Laparoscopic Appendectomy Procedures Research Articles

Comparison of pain between laparoscopic appendectomy vs open appendectomy in patients with acute appendicitis

IntroductionPain is almost the main problem after surgery, effective pain management is crucial for recovery, since poorly managed pain can have detrimental effects on a patient's physical functioning, mental health, interpersonal connections, and productivity. ObjectiveOur study compares LA and OA to evaluate post-operative pain in 42 ​h using the Visual Analouge Scale (VAS) with the goal decreasing the requirement for opioids to address postoperative pain. MethodsA retrospective analysis of patients with an appendicitis diagnosis who were admitted to the Department of General Surgery at General Hospital University of Muhammadiyah Malang between January 2018 and June 2019. 258 individuals with acute appendicitis, with 137 undergoing open appendectomy (OA) and 121 undergoing laparoscopic appendectomy (LA). ResultWe reported patients who obtained OA surgery experienced significant pain on first day, compared with patients who underwent LA operation, who reported light pain (P ​= ​0.000). On second day Thirteen patients who underwent OA surgery reported a reduction in pain levels from moderate to mild (P ​= ​0.000). Patients who underwent LA procedure, 59 participants had a significant reduction of pain level, 54 patients reduced from mild to no pain. and moderate pain to light pain reported in 5 patients, whereas the remaining 62 had no change level of pain (P ​= ​0.000). ConclusionIn terms of post-operative pain, the LA operation is a reliable surgical technique and is preferable to an OA appendectomy.

A Comparative Study of Propofol and Sevoflurane for General Anesthesia in Laparoscopic Appendectomy

Introduction: Anesthesia plays a vital role in the success of surgical procedures, with the choice of anesthetic agents influencing patient recovery and postoperative complications. Propofol and sevoflurane are two commonly used anesthetic agents, each with distinct properties and implications on patient outcomes. The primary objective of this study was to compare the effects of propofol and sevoflurane on intraoperative hemodynamic parameters, recovery profiles, and postoperative complications in patients undergoing laparoscopic appendectomy. Methods: This prospective randomized trial was conducted over 2 years at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, and included 180 laparoscopic appendectomy cases. Participants were randomized into two groups: 90 receiving propofol and 90 receiving sevoflurane for general anesthesia. The study received ethical approval from the hospital's review committee. Result: The mean age of patients in the Propofol group was 59.5 years (SD=2.6), while in the Sevoflurane group, it was 56.3 years (SD=7.9). Intraoperative heart rate and recovery profiles showed statistically significant differences between the two groups (p<0.05). The time to eye opening was 6.8 minutes (SD=1.5) for Propofol and 7.4 minutes (SD=1.7) for Sevoflurane. Postoperative complications were significantly higher in the Sevoflurane group: pain (35.56% vs. 24.44%), nausea and vomiting (27.78% vs. 16.67%), and analgesic requirements (44.44% vs. 30.00%). Conclusion: The findings of this study suggest that propofol may be a more favorable anesthetic agent compared to sevoflurane in laparoscopic appendectomy procedures. Propofol demonstrated better intraoperative heart rate control, faster recovery profiles, and reduced postoperative complications, potentially enhancing overall patient outcomes and satisfaction.

Clinical outcomes of laparoscopic versus open appendectomy for acute appendicitis in a resource-limited setting

Background: Acute appendicitis is the most common cause of the acute abdomen; thus, appendectomy is part of most daily emergency surgical duties. It is conducted through either open or laparoscopic approach. Methods: A prospective hospital-based study compared the clinical outcomes of open versus laparoscopic appendectomy for patients with acute appendicitis in El-Mek Nimir University Hospital, Sudan. Results: A total of 550 cases of acute appendicitis were studied, of which 328 (59.6%) underwent open appendectomy surgery and 222 (39.4%) underwent laparoscopic appendectomy. The majority of the study’s population was female.Laparoscopic appendectomy generally involved a longer operation time than open appendectomy (mean duration, 42.4±12.5 vs. 29±16 minutes), lesser incidence of severe pain postoperatively (3% vs. 11%; p=0.000), shorter hospital stay (i.e., <24 hours; 96% vs.77%; p=0.000), and a higher rate of patient return to normal activities within 1 week (92% vs.15%; p=0.000). Differences in the occurrence of bleeding, wound infection, or intra-abdominal septic collection were not statistically significant. Conclusion: Both open and laparoscopic appendectomy procedures are safe for the management of acute appendicitis; however, laparoscopic appendectomy is associated with fewer complications and a faster recovery.

