Laparoscopic Appendectomy For Uncomplicated Appendicitis Research Articles

Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis

BackgroundAppendicitis is a common surgical emergency with diverse clinical presentations, making its diagnosis challenging. Laparoscopic appendectomy has become the standard treatment, with various methods for appendiceal stump closure, including polymeric clips and endoloops. This study aims to compare the efficacy and safety of polymeric clips compared with endoloops in laparoscopic appendectomy. MethodsA systematic review and meta-analysis were conducted followingPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Scopus, and Embase were searched for studies up to March 25, 2024. ResultsIn total, 13 studies, including 6 randomized controlled trials, were analyzed. Polymeric clipping demonstrated significantly shorter surgical time compared with the endoloop (standardized mean difference 0.37, 95% confidence interval 0.22–0.53, P < .00001), with no difference in hospital stay or overall complications. However, the endoloop was associated with a greater incidence of intra-abdominal abscess (risk ratio 3.53, 95% confidence interval 1.56–8.00, P = .003). Other outcomes, including time from instrument application to appendiceal cutting, ileus, and surgical-site infection, showed no significant differences between the 2 techniques. ConclusionPolymeric clipping appears to be superior to endoloop in terms of shorter surgical time and lower risk of intra-abdominal abscess formation in laparoscopic appendectomy for uncomplicated appendicitis. However, both techniques have similar outcomes regarding hospital stay and overall complications. Further research addressing study limitations and exploring patient-centered outcomes is warranted to guide clinical practice.

Efficacy of Landmark-Guided Transverse Abdominis Plane (LTAP) Block in Pediatric Patients Undergoing Laparoscopic Appendectomy.

Optimizing perioperative analgesia in patients undergoing abdominal surgery remains a challenge given the side effects of narcotics and the potential for abuse. While transversus abdominis plane block has been shown to improve clinical outcomes, such as decreased opioid consumption and pain scores among adult patients, there is limited data regarding its efficacy for pediatric patients. This study evaluates efficacy amongst pediatric patients undergoing landmark-guided transversus abdominis plane (LTAP) during laparoscopic appendectomy. A retrospective chart review of patients, ages 0-18years old, who underwent laparoscopic appendectomy for uncomplicated appendicitis at a single institution from January 2021 to December 2022 was conducted. Pearson's chi-square test or Fisher's exact test and Welch's t test were used to assess differences between the two cohorts for categorical and continuous variables, respectively. Results are statistically significant at P < .05. Of the 90 patients who met inclusion criteria, 40% (n = 36) underwent LTAP block. Those with LTAP block had a shorter average operative time than those without LTAP block (.6 vs .7 hours; P = .009). Similarly, patients with LTAP block had a shorter average time to discharge (4.1 vs 11.0h; P = .039). There were no other statistically significant differences in postoperative outcomes including narcotic use between both cohorts. Landmark-guided transversus abdominis plane blocks did not increase operative times yet reduced time to discharge for pediatric patients who underwent laparoscopic appendectomy at our institution. Larger studies are needed to evaluate the relationship between LTAP administration and postoperative narcotic consumption to make clinical recommendations.

Let them play: A prospective study of postoperative activity restrictions in children

BackgroundWe aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries. MethodsWe conducted a single institution, clinical trial (NCT04145895) from January 2020 to February 2022. Patients who presented for a routine inguinal hernia repair (ages 2-13) or laparoscopic appendectomy for uncomplicated appendicitis (aged ≤ 18) were eligible for participation. Participants chose to enroll in either the control (PDAR) or experimental (SDAR) groups. Control patients were instructed to restrict full activities for two weeks. For SDAR, patients were instructed to return to full activity when the patient and family felt comfortable doing so. Postoperatively, participants were asked to complete a survey to assess time to resume full activity, surgical complications, and patient and caregiver satisfaction. Results20 (24.4%) enrolled in PDAR and 62 patients (75.6%) enrolled in SDAR. The majority of patients underwent laparoscopic appendectomy (78%). Of patients who completed the postoperative survey, the average time to resume full activity was 11.91 days for PDAR and 9.51 days for SDAR (p = 0.328). There was no difference in parent satisfaction or postoperative complications (p >0.999). ConclusionsThe time to resume full activity was two days sooner for SDAR without compromising post-operative outcomes. There are psychosocial benefits to children resuming normal activities, and SDAR may lessen a family's societal burden. Therefore, we propose that SDAR appears safe and should be utilized for routine surgery.

