Laparoscopic Appendectomy Research Articles

P-1176. Optimal Agent and Timing of Surgical Antibiotic Prophylaxis and Surgical Site Infection in Pediatrics

Abstract Background Surgical site infections (SSI) make up ∼20% of all healthcare-associated infections (HAI), with 75% of SSI-associated deaths directly attributable to the SSI. Beta-lactams (BL) including cefazolin (CFZ) and cefoxitin (CFO) are recommended as surgical antibiotic prophylaxis (SAP). Cephalosporins are often avoided in patients with reported BL allergies despite cross-reactivity with penicillin at < 1%. Guidelines recommend giving SAP 60 min prior to incision. Cefazolin and cefoxitin pharmacokinetics (PK) exhibit rapid time to peak serum level and short elimination half-life. We aim to evaluate differences in SSI rate in patients who received CFZ or CFO vs. non-BL alternatives (BLA) and administration of preop BL dose at different time interval prior to incision. Methods Retrospective observational study included patients aged 0 – 17 years who received SAP at CHOC from Jul 2021 – Jun 2023. Outcomes include differences in SSI rate within 90 days of surgery between patients receiving recommended BL (CFZ, CFO) vs BLA (clindamycin, gentamicin, metronidazole, vancomycin). Rate of SSI in patients who received pre-op CFZ or CFO at different time interval (0-20 min, 21-40 min, 41-60 min) will be examined. Wound classification (I to IV) as defined by CDC. SSIs were defined according to National Healthcare Safety Network. Bivariate logistic regression analyses compare the odds of experiencing an SSI between study groups. Results Median age was 9.0 years [IQR: 3.0, 14.0], 58.8% males. Wound classification is as follows: 37.6% (Class I), 34.1% (Class II), 22.9% (Class III), and 5.1% (Class IV). Overall SSI occurred in 1.0% (92/9054) of procedures. Beta-lactams were used as SAP in 96% of procedures, with 89.8% receiving pre-op dose within 20 min of incision. Laparoscopic appendectomy was the most common procedure at 10.9%. Age < 1 year, use of non-BL SAP and administration of SAP >20 min from incision was associated with significant increase in SSI (p< 0.05, Table 1). No difference in SSI rate observed in patients who continued receiving post-op SAP for class I-II procedures. Conclusion Our study supports the continued use of CFZ, CFO compared to BLA for SAP. Pre-op doses of CFZ or CFO within 20 min of incision time were associated with decreased risk of SSI, likely due to their PK characteristics. Disclosures All Authors: No reported disclosures

Acute appendicitis and secondary peritonitis in a patient with end-stage renal failure and a dormant peritoneal dialysis catheter

Peritoneal dialysis (PD) is a common renal replacement therapy for patients with end-stage renal disease (ESRD). Despite its benefits, PD-related peritonitis remains a severe complication, often associated with significant morbidity and mortality. Although most cases of PD-related peritonitis are due to touch contamination, intra-abdominal infections, such as appendicitis, are less common but can result in severe outcomes. We present a case of severe peritonitis secondary to perforated appendicitis in a patient with a dormant PD catheter. A 41-year-old male with ESRD, previously on PD, presented with a 36-hour history of fever, chills, nausea, and abdominal pain. Despite transitioning to hemodialysis, the patient had retained his PD catheter, which had not been used for months. On admission, the patient was septic with evidence of peritonitis. Blood cultures were positive for Escherichia coli, while PD catheter cultures were negative. An abdominal CT scan revealed a gangrenous perforated appendix. The patient underwent an emergency laparoscopic appendectomy and PD catheter removal, resulting in significant clinical improvement. Perforated appendicitis in ESRD patients with a PD catheter can result in severe peritonitis with life-threatening complications, including sepsis and cardiac events. This case underscores the importance of maintaining a high index of suspicion for intra-abdominal causes of peritonitis in PD patients, even when the PD catheter is dormant. Timely diagnosis, empiric antibiotic therapy, and prompt surgical management are essential to reduce mortality in these patients.

Is Routine Group and Save Sampling Necessary for Emergency Laparoscopic Appendicectomy?

Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurredin 2024. The patient population consisted of 46.4% males (n = 141) and 53.6% females (n = 163), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.