Comparative Effectiveness of Endoloop, Instrumental Tie and Ligaclip in Laparoscopy Appendectomy

Background: Appendectomy is the most commonly performed surgical procedure for patients. To examine the safety, complications, and cost-effectiveness of the instrumental tie, ligaclip and endoloop procedures have been used for the closure of the appendix stump. The objective of this study was to analyze the clinical outcomes, as well as to compare the effectiveness of the endoloop, instrumental tie, and ligaclip in laparoscopic appendectomy procedures. Methods: The Sir Syed Medical College Hospital, Karachi was the center of this Randomized Control Study, from June 2020 to December 2020. Acute appendicitis patients (n=120) having age 7-85 years were categorized into three groups: A, B, and C. Ligaclips were applied to those in Group A, Instrumental Tie to Group B, and Endolope to Group C patients. Each group consisted of 40 participants. The Kolmogorov Smirnov test was used to determine the variables for normal distribution. The Chi-square test was used to measure the association between the duration of surgery and hospital stay. Results: The statistical significance (p<0.05) of the relationship between the length of hospital stay and the duration of surgery had been established. The ligaclip demonstrates the shortest hospital stay of 2-3 days and the shortest operation time of 50-60 minutes, whereas the instrumental tie displayed the longest operation time of 72-75 minutes and the longest hospital stay of 4-5 days. Conclusion: Ligaclip application of the appendiceal base showed statistically significant outcomes (p=0.00) regarding technical comfort, cost-effectiveness and operating time compared to endoloop and surgical tie applications. Keywords: Ligaclip; Instrumental Tie; Endoloop; Laparoscopy Appendectomy.

Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Appendicitis

Objective: To compare the outcomes in relations to postoperative pain and complications, and hospital stay of laparoscopic versus open appendectomy in management of appendicitis.
 Study Design: Cross sectional study.
 Place and Duration of Study: This study was conducted in department of surgery Unit III of PUMHS Nawabshah and Suleman Roshan Medical College Tando Adam, Sindh Pakistan, from January 2020 to December 2021.
 Methodology: This study consisted of 136 consecutive cases of either gender, aged between 13 to 60 years, that were enrolled during study period and matching with the inclusion and exclusion criteria. After the permission of ethical committee, a detailed history was taken from all the patients with special regard to the pain in RIF, Pain starting around umbilicus, nausea, vomiting, fever and altered bowel habits. All the cases were randomly divided into Group A comprising of 68 cases which were operated by conventional open appendectomy (OA) and other group B also comprising of 68 cases which were operated by laparoscopically appendectomy (LA). All the clinical and demographic data was collected on a proforma designed for the study, and analyzed by using Statistical Package for Social Science (SPSS) software version 22. Effect modifier like age, gender was controlled by stratification and chi-square test was applied to see the effect of these on both open versus laparoscopic appendectomy outcome variable. P <0.05 was taken as significant.
 Results: In open appendectomy group male:female ratio of 1.2:1 and in laparoscopically appendectomy group male:female ratio of 1.5:1. The mean age was 31.28±4.30 years for OA group and 35.47±3.23 years for LA group (p 0.02).Alvarado score was showed <4 Score 0% in both groups, where as 4-7 Score in 9(13.23%) patients of OA group and 8(11.76%) patients of LA group, and > 7 Score was seen in 59(86.76%) patients of OA group and 60(83.23%) patients of LA group. The mean time in OA group was 45.21±12.1 minutes and LA group was 43.44±9.4 minutes (p 0.026).Mild pain was felt in 7(10.29%) patients of OA group and 39(57.35%) patients of LA group, Moderate pain was seen in 31(45.58%) patients of OA group and 26(38.23%) patients of LA group, severe pain was described by 30 (44.11%) patients in OA group and 3(4.41%) patients in LA group (p 0.005).The common complications seen in this study Ileus was 29(42.64%) patients in OA and 18(26.47%) patients in LA group) followed by wound infection 10(14.70%) patients in OA and 1(1.47%) patients in LA group. The duration of hospital stay was longer about 3-4 days in 58(85.29%) of OA patients as compared to LA cases where majority 65(95.58%) were discharged within 2 to 3 days. 
 Conclusion: We conclude that laparoscopic appendectomy procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than open appendectomy procedure.