Defining a Relationship Between Postoperative Antibiotic Use and Wound Complications in the Setting of an Uncomplicated Laparoscopic Appendectomy.

Appendicitis is a very common diagnosis that surgeons manage daily. Some surgeons are still giving antibiotics to patients suffering from uncomplicated appendicitis in the postoperative setting, despite an abundance of evidence to support a single preoperative dose of antibiotics.In this paper, we will describe the management of post-operative antibiotics at our institutions following uncomplicated appendicitis with regard to the use of antibiotics in the post-operative setting. A retrospective chart review was performed analyzing post-operative antibiotic use and postoperative complications in 179 patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. We retrospectively examined the patients to change our future practices as we perform appendectomies routinely, and there is practice variation at our centers. Current Procedural Terminology (CPT) codes for 'laparoscopic appendectomy' were used to identify the patients within our inclusion criteria. Twenty-four patients were excluded from the analysis as they had complicated appendicitis or met other exclusion criteria. We only studied the patient with uncomplicated appendicitis, as those with complicated appendicitis have a different clinical course that involves post-operative antibiotic administration or prolonged antibiotic administration with or without drain placement. Both arms of the study were homogeneous regarding patient characteristics. An independent test of the development of wound infection for those patients receiving post-operative antibiotics versus those not receiving post-operative antibiotics was conducted using the SPC XL 2010 Microsoft Excel (Redmond, USA) add-in. A p-value of <0.05 was considered statistically significant. This included the odds ratio for the development of complications. Results: There was no difference in the risk of infection rate in patients given post-operative antibiotics; however, given the odds ratio of 6.53, there is an association between an increased wound infection rate and patients who received post-operative antibiotics. Discussion: An appendectomy is a standard surgical procedure for acute appendicitis. The guidelines for using pre-operative antibiotics in uncomplicated appendicitis are well established; however, there is no specific recommendation on whether to continue antibiotics post-operatively. However, there is significant provider variability on this topic. Antibiotic use post-operatively in clean-contaminated cases, such as uncomplicated acute appendicitis, has been associated with higher risks of surgical site infections. Conclusion: The use of antibiotics post-operatively may not be indicated for uncomplicated laparoscopic appendectomy and may increase wound infections. A large-scale study including a larger population and extending it to other hospitals may increase statistical significance and help guide physician management.

Effectiveness of Use of Single Dose Preoperative Antibiotic versus both Pre and Post Operative Antibiotics in Patients Undergoing Laparoscopic Uncomplicated Appendectomy in Birat Medical College Teaching Hospital (BMCTH)

Introduction: Acute appendicitis is one of the most common surgical emergency. Rationalized use of antibiotics prevents the risk of post operative complications. There is no conclusive recommendation on the duration of antibiotic usage and role of postoperative use of antibiotics in preventing complications in uncomplicated cases remains controversial till date.&#x0D; Objectives: To compare the effectiveness of single dose preoperative antibiotic with preoperative and postoperative antibiotics for patients undergoing laparoscopic uncomplicated appendectomy.&#x0D; Methodology: A total number of 113 patients who fulfilled the selection criteria underwent laparoscopic appendectomy for uncomplicated appendicitis and were randomly divided into two groups. Group A patients received only pre operative antibiotics whereas Group B patients received both preoperative and postoperative antibiotics. Patients of both the groups were followed up postoperatively till discharge from the hospital&#x0D; Results: In this study, patients who received only pre-operative antibiotic were 57 (50.4%) and patients who received both preoperative and postoperative antibiotics were 56(49.6%). SSI was detected in total of 2 patients (1.8%) one from each group and postoperative lump noted in right iliac fossa (RIF) in 2 patients (1.8%) one in each group intraoperatively in which further antibiotic was continued postoperatively. Hematoma, seroma and peritonitis were absent in both the groups. The difference between the two groups for incidence of SSI and postoperative RIF lump was statistically insignificant with P value of 0.748.&#x0D; Conclusion: Single dose preoperative antibiotic is sufficient in preventing postoperative complications in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. This can be recommended for implementation as standard operating protocol in such cases.