DOP053 Efficacy of appendectomy in inducing remission in moderate-to-severe ulcerative colitis: preliminary one year results of a multicentre prospective cohort study (COSTA)

Abstract Background This study aimed to evaluate the efficacy of appendectomy in inducing remission in patients with moderately to severely active ulcerative colitis (UC), despite biological or small molecule therapy. Methods This multicentre, prospective cohort study included patients aged ≥16 years with moderately to severely active UC (total Mayo score [TMS] ≥5; endoscopic subscore of ≥2) despite optimised prior treatment with advanced medical therapy (i.e. biological/small molecule exposed). Eligible patients where those for whom the next treatment step was considered to be switching to a Janus kinase (JAK) inhibitor or undergoing (procto)colectomy. Enrolled patients were counselled (patient-preference model) to either undergo laparoscopic appendectomy (study intervention) or continue standard step-up therapy, which included: 1) switching to a JAK inhibitor or 2) undergoing staged restorative proctocolectomy with ileoanal pouch. The primary outcome was the proportion of patients achieving clinical remission (TMS≤2 with no subscore >1) at 12 months without therapy failure. Therapy failure was defined as (re)start of oral corticosteroids, switch of advanced therapy, start trial medication or proctocolectomy. Patients without therapy failure and pMS≤2 at 12 months without endoscopic follow-up were considered failures for the primary outcome. Primary analyses will be conducted based on a modified intention-to-treat (mITT) principle. Patients who received the assigned intervention (appendectomy in the intervention group, proctocolectomy in the control group) or at least one dose of the assigned medication (JAK-inhibitor in the control group) will be analysed. The last patient 12-month follow-up visit was completed in September 2024. Results A total of 120 patients were included in the mITT analysis (appendectomy group: n=65, JAK-inhibitor group: n=50, proctocolectomy group: n=5). Numerical baseline differences across groups (appendectomy vs JAK-i vs proctocolectomy) were: male gender (35.4% vs 54.0% vs 20.0%, p=0.08), family history of IBD (33.8% vs 12.0% vs 0%, p=0.02), current smoking (13.8% vs 2.0% vs 0%, p=0.22), disease extent (E3: 41.5% vs 60.0% vs 80.0%, p=0.18), TMS (median 9 [IQR, 7-10] vs 9 [IQR, 8-10] vs 10 [0-.], p=0.16) and concomitant oral corticosteroids (26.2% vs 46.0% vs 80.0%, p=0.01). The appendectomy group had a significantly higher proportion of patients in clinical remission at 12 months without therapy failure after appendectomy, compared to the JAK inhibitor group (33.8% vs 12.0%, p=0.007, Figure 1.). Final analysis are scheduled for Q4 2024 and Q1 2025. Conclusion Appendectomy may be an effective treatment option for inducing clinical remission in moderately to severely active UC. Final analyses are expected in Q1 2025.

A Prospective and Comparative Study of Laparoscopic Appendectomy and Open Appendectomy in the Surgical Treatment of Appendicitis

A Prospective and Comparative Study of Laparoscopic Appendectomy and Open Appendectomy in the Surgical Treatment of Appendicitis

Pain control and analgesic requirements following laparoscopy-assisted transversus abdominus plane (TAP) block compared to port site infiltration post-paediatric laparoscopic appendicectomy. A Randomised controlled trial.

Appendicectomy is a common procedure in children. Regional anaesthesia helps reduce requirements for opioids and hospital stay and enhances recovery. Laparoscopic-assisted Transversus Abdominus Plane block (L-TAP) was shown to be efficient and potentially superior to port site infiltration (PSI); however, this was not previously studied in paediatric appendicitis. This study aimed to evaluate the effectiveness of L-TAP compared to PSI in children undergoing laparoscopic appendicectomy (LA). A single-blinded RCT was performed to compare L-TAP to PSI with 0.25% plain bupivacaine at the end of an LA. Patients aged 6-16 years diagnosed with uncomplicated acute appendicitis (AAST grade 1) were randomised to either group in a 1:1 fashion. Complicated appendicitis, open or Lap-converted to open appendicectomies, were excluded. Outcome measures included the total amount and number of doses of opiates and clonidine required, length of stay (LOS), and visual analogue score (VAS) of pain. 49 patients in the PSI group and 41 in the L-TAP group were included; the mean age was 11.3 ± 2.4 years. There was no significant difference in age and weight between the groups. One patient in each group required opioid-based patient-controlled analgesia (PCA) in the theatre recovery room; however, on retrospective review, this was not clinically warranted. Seven patients in each group required morphine while in recovery (p = 0.4). There was no significant difference in total morphine (PSI 0.12 vs L-TAP 0.04 mg/kg body weight, p = 0.1) and clonidine (PSI 0.57 vs L-TAP 0.59 micro gm/kg body weight, p = 0.5) requirement during the hospital stay. Patients in the L-TAP group had two hours shorter LOS than the PSI group (38.0 ± 3.9 vs 39.7 ± 4.1, p = 0.38). There was no significant difference in VAS scores. There was no difference between L-TAP and PSI. L-TAP was feasible, easy to earn, and safe. We recommend that it be considered in clinical protocols and local guidelines as part of the peri-operative analgesia regimen, especially when ultra-sound guided blocks are unavailable. Overall, patients with uncomplicated appendicitis who undergo LA have low VAS scores and require mostly simple analgesia.