Survey of school aged patients and their parents with regards to comprehension of laparoscopic appendectomy procedure

Survey of school aged patients and their parents with regards to comprehension of laparoscopic appendectomy procedure

Endoscopic retrograde appendicitis therapy for management of acute appendicitis

This study investigated the feasibility of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute appendicitis. There were 210 patients included who were admitted to our hospital from January 2017 to October 2019 with a diagnosis of acute appendicitis. According to the method of treatment, patients were stratified into the ERAT group, laparoscopic appendectomy (LA) group, or open appendectomy (OA) group for comparison of perioperative information extracted from the medical records of the patients. The operations were successfully completed in all patients. The length of operation in the ERAT group (median: 48 min, range: 34-78 min) was significantly shorter compared to the LA group (median: 67 min, range: 47-90 min) or OA group (median: 85 min, range: 58-120 min). Postoperatively, the length of the hospital stay, the amount of time spent bedridden following surgery, surgery-related complications, and in-patient expenses were all significantly less than those in both the LA and OA groups (all p < 0.05). Moreover, the recurrence rate of appendicitis after ERAT was 2.86% during the first six months of postoperative follow-up. Thirteen patients in the ERAT group were diagnosed with appendicular abscesses, all of which successfully proceeded by colonoscopically incising the most protruding or fluctuating place around the appendix opening without procedure-related complications during the follow-up period. ERAT is a safe and effective endoscopic treatment method for acute appendicitis and abscesses of the appendix. The advantages include reduced trauma, faster recovery times, and lower costs in comparison with either OA or LA procedures. ERAT with internal incision and drainage can be safely performed with immediate effect, especially in patients with acute uncomplicated appendicitis accompanied by either fecal stones or stenosis of the appendix cavity, or an abscess within the appendix cavity.

Evaluation of gastroesophageal reflux in pediatric laparoscopic appendectomy procedures.

The increased intra-abdominal pressure during laparoscopic surgical procedures was reported to be a factor in the development of gastroesophageal reflux. This study evaluated the presence of gastroesophageal reflux and associated factors using 24-h pH monitoring in children undergoing laparoscopic appendectomy. Children who underwent laparoscopic surgery for presumed acute appendicitis between June 2017 and June 2018 were included in the study. After pre-operative endotracheal intubation, pH catheters were placed for 24-h esophageal pH monitoring. Relationships between gastroesophageal reflux and procedure time, pre-operative fasting time, age, weight, and body mass index (BMI) were evaluated. A total of 60 pediatric patients were included in the study. Their mean (SD) age was 11.82 (3.71) years (range, 4-17 years). The mean (SD) body weight was 41.27 (16.72) kg (range, 15-90 kg) and the mean (SD) BMI were 17.96 (4.37). The mean pre-operative fasting time was 15.52 (12.1) h, while the mean operative time was 38.42 (17.96) min. Lower age and weight were significantly associated with the presence of post-operative gastroesophageal reflux (p<0.05). Mean procedure time, mean pre-operative fasting time, and BMI were not significantly associated with intra- or post-operative gastroesophageal reflux (p>0.05). The lack of a significant relationship between mean procedure time and gastroesophageal reflux suggests that the mean duration of the laparoscopic procedures performed in this study is safe in terms of gastroesophageal reflux. The results also indicate that young age and low weight should be considered risk factors for gastroesophageal reflux in pediatric patients undergoing laparoscopic appendectomy.

Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study.