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

Post-Operative Day Zero Discharge after Laparoscopic Appendectomy Does Not Worsen High-Yield Outcomes: A NSQIP Database Observational Study

Background: Post-operative day zero (POD-0) discharge after laparoscopic appendectomy for uncomplicated appendicitis has been studied primarily in single-center or pediatric studies. A larger study from a national sample addressing high-yield outcomes can update and supplement current literature and evaluate early discharge rates. Methods: This is a retrospective, observational National Surgical Quality Improvement (NSQIP) database study of laparoscopic appendectomies for uncomplicated appendicitis performed 2016–2019, with discharge POD-0 or post-operative day one (POD-1). Study outcomes included any or serious complication, unplanned readmission, and unplanned return to operating room (OR). Unadjusted outcomes comparisons were estimated via chi-square tests. Multivariate logistic regression models were constructed to adjust for potential confounders (sex, ethnicity, frailty, ASA score, tobacco use and diabetes). Results: A total of 25,629 patients were included in this analysis. More patients were discharged POD-1 (n = 15,229) than POD-0 (n = 10,440). Rate of any or serious complication was lower in patients discharged POD-0 than POD-1 (any complication: 2.0 vs. 2.8, p = 0.0002, serious complication: 1.4 vs. 2.1, p < 0.0001). Unplanned return to OR and unplanned readmission rates were not different between POD-0 and POD-1 discharged groups (p = 0.9 and p = 0.6, respectively). These findings were robust to adjustment for covariates in logistic regression modeling. Conclusions: This study found that unplanned readmission and other outcomes do not appear to be adversely affected by early discharge after laparoscopic appendectomy for uncomplicated appendicitis, confirming prior evidence on the topic in a large, national sample. It also found that early discharge does not appear to be used in most of these patients.

Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients-Is It Possible?

(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0–4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.

Same day discharge after pediatric laparoscopic appendectomy in community hospitals

IntroductionSame-day discharge (SDD) protocols after pediatric laparoscopic appendectomy have not been well studied in a community hospital setting, especially when hospitals with low inpatient pediatric censuses are increasingly closing their pediatric units. This study evaluates the outcomes of a SDD protocol after pediatric appendectomy that was implemented across an integrated healthcare system in which hospitals experienced closure of pediatric units. MethodsPatients between ages 6 to 13 years-old who underwent laparoscopic appendectomy for uncomplicated appendicitis from January 1st 2015 to December 31st 2020 were reviewed. During the study period, an inter-hospital SDD protocol was introduced at nine hospitals, four of which closed their pediatric units. ResultsThere were 1293 patients in the pre-protocol cohort and 953 patients in the post-protocol cohort. There were 588 (45.5%) patients who underwent SDD in the pre-protocol cohort, compared with 804 (84.4%) patients in the post-protocol cohort (p<0.00001). Postoperative narcotics were prescribed to 358 (27.7%) patients in the pre-protocol cohort, compared to 482 (50.6%) patients in the post-protocol cohort (P<0.00001). There was no difference in the 30-day emergency department visit rate or 30-day readmission rate between the two cohorts. A subgroup analysis comparing the surgical outcomes at community hospitals with and without pediatric units after implementation of the SDD protocol showed no difference. ConclusionSame-day discharge after laparoscopic appendectomy for uncomplicated appendicitis in community hospitals, even after pediatric unit closure, is safe and feasible. The decrease in postoperative LOS and the increase in SDD are not associated with higher complication rates.

Outcomes for Same-Day Discharge after Laparoscopic Appendectomy for Uncomplicated Appendicitis

Outcomes for Same-Day Discharge after Laparoscopic Appendectomy for Uncomplicated Appendicitis

Same-day discharge after appendectomy for acute appendicitis: a systematic review and meta-analysis