Influence of intravenous lidocaine infusion on haemodynamic response to tracheal intubation and metabolic-hormonal responses during laparoscopic procedures in children: a randomised controlled trial

BackgroundLidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children.MethodsA single-centre, parallel, double-masked, randomised, placebo-controlled trial. 132 patients, aged 18 months to 18 years, with no contraindications to lidocaine administration and qualified for laparoscopic appendectomy were enrolled. The intervention studied was a lidocaine bolus of 1.5 mg⋅kg− 1 over 5 min given before induction of anaesthesia, followed by intraoperative lidocaine infusion at 1.5 mg⋅kg− 1⋅h− 1 intraoperatively. Patients in the control group were administered a placebo. Mean arterial pressure, glucose, cortisol, lidocaine blood levels, lidocaine-related side effects, and intraoperative opioid requirements were analysed.Results132 participants completed the trial. The number of patients who experienced an excessive cardiovascular response to induction of anaesthesia or intubation was 23 (37%) in the control group and 21 (34%) in the lidocaine group (p = 0.707). No statistically significant difference was found between the control and lidocaine groups in the hormonal and metabolic responses, as well as intraoperative fentanyl requirements. Serum lidocaine levels remained below the toxic threshold in all patients.ConclusionsAlthough the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo.Trial registration numberNCT05238506. The date of first registration: 14/02/2022.

Comparative systematic analysis of postoperative infection rates between laparoscopic and open appendectomy approaches

Acute appendicitis remains one of the most common surgical emergencies worldwide, requiring prompt intervention to prevent severe complications. This systematic review aimed to compare postoperative infection rates and recovery outcomes between laparoscopic and open appendectomy. A comprehensive search was conducted in databases such as PubMed, Scopus, and Web of Science, focusing on studies published in the last 11 years. Inclusion criteria encompassed clinical trials, cohort studies, and systematic reviews that evaluated postoperative complications, surgical site infections, and recovery metrics. Findings indicate that laparoscopic appendectomy is generally associated with lower rates of surgical site infections, shorter hospital stays, and faster recovery times compared to the open approach, particularly in adult and obese patient populations. However, evidence suggests that in cases of advanced appendicitis, laparoscopic surgery may increase the risk of intra-abdominal abscesses compared to the open method. Additionally, studies involving pediatric populations found no significant differences between the two techniques in terms of infection rates and postoperative complications. The review underscores that while laparoscopic appendectomy offers significant advantages in most scenarios, the choice of surgical technique should be tailored to individual patient profiles, considering factors such as appendicitis severity, comorbidities, and age. These findings highlight the importance of a personalized approach in surgical decision-making to optimize patient outcomes. Further research is recommended to explore long-term outcomes and refine strategies for managing high-risk cases, particularly in children and patients with complex appendicitis presentations.