ABSTRACTAimDefinition of the type of appendicitis is based on examination of the peritoneum and appendix. Gomes et al. proposed a laparoscopic grading system of acute appendicitis (grades 1 and 2, noncomplicated appendicitis, grade 3-5 complicated appendicitis). The aim of this study was to evaluate the reproducibility of this score.Patients and methodsAll patients managed for acute appendicitis between January 2016 and June 2016 were included in this single-center prospective study. Laparoscopic appendectomy procedures were filmed by analogy to Sugerbaker's peritoneal carcinomatosis score (9 quadrants, all of the abdomen was filmed). The videos were then analyzed by seven staff surgeons blinded to each other and the operative report. The primary endpoint was to determine the concordance between staff surgeons for grading of appendicitis using the laparoscopic grading system of acute appendicitis described by Gomes et al.ResultsA total of 40 patients were included in this study. A concordance was observed between the seven staff surgeons in 85% of cases. For regional peritonitis, the mean ± (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 1.44 ± 0.63. For diffuse peritonitis, the mean (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 2.59 ± 0.51. On ROC curve analysis, two quadrants was the best cut-off between grade 4B (local peritonitis) and five (diffuse peritonitis) acute appendicitis (AUC = 0.92, Se = 100%, Sp = 92%, p = 0.005).ConclusionThe classification used to determine the type of appendicitis is reproducible.Clinical significanceTo give a definition of complicated appendicitis.How to cite this articleMariage M, Sabbagh C, et al. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol 2019;9(1):1-4.

Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: A prospective observational study.

Despite the recent increase in the use of laparoscopic appendectomy procedures to treat acute appendicitis, laparoscopic appendectomy is not necessarily the best treatment modality. The aim of this study is to examine the value of laparoscopic intracorporeal knotting and glove endobag in terms of various parameters and in terms of reducing the costs related to laparoscopic appendectomy procedures. Seventy-two acute appendicitis patients who underwent laparoscopic appendectomy and open appendectomy surgery were enrolled in the study and were evaluated prospectively. The patients were divided into two groups: group 1 was treated with laparoscopic appendectomy using laparoscopic intracorpreal knotting and glove endobag (n=36) and group 2 was treated with open appendectomy (n=36). The two groups were statistically compared in terms of preoperative symptoms and signs, laboratory and imaging findings, operation time and technique, pain score, gas and stool outputs, duration of hospital stay, return to normal activity, and complications. No statistically significant differences were found between the groups in relation to gender, age, body mass index, or pre-operation findings, which included loss of appetite, vomiting, time when pain started, displacement of pain, defense, rebound, imaging methods, and laboratory and pathology examinations (p>0.05). Moreover, there were no differences between the groups with respect to drain usage, hospital stay time, or complications (p>0.05). In contrast, a statistically significant difference was found between the groups in terms of operation time, pain scores, gas-stool outputs, and return to normal activity in the laparoscopic appendectomy group (p=0.001). Laparoscopic appendectomy can be performed in a facile, safe, and cost-effective manner with laparoscopic intracorporeal knotting and glove endobag. By using these techniques, the use of expensive instruments can be avoided when performing laparoscopic appendectomy.

Surgical Wound Infections After Laparoscopic Appendectomy With or Without Using Reusable Retrieval Bag: A Retrospective Study

Background: Despite the reported advantages of laparoscopic appendectomy (LA), an ongoing debate exists about a possible increase in postoperative infectious complication rates. The analyses of risk factors associated with surgical site infections (SSIs) after LA, have been limited. Patients and Methods: One hundred twenty laparoscopic appendectomies performed over one year, were included in this retrospective study. The patients were divided into 2 group; group A was the one in which LA was done with using reusable retrieval bag and group B without using that. Demographic details, operative time, hospital stay and infective postoperative complications were recorded. Results: This patient groups were selected to be similar in both groups A and B in form of appendicitis types. Each group included 27 (45%) acute catarrhal appendicitis, 20 (33.3%) suppurative appendicitis and 13 (21.7%) perforated appendicitis, P = 1.0. The median patients ages were 21 years (range, 16 to 49) in group A and 25 years (range, 18 to 56) in group B, P = 0.053. Group A included 60 patients (35 males and 25 females) and group B 60 patients (32 males and 28 females), P = 0.071. Mean operative time in group A was 55.7 minutes and in group B was 57 minutes, P = 0.0231. Superficial wound infections were recorded in one patient (1.7%) in group A and in 8 patients (13.3%) in group B, P = 0.007. Intra-abdominal abscess formation was a complicated outcome in 2 patients (3.3%) of group B, P = 0.005. Mean hospital stay was 1.6 days in group A and 2.7 days in group B, P = 0.05. Conclusions: Surgical wound infections are less common by using reusable retrieval bag during laparoscopic appendectomy procedure. Also, using reusable retrieval bag has less cost.