PurposePatients presenting with acute appendicitis are usually hospitalized for a few days for appendectomy and postoperative recovery. Shortening length of stay may reduce costs and improve patient satisfaction. The purpose of this study was to assess the safety of same-day discharge after appendectomy for acute appendicitis.MethodsA systematic review was performed according to PRISMA guidelines. A literature search of EMBASE, Ovid MEDLINE, Web of Science, Cochrane Central, and Google Scholar was conducted from inception to April 14, 2020. Two reviewers independently screened the literature and selected studies that addressed discharge on the same calendar day as the appendectomy. Risk of bias was assessed with the ROBINS-I tool. Main outcomes were hospital readmission, complications, and unplanned hospital visits in the postoperative course. A random effects model was used to pool risk ratios for the main outcomes.ResultsOf the 1912 articles screened, 17 comparative studies and 8 non-comparative studies met the inclusion criteria. Most only included laparoscopic procedure for uncomplicated appendicitis. Most studies were considered at moderate or serious risk of bias. In meta-analysis, same-day discharge (vs. overnight hospitalization) was not associated with increased rates of readmission, complication, and unplanned hospital visits. Non-comparative studies demonstrated low rates of readmission, complications, and unplanned hospital visits after same-day discharge.ConclusionThis study suggests that same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis is safe without an increased risk of readmission, complications, or unplanned hospital visits. Hence, same-day discharge may be further encouraged in selected patients.Trial registrationPROSPERO registration no. CRD42018115948

Frequency of port-site infection in children undergoing laparoscopic appendectomy for uncomplicated appendicitis

Background: Laparoscopic appendectomy is being practiced throughout the world for the treatment of acute appendicitis in children and adults. The objective of this study was to determine the frequency of port sites infection in children undergoing laparoscopic appendectomy at our institution. Methods: The study was conducted at the Pediatric Surgery Unit of Lady Reading Hospital Peshawar from January 2014 to Jan 2015. All the patients with the diagnosis of acute appendicitis underwent a three-port laparoscopic appendectomy. Port-site infection was noted postoperatively. Results: Total number of patients in this study was 207 including 138 males (66.70%) and 69 (33.3%) females (M:F 2:1). The age ranged from 6 to 14 years, with mean age of 11 years ±2.096. The overall complications occurred in 39 (18.84%) patients. The port-site infection occurred in 33 (16%) patients. Port-site infection involved only the umbilical port sites and was superficial. Port-site infection was managed conservatively without any sequelae. Conclusion: Laparoscopic appendectomy is a safe technique in children with port-site infection rate of 16%. There is no morbidity as all the port-site infections occurred at umbilical port-site were superficial thus managed conservatively.

Success of Antibiotic Therapy vs Laparoscopic Appendectomy for Uncomplicated Appendicitis in Children

Success of Antibiotic Therapy vs Laparoscopic Appendectomy for Uncomplicated Appendicitis in Children

Day Care Appendectomy Is Safe in Young Patients with Uncomplicated Early Presentation

We analyzed the surgical outcomes of uncomplicated appendicitis in patients treated with conventional or laparoscopic appendectomy on an ambulatory basis compared with those who stayed overnight. Demographics, clinical course, surgery type, length of stay, and surgical outcomes of patients who underwent conventional or laparoscopic appendectomy for uncomplicated appendicitis were measured. Comparisons were performed using Student t test and chi square analysis. A total of 197 patients were enroll in the study, 69 (35%) patients were discharged within 12 h after their surgery with a mean age of 26.1 years ± 10.23, and the rest of the patients (n = 128,65%) were hospitalized, with a mean age of 27.0 years ± 12.2 (p < 0.608). Open treatment was practice on 124 (62.9%) patients, laparoscopic approach was achieved on 73 (37%) patients, and three (1.5%) patients underwent conversion due to difficult dissection. There was a 14-h mean difference between groups, from the initial time of abdominal pain until arrival to the emergency room, with a mean time in the ambulatory group of 27.7 h ± 19.7 and hospitalized group of 42.4 h ± 39.7 (p < 0.001). Five (7.2%) patients on the ambulatory group presented post-surgical complications, with no significant difference from the patients of the inpatient group (n = 6, 4.7%) (p < 0.456). Overall, mortality rate was 0%, and all patients are well and alive with a mean follow-up of 8 months (range, 6–18 months). This study confirms suitability of conventional appendectomy as an outpatient procedure for uncomplicated appendicitis’ management.

Interval laparoscopic appendectomy after antibiotic therapy for appendiceal abscess in elderly patients.