EP125 Who does the Laparoscopic Appendicectomy: Struggles of the Modern-Day Core Surgical Trainees and Junior Clinical Fellows

eP125 Who does the Laparoscopic Appendicectomy: Struggles of the Modern-Day Core Surgical Trainees and Junior Clinical Fellows

Laparoscopic versus open appendectomy for treatment of acute appendicitis: a prospective comparative study

Laparoscopic versus open appendectomy for treatment of acute appendicitis: a prospective comparative study

A rare case of long subserosal paracolic subhepatic appendix

Appendicitis is the most common surgical emergency worldwide with variable presentation and unusual positions of appendix. Subhepatic appendicitis is a rare presentation due to congenital malpositioning of the appendix under the liver rather than its typical location in right iliac fossa. This atypical location of appendix leads to recurrent episodes of appendicitis, delayed diagnosis and increased risk of complications. In this case report, A 17-year-young female presented to the emergency room with complaints of pain in right lower abdomen associated with vomiting and fever for 3 days, diagnosed with sub-acute appendicitis. She also had similar 3 episodes in past with complaints of pain in the abdomen for the last one year. She managed conservatively and with advice of a laparoscopic interval appendectomy. Intra-operatively, she was diagnosed with long subserosal paracolic subhepatic appendix. Through previous literature reviews and case analysis, this case report highlights the importance of the unusual position of the appendix and its surgical management. Clinicians should keep all anatomical variants in mind while diagnosing appendicitis for early recognition, prevention of recurrent episodes and complications associated with delayed treatment.

Necessity of invaginating the appendiceal stump in laparoscopic appendectomy for acute nonperforated appendicitis

Abstract: Objectives This study aimed to assess the necessity of invaginating the appendiceal stump in laparoscopic appendectomy for patients with acute nonperforated appendicitis. Summary of Background Data: Laparoscopic appendectomy has become the preferred method over open appendectomy for acute appendicitis, offering benefits like shorter intraoperative times and reduced wound sepsis. However, the necessity of invaginating the appendiceal stump, aimed at preventing stump leakage and intrabdominal infection, remains unclear. Methods This retrospective observational study was conducted at Nippon Medical School Musashikosugi Hospital from 2009 to 2018 and involved patients aged ≥15 years diagnosed with acute nonperforated appendicitis who underwent emergency surgery without preoperative intra-abdominal abscess. Patients were divided into two groups: open appendectomy with stump invagination (Group O) and laparoscopic appendectomy without stump invagination (Group L). The primary outcomes were incidences of appendiceal stump leakage and postoperative intra-abdominal abscess. Results The study involved 119 patients in Group O and 175 in Group L. Both groups were comparable in age, sex, body mass index, blood examination results, operating time, and drain insertion rate. Group L presented more cases of gangrenous appendicitis with severe inflammation but had shorter postoperative stays compared with Group O. The incidence of postoperative intra-abdominal abscess was 2% (2 cases) in Group O and 2% (4 cases) in Group L, with no significant difference. No cases of stump leakage were observed in either group. Conclusions Invaginating the appendiceal stump in laparoscopic appendectomy for nonperforated appendicitis may be unnecessary, as its omission does not increase short-term postoperative complications.

Evaluating Safety and Efficiency of Laparoscopic General Surgery Techniques in Pakistan. A Retrospective Study

Background: The minimally invasive nature, reduced complications, and quick recovery of laparoscopic general surgery have changed the face of surgical practice around the world. However, the barriers, adoption of the technology is not widespread in low and middle-income countries (LMICs) such as Pakistan. Objectives: The objectives of present study were to assess the safety and efficiency of laparoscopic general surgery techniques in Pakistan. Methods: This retrospective study comprised 200 patients who were scheduled for elective laparoscopic surgeries (50%) cholecystectomy, (30%) appendectomy, and (20%) hernia repairs at tertiary care hospitals in Lahore, Pakistan from June 2023 to September 2024. Intraoperative and postoperative outcomes and predictors of complications were analyzed, and demographic data were analyzed. Logistic regression was used to identify significant predictors of statistical analysis performed using SPSS version 27. Results: The Patients were 45.6 ± 12.3 years old and had a mean BMI of 28.7 ± 3.4 kg/m². Eighty-five percent of the cases had intraoperative complications; bleeding (4%) was the most common. In 6.5% of cases, conversion to open surgery was noted. In 15%, postoperative complications were found, and wound infection (6%) and seroma formation (5%) were most frequent. Hospital stays were longer in patients with complications (5.5 ± 1.6 days, p<0.001). Logistic regression identified BMI >30 kg/m² (OR: 2. Operative time >90 minutes (OR: 2.6) and 1) as predictors of complications. Conclusion: Safety & efficiency outcomes of laparoscopic general surgery in Pakistan, comparable to global standards, are demonstrated. To further improve access and outcomes, targeted investments in training, infrastructure, and patient optimization are necessary.