Methods for closure of appendix stump during laparoscopic appendectomy procedure.

The most frequent abdominal pathology requiring emergent surgery is acute appendicitis. Laparoscopic appendectomy has been performed for the treatment of acute appendicitis since 1983. Closure of the appendix stump is vital to prevent severe postoperative complications. Different methods are described for closure such as stapler, endoloop, titanium clips, non-absorbable polymer clips (hem-o-lok clip), handmade loops, transsection by Ligasure or with bipolar cautery. The ideal method should be safe, applicable and cheap. The most appropriate method remains to be controversial. All methods are reported as safe, but some have higher costs, and some prolong the operation. In this article, we reviewed clinical and experimental studies on different methods of stump closure, and we tried to compare the benefit of these methods over others.

Laparoscopic Appendectomy in a Nigerian Teaching Hospital

Laparoscopic appendectomy in a setting where resources are poor is still controversial. This study evaluates the impact of laparoscopy on the early outcome of acute appendicitis in a developing country. All patients who underwent appendectomy from January 2010 through June 2011 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were recruited for this study. Of the 139 patients with acute appendicitis within the study period, 83 (59.7%) had open appendectomy (OA), 19 (13.7%) whose clinical and radiological findings suggested complicated appendicitis at presentation had laparotomy, while 37 (26.6%) had laparoscopic procedures. In the laparoscopy group, initial diagnostic laparoscopy in 4 (10.8%) patients revealed a normal appendix along with other findings that precluded appendectomy. Laparoscopic appendectomy (LA) was then performed in 33 (23.7%) patients with 2 of these (6.1%) requiring conversion to open laparotomy. Mean time for the LA procedure was higher than that observed for OA (56.2 vs 38.9 min). Patients in the LA group had a shorter mean postoperative stay (1.8 vs 3.0). Wound infection occurred in 2 (6.5%) patients from the LA group and 8 (9.6%) from OA. Laparoscopic appendectomy reduced the rate of unnecessary appendectomy and postoperative hospital stay in our patients, potentially reducing crowding in our surgical wards. We advocate increased use of laparoscopy especially in young women.

Evaluation of a Possible Inflammatory Response after Appendectomy for Non-Perforated Appendicitis in Children

The inflammatory process in the post-appendectomy period is not well characterized. In a pilot study, we prospectively followed the kinetics of different inflammatory mediators before and after appendectomy in children, and compared the results of the groups open appendectomy (OA) and laparoscopic appendectomy (LA). Levels of sP-selectin, tPA, MCP-1, IL-6, IL-8, sVCAM-1, and sCD40L were measured before appendectomy and on the next three consecutive days in the serum of 25 children (16 males and 9 females) aged 7 - 16 years (mean 12.6+/-2.47 years) with non-perforated acute appendicitis. LA and OA were performed in 16 and 9 patients respectively. None of the markers of inflammation differed significantly by surgical approach at any point of observation. However, sP-selectin, MCP-1 and sVCAM-1 levels were found to have significantly different postoperative kinetics with a trend towards higher values in the laparoscopic group compared to the open appendectomy group (p=0.034, p=0.016 and p=0.025, respectively). The cytokines sP-selectin, MCP-1 and sVCAM-1 may play a role in the possible post-appendectomy cytokine activation after non-perforated appendicitis. Since this phenomenon is more evident after LA than after OA, the contribution of the different LA procedures has to be further investigated.

A Critical Analysis of Laparoscopic Appendectomy: How Experience with 1,400 Appendectomies Allowed Innovative Treatment to Become Standard in a University Hospital