The aim of this study was to evaluate the safety and efficacy of interval laparoscopic appendectomy after antibiotic therapy in elderly patients with appendiceal abscess. We retrospectively analyzed data for 50 patients with appendiceal abscess aged ≥18 years who had initially planned to undergo interval laparoscopic appendectomy after antibiotic therapy and 50 patients with appendicitis aged ≥70 years who had undergone early laparoscopic appendectomy. All patients were treated at the National Hospital Organization Kumamoto Medical Center between 2012 and 2018. We compared perioperative outcomes after interval appendectomy between patients aged <70 years and ≥70 years. Clinical progression of appendicitis during antibiotic therapy developed in one patient (2.0%), and recurrent appendicitis after antibiotic therapy for appendiceal abscess occurred in two patients (4.0%). Pathological findings confirmed appendiceal neoplasms in four patients (8.0%). Postoperative infectious complications occurred in 1 of 47 patients (2.1%) who had undergone successful interval laparoscopic appendectomy, and the median length of postoperative hospital stay was 4 days (interquartile range, 3-5 days). There were no significant differences in outcomes after interval appendectomy between patients aged <70 years and ≥70 years. In the secondary analysis, the median length of postoperative hospital stay after interval laparoscopic appendectomy for appendiceal abscess (4 days) was significantly shorter than that after early laparoscopic appendectomy for uncomplicated appendicitis (7 days; P < .001). Interval laparoscopic appendectomy for appendiceal abscess may be safe and effective in elderly patients without severe comorbidities. Interval appendectomy may be necessary for determining the underlying cause of appendiceal abscess in adults.

Is there a role for prophylactic drainage of the abdominal cavity after laparoscopic appendectomy for non-complicated appendicitis in children?

Peritoneal drainage has been used to prevent infectious complications after either laparoscopic or open appendectomy. Unlike in complicated appendicitis, where intraoperative drainage at the end of the procedure has clear benefits, in un-complicated appendicitis, the usefulness of peritoneal drainage is still under debate. This study aims to clarify if intraoperative drainage of the peritoneal cavity during laparoscopic appendectomy for uncomplicated appendicitis in children has beneficial consequences for the postoperative course of the patient. In a 12-month period, we performed 120 consecutive laparoscopic appendectomies, for uncomplicated appendicitis. Postoperative drainage was used in 44 patients. We have collected and analyzed data concerning operating time, postoperative course and complications, need for analgesia, time to resumption of bowel movement and hospital stay. No significant incidents during surgery have been recorded. Postoperative intraabdominal abscesses occurred in two cases, one for each group. Mean hospital stay, operating time, the need for postoperative analgesia and regain of the gastro-intestinal transit were all longer for the drained group. Complication rate, postoperative pain, hospital stay are all higher after prophylactic drainage of the peritoneal cavity after laparoscopic appendectomy for non-complicated appendicitis. The prophylactic use of abdominal drainage after laparoscopic appendectomy for non-complicated appendicitis in children does not prevent postoperative complications and has no or even negative consequences for the postoperative course of the patients.

Parental satisfaction with same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis.

Recent studies suggest that same-day discharge is safe for the paediatric population after various laparoscopic procedures. Same-day discharge is increasingly common after laparoscopic surgery for uncomplicated appendicitis although it is not standard practice. This prospective study aims to assess parental satisfaction with same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis. At our institution, 849 patients with uncomplicated acute appendicitis underwent laparoscopic appendectomy in 2016; of which, 382 were discharged on the same calendar day. Postdischarge surveys assessing parental satisfaction were administered by telephone at the 2-week follow-up. Approximately 65% of 185 total parental responses reported initial satisfaction with same-day discharge. About 30% were nervous at that time, and 5% did not feel ready to go home yet. Upon reflection, a higher proportion of parents (81.6%) felt same-day discharge was the appropriate course of action, 11.4% were unsure, and 7.0% would not do it again. Some parents cited concerns regarding pain control and incongruous expectations from conversations with staff or surgical experiences of their own. The majority of parents recalled being happy at discharge, with an increase to 82% retrospectively. Only 7% of parents would not elect to go home on the same day again. Opportunities for improvement include a unified plan from all providers with expectations of same-day discharge if appendicitis is intraoperatively confirmed to be uncomplicated and better analgesic instructions at discharge.