Concurrent Acute Appendicitis and Epiploic Appendagitis: A Rare Clinical Case

Background: Epiploic appendagitis is a rare cause of acute abdominal pain due to ischemia or inflammation of the epiploic appendages, small fat filled structures along the colon. Because of its clinical presentation often mimicking more common conditions such as appendicitis or diverticulitis, it can be a diagnostic challenge. The appendix is equally uncommon in a subhepatic location, and this atypical location adds further to the diagnostic difficulty. Early recognition and treatment are important to prevent complications and to ensure effective treatment. Case Presentation: A non-hypertensive, non-diabetic male presented with a 3-day history of continuous right upper quadrant pain, accompanied by nausea and vomiting. Physical examination revealed right upper quadrant tenderness with rebound tenderness, while laboratory tests showed elevated inflammatory markers. Ultrasound findings included a non-compressible, edematous blind loop in the subhepatic region measuring 9.2 mm in diameter. It is surrounded by stranded mesenteric fat, echogenic mesocolic fat, colonic wall edema, and a minimal free fluid collection. Based on these findings, subhepatic acute appendicitis with associated acute epiploic appendagitis was diagnosed. The patient underwent emergency laparoscopic appendectomy and removal of the inflamed epiploic appendages. Intraoperative findings confirmed a suppurative appendix in the subhepatic region and thickened epiploic appendages surrounded by inflamed tissue. Histopathological analysis corroborated features of subhepatic appendicitis and epiploic appendagitis. Conclusion: The diagnostic and surgical complexities of subhepatic appendicitis and epiploic appendagitis are illustrated in this case. Laparoscopic surgery remains a safe and effective treatment and imaging is important in identifying atypical presentations. Management of atypical acute abdominal pain presentations requires awareness of these conditions.

Comparison of Climate Impact, Clinical Outcome, and Cost-Efficiency of Pediatric Transumbilical Laparoscopic Assisted Appendectomy vs Standard 3-Port Laparoscopic Appendectomy.

Healthcare is responsible for 8.5% of US greenhouse gas emissions. These impacts must be mitigated while maintaining clinical excellence. This study compares clinical outcomes, cost-efficiency, and climate impact of trans-umbilical laparoscopic assisted appendectomy (TULAA) versus 3-port laparoscopic appendectomy (LA). Institutional Review Board approval was obtained. Appendectomies performed between Jan 1, 2020 and December 31, 2022 at a tertiary children's hospital were reviewed. Data abstracted included clinical characteristics, operative approach and findings, supplies and equipment utilized, and complications. For analysis TULAA was combined with cases converted to LA (TULAA+C). To determine a surgical site infection (SSI) increase of ≤ 2.5%, a minimum sample size of 479 patients per group was needed to achieve a power of 80%. A composite supply list for each approach was determined by averaging supplies from cases reviewed. The composite was used to calculate cost-efficiency and climate impact. Life cycle assessment was used to determine the carbon footprint (according to ISO 14067) of supplies and equipment. Analysis was performed on 1,611 appendectomies: 497 LA and 1,114 TULAA+C (932 TULAA, 182 converted). Except for BMI, there were no clinically significant differences between groups. SSI did not increase with TULAA+C (n=15, 1.3%) versus LA (n=6, 1.2%), p=0.81. TULAA+C ($369.21/case) was more cost efficient than LA ($879.30/case) and TULAA+C (24.8 kg CO2e) produced fewer emissions than LA (27.4 kg CO2e). While patient safety and excellent clinical outcomes must remain the top priority in healthcare, the current environmental crisis demands consideration of climate impacts. When clinical non-inferiority can be demonstrated, treatment options with a fewer greenhouse gas emissions should be chosen.

Invited Commentary: Toward Sustainable Surgery: Evaluating the Environmental and Economic Benefits of Transumbilical Laparoscopic Appendectomy vs 3-Port Laparoscopic Appendectomy.

Invited Commentary: Toward Sustainable Surgery: Evaluating the Environmental and Economic Benefits of Transumbilical Laparoscopic Appendectomy vs 3-Port Laparoscopic Appendectomy.

Comparative analysis of suture-based and Hem-O-lok closure techniques in laparoscopic appendectomy for uncomplicated acute appendicitis: a retrospective propensity score matching study.