Although advantages of laparoscopic appendectomy (LA) have not yet been proved, there is increasing evidence that LA provides diagnostic and therapeutic advantages as compared to conventional surgery. This article reports the introduction of LA in a university hospital where LA now represents the standard operative procedure in patients with suspected appendicitis. Consecutive patients with appendectomy were prospectively included in the surgical database from 5/1991 to 10/2005. Operating time skin-to-skin in minutes, conversion from laparoscopy to open appendectomy, and complications requiring reoperation as well as surgical expertise were recorded. After initial performance of LA by four experienced specialists in laparoscopic surgery between 1991 and 1994, LA was routinely implemented from 1995 to 2005. Laparoscopic appendectomy was performed in 1,012 patients, and conventional appendectomy in 449 patients, with a LA rate of about 90% in recent years. Intraoperative conversion was deemed necessary in 62 patients (6.2 %) by 40 surgeons among the 103 surgeons who performed LA over 14 years with a mean operative time of 57 +/- 2 min. Between 1995 and 2005 about 25%-30% of LAs were performed as the first LA for the respective surgeon. Laparoscopic appendectomy was associated overall with a reduced length of stay in the hospital compared to open appendectomy (LA: 4.4 +/- 0.1 days versus 6.6 +/- 0.2 in open appendectomy; p < 0.001). This analysis provides evidence that LA can be introduced in an university hospital with acceptable results despite low operation numbers per surgeon and a liberal teaching policy. The LA procedure, which is associated with a 2%-4% rate of reoperation, may serve as laparoscopy training for young surgeons.

Improved Outcomes for Laparoscopic Appendectomy Compared with Open Appendectomy in the Pediatric Population

The appendectomy is a common emergent surgical procedure in the pediatric population. The aim of this study was to examine our institution's experience and outcomes in the appendectomy in the pediatric population early in our transition from open surgery to a predominantly laparoscopic approach. We retrospectively studied all pediatric patients (age 20 years) that underwent an appendectomy at a tertiary care center over 2 years. The data collected included patient demographics, comorbidities, operative details, outcomes, and complications. Two hundred twenty-three consecutive patients, with a mean age of 9.5 (3.9) years, were included in the study. Forty-four laparoscopic and 179 open appendectomies were performed. Two of the laparoscopic cases were converted to open appendectomies. Significant differences were seen between the two groups, with longer operative times (P < 0.0001) and lower estimated blood loss (P = 0.007) in the laparoscopic group. Operative times improved significantly for the laparoscopic group as the surgeons became more experienced (P = 0.03). The laparoscopic group used intravenous pain medication for a shorter time (0.8 vs. 1.9 days; P = 0.0003) and had a shorter postoperative hospital length of stay (2.2 vs. 3.4 days; P = 0.004). The laparoscopic group had fewer wound infections (2.3% vs. 6.2%; P = 0.3), intra-abdominal abscesses (4.5% vs. 5.6%; P = 0.8), and postoperative ileus (0% vs. 2.2%; P = 0.3), although these differences did not reach statistical significance. The laparoscopic appendectomy procedure is a safe alternative to open appendectomy in pediatric patients and results in shorter hospital stays with less postoperative pain.

Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical

Laparoscopic appendectomy (LA) has become very popular. One criticism of this approach is the high cost of the disposable equipment such as the linear stapler. An alternative would be suture ligation of the appendiceal base. To prove the safety of the Gea extracorporeal sliding knot (GESK) for closure of the stump after LA, a retrospective study was conducted. For this study, 63 LA procedures performed by one surgeon using the Gea knot (group A) were reviewed and compared with 63 LA procedures performed by two other surgeons (group B) using the linear stapler. The GESK is created with 0-prolene in the manner already described. The main variable was the presence or absence of blowout, leak, or fistula from the appendiceal stump. The secondary variables were abdominal abscess, wound infection, and need for readmission or reoperation. The results were analyzed using the appropriate statistical methods. Both groups were similar in terms of age, gender, and pathologic diagnosis. No patient in group A or B experienced a colonic fistula, stump blowout, or leak. In group A, one patient experienced interloop abscesses. There were two wound infections. In group B, one patient experienced a wound infection, and another patient had a wound dehiscence of the umbilical port, which required reoperation. No statistical differences were noted between the two groups. There are surgeons who routinely use sutures to secure the stump of the appendectomy. This study aimed to demonstrate that the GESK is as secure as the stapler for closure of the appendiceal stump. The GESK could be passed through a 5-mm trocar, potentially avoiding complications of a larger trocar site. The GESK seems to be an economic and safe alternative to the stapler.

Laparoscopic appendectomy in Italy: an appraisal of 26,863 cases.

To evaluate the practice of laparoscopic appendectomy (LA) in Italy. On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 +/- 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 +/- 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.