis cases. All three techniques can be used safely. Accordingly, the technique should be selected based on the assessment of the surgeon, patient’s characteristics, and cost.

Comparative study between Open Surgical Technique versus Laparoscopic Appendectomy in Complicated Appendicitis

Comparative study between Open Surgical Technique versus Laparoscopic Appendectomy in Complicated Appendicitis

Outcomes for open and laparoscopic appendicectomy for complicated appendicitis in children

The study aimed to compare the outcomes of paediatric laparoscopic appendectomy (LA) with open appendectomy (OA) for complicated appendicitis (CA). All trainees could perform OA without supervision.This is a single-centre, retrospective, non-randomised review of children 4-12 years of age, who had either an OA or LA for CA. The data was collected from August 2012 to June 2016. Nineteen surgical trainees were initially supervised by a consultant until deemed able to perform LA safely. The on-call surgeon decided on operative approach. Intra- and postoperative complications were analysed. Primary endpoint was comparison of infection rates between groups, simultaneous differences between the two procedures performed by surgical trainees and consultants were evaluated.One hundred and fifty-five patients had appendicectomy for CA during the study period. Fourteen patients with incomplete information were excluded. Ninety had OAs and 51 LAs. Both groups were well matched demographically. Postoperative infective complications occurred in 13/51 (25.5%) of the LAs, and in 23/90 (25.6%) of the OA (p = 0.159). Fourteen trainees performed 27 LAs without consultant supervision by the conclusion of the study. The mean duration of LA surgery for surgical trainees was 110.35 minutes (IQR 22.5) and for consultants 93.87 minutes (IQR 35, p = 0.497).There is no difference in intra- and postoperative complications between LA and OA for CA. Duration of surgery between surgical trainees and consultants were comparable. This indicates that surgical trainees acquire LA skill over a short period of time and that LA as a laparoscopic teaching procedure merits consideration.

Is Abdominal Drain Necessary after Laparoscopic Appendectomy for Complicated Appendicitis?

Is Abdominal Drain Necessary after Laparoscopic Appendectomy for Complicated Appendicitis?

Mastering the learning curve significantly reduces operative time for laparoscopic treatment of complicated appendicitis

Laparoscopic appendectomy is the preferred operative method for acute appendicitistreatment. In terms of complicated appendicitis it can be effective in hands of an experiencedlaparoscopist that overwhelmed the learning curve for the method. Aim: Тhis retrospectivestudy examines whether the operative time for laparoscopic appendectomy for complicatedappendicitis is shortened after mastering the learning curve. Material and methods: A totalnumber of 196 patients were operated for the diagnosis of acute appendicitis, of whom 77were diagnosed with complicated appendicitis. They were subsequently divided in two groups(laparoscopic and open). Operative time in both groups was measured and the conversionand postoperative complications were noted. Results: Conversion rate was 2.3%. Operativetime was shorter in the laparoscopic group (67.4 ± 22.9 vs. 77.9 ± 17.9 minutes; p = 0.033).Overall postoperative morbidity was 25.97% with wound infection present only in the opengroup (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopicgroup (0.38%). Length of hospital stay was shorter in the laparoscopic group (4.3 ± 2.2 vs. 5.7 ± 2.1, p = 0.0052).

Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis.

This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.