The optimal method for appendix stump closure in laparoscopic appendectomy (LA) remains debated. This study aims to evaluate the impact of suture-based closure and Hem-O-lok techniques on postoperative complications following LA for uncomplicated appendicitis. A retrospective analysis was conducted on patients with uncomplicated appendicitis treated by LA from January 2019 to December 2021. These patients were categorized into two groups: the suture-based closure group (223 cases) and the Hem-O-lok group (272 cases). Propensity score matching addressed potential discrepancies between the groups. Intraoperative and postoperative parameters of both groups were then compared. Post-matching, the operative duration in the suture-based group was longer than in the Hem-O-lok group (45.9 ± 9.7min versus 42.8 ± 8.9min, P = 0.001). The incidence of postoperative intra-abdominal abscesses and fluid collections was significantly lower in the suture-based closure group (P = 0.032). Multivariate logistic regression analysis revealed that the Hem-O-lok clamp technique [odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.01-64.25, P = 0.047] was a notable risk factor for intra-abdominal abscesses and fluid collections. The suture-based closure technique significantly reduced the incidence of postoperative intra-abdominal abscesses and fluid collections compared with the Hem-O-lok technique in patients undergoing LA for uncomplicated appendicitis.

Comparison of open and laparoscopic appendectomy according to the trimester of pregnancy: A nationwide observational study.

To compare the outcomes of open appendectomy (OA) and laparoscopic appendectomy (LA) for acute appendicitis during pregnancy by trimester. We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination database in Japan. We identified pregnant women diagnosed with appendicitis who underwent OA or LA from 2010 to 2022. Pathological confirmation of appendicitis was not required for inclusion. The patients were categorized by the trimester of pregnancy. Outcomes were compared using multivariate analysis with generalized estimating equations. A total of 1624 patients were included. In the first trimester, 64.2% patients underwent OA, whereas 35.8% patients underwent LA; in the second trimester, 59.1% patients had OA and 40.9% patients had LA; and in the third trimester, 72.8% patients had OA and 27.2% patients had LA. LA was associated with a higher rate of preterm labor, preterm delivery, or abortion in the second (odds ratio, 3.37; 95% confidence interval, 1.76-6.47; and p<0.001) and third trimesters (odds ratio, 2.57; 95% confidence interval, 1.15-5.70; and p=0.021) but not in the first trimester. The duration of surgery was longer across all trimesters in patients who underwent LA. Additionally, the postoperative hospital stay was shorter in patients who had LA than in those who had OA in the second trimester. In-hospital outcomes vary by trimester, and our results suggest that LA does not consistently lead to better outcomes than OA. Based on our findings, treatment options for appendicitis during pregnancy must be carefully selected.

Out-of-Hours Laparoscopic Appendectomy: A Risk Factor for Postoperative Complications in Acute Appendicitis?

Background: The surgical environment can influence the clinical outcomes of procedures and patient conditions. This retrospective study aimed to evaluate how surgical timing affects short-term outcomes in emergency laparoscopic appendectomy for acute appendicitis. Methods: A total of 647 patients with acute appendicitis who underwent emergency laparoscopic appendectomy at Chuncheon Sacred Heart Hospital between January 2018 and June 2021 were included in this study. The study cohort was divided into the following two groups based on the timing of surgery: work hours and out-of-hours (weekends, holidays, or weekday nights). Clinical outcomes were then compared between the groups. Results: Work-hour and out-of-hours appendectomies were performed in 282 and 365 patients, respectively. Baseline characteristics and types of appendicitis were similar between the groups (complicated appendicitis: 26.6% in the work-hours group versus 30.4% in the out-of-hours group, P = .288). Operation times were comparable (35.10 minutes versus 34.33 minutes, P = .620), with no cases requiring conversion to open appendectomy in either group. The overall rate of 30-day postoperative complications did not differ significantly between the groups (7.8% versus 10.4%, P = .849). The severity of postoperative complications, categorized by the modified Clavien-Dindo classification, did not show significant differences between the groups (P = .849). In addition, the time to functional recovery was similar in both groups. Conclusions: The clinical outcomes of out-of-hours laparoscopic appendectomy were similar to those of procedures performed during working hours. Therefore, scheduling emergency surgery can be determined based on the patient's condition and the hospital's capacity to manage acute appendicitis.

Invited Commentary: "Open or laparoscopic appendectomy in pregnancy?"

Invited Commentary: "Open or laparoscopic appendectomy in pregnancy?"