Nebulized analgesia during laparoscopic appendectomy (NALA): A randomized triple-blind placebo controlled trial

PurposePostoperative pain remains a considerable concern for patients and families. We assessed whether nebulized ropivacaine reduces morphine consumption and pain after laparoscopic appendectomy for uncomplicated appendicitis in children. MethodsPatients 7–17 years old with uncomplicated appendicitis were randomized to ropivacaine (intervention arm) or saline nebulization (placebo arm) at the onset of laparoscopy. Nonconsenting individuals were treated with standard care and invited to provide clinical data (baseline arm). The primary outcome was in-patient morphine utilization. Secondary outcomes included pain scores at multiple time-points, markers of recovery, operative times, and surgeon satisfaction. The trial was registered (NCT02624089). ResultsStudy enrollment was 116 patients over a 1-year period: Intervention (n = 43), Placebo (n = 39), Baseline (n = 34). No differences in baseline characteristics were noted between groups. No difference was noted in overall in-patient morphine consumption between randomized groups (0.31 vs. 0.35 mg/kg, p = 0.42) or between ropivacaine and baseline (0.31 vs. 0.277 mg/kg, p = 0.62). Although operative times were comparable between groups, 63% of surgeon respondents felt that nebulization obscured visualization. ConclusionNebulized ropivacaine did not reduce postoperative morphine consumption or pain scores after laparoscopic appendectomy for simple appendicitis in children. Given that it decreases visualization and likely increases costs, nebulized administration of intraperitoneal analgesia does not appear warranted in this context. Type of studyTreatment study. Level of evidenceLevel I.

Efficacy and Safety of Laparoscopic Appendectomy for Complicated Appendicitis in Children in Tertiary Care Hospital

Laparoscopic appendectomy for uncomplicated appendicitis is associated with good outcomes but the role of laparoscopy in complicated appendicitis is more controversial because of high incidence of infectious complications. The aim of this current study is to evaluate the efficacy and safety of laparoscopic appendectomy in complicated appendicitis in children. This interventional study was carried out during the period from January 2015 to May 2018 in Holy Family Red Crescent Medical College Hospital. The study included 43 patients, age ranges from 3 years to 15 years who underwent laparoscopic appendectomy for complicated acute appendicitis. The following variables were analyzed : age, sex, operative findings, operative time, return of bowel function, resumption of oral feeds, length of hospital stay, postoperative complications such as deur, wound infection and intraabdominal abscess etc. The mean age of studied cases was 7.1 years. In 41 patients (95.3%) the procedure was completed laparoscopically. Two (4.7%) patients required conversion to open appendectomy. The operative time was 83.5+,25.8 minutes. Two patients (4.6%) had post-operative ileus. Four patients (9.7%) developed superficial wound infection. Three patients (7.3%) developed infra-abdominal collections. One (2.4%) patients were readmitted because of recurrent abdominal pain One patients (2.4%) developed postoperative pyrexia due to pneumonitis and Three patients (7.3) developed gastroenteritis. The mean length of hospital stay was 5.8±2.1 days. No mortality was recorded.Laparoscopic appendectomy can be the first choice for cases of complicated appendicitis in children. It is a feasible, safe procedure and is associated with acceptable post-operative morbidity with rapid recovery and better cosmetic results.

Parental Satisfaction with Same-Day Discharge after Laparoscopic Appendectomy for Uncomplicated Appendicitis

Objectives Recent studies suggest that same-day discharge is safe for the paediatric population after various laparoscopic procedures. Same-day discharge is increasingly common after laparoscopic surgery for uncomplicated appendicitis although it is not standard practice. This prospective study aims to assess parental satisfaction with same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis. Methods At our institution, 849 patients with uncomplicated acute appendicitis underwent laparoscopic appendectomy in 2016; of which, 382 were discharged on the same calendar day. Postdischarge surveys assessing parental satisfaction were administered by telephone at the 2-week follow-up. Results Approximately 65% of 185 total parental responses reported initial satisfaction with same-day discharge. About 30% were nervous at that time, and 5% did not feel ready to go home yet. Upon reflection, a higher proportion of parents (81.6%) felt same-day discharge was the appropriate course of action, 11.4% were unsure, and 7.0% would not do it again. Some parents cited concerns regarding pain control and incongruous expectations from conversations with staff or surgical experiences of their own. Conclusions The majority of parents recalled being happy at discharge, with an increase to 82% retrospectively. Only 7% of parents would not elect to go home on the same day again. Opportunities for improvement include a unified plan from all providers with expectations of same-day discharge if appendicitis is intraoperatively confirmed to be uncomplicated and better analgesic instructions at discharge.