Treatment Of Complicated Appendicitis Research Articles

Application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents

ObjectiveTo investigate the clinical efficacy of transumbilical single-incision laparoscopic surgery in the treatment of complicated appendicitis in overweight/obese adolescents.MethodsA retrospective analysis was conducted on the clinical data of 226 adolescent patients with complicated appendicitis who were admitted to our hospital from January 2014 to June 2022. Among them, 102 cases underwent transumbilical single-incision laparoscopic appendectomy as the observation group, and another 124 cases underwent conventional three-port laparoscopic appendectomy as the control group. The surgical time, intraoperative blood loss, duration of incisional pain, postoperative flatus time, length of hospital stay, surgical site infection (SSI), satisfaction with cosmetic result, and occurrence of postoperative complications were compared between the two groups.ResultsBoth groups completed the surgery smoothly, and there were no statistically significant differences in gender, age, BMI, duration of illness, white blood cell count, and preoperative CRP value between the two groups (P > 0.05). There were no statistically significant differences in surgical time and intraoperative blood loss between the two groups (P > 0.05). However, the observation group had shorter hospital stays, shorter duration of incisional pain, shorter postoperative time to flatus, and lower overall postoperative complication rates compared to the control group, with statistically significant differences (P < 0.05). The observation group had higher satisfaction with cosmetic result compared to the control group, with statistically significant differences (P < 0.05). Both groups were followed up for one year postoperatively, and there were no occurrences of residual appendicitis or severe adhesive intestinal obstruction.ConclusionWhen proficiently mastered, the application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents offers advantages such as minimal trauma, rapid recovery, fewer complications, and improved aesthetic outcomes.

Laparoscopic Appendectomy in Complicated Appendicitis: A Narrative Review

The treatment of complicated appendicitis has moved from conservative treatment to immediate appendectomy and laparoscopic appendectomy has become the treatment of choice for this condition. Laparoscopic appendectomy is safe and associated with reduced morbidity, but it was initially associated with increased intra-abdominal abscess rates. With time there seems to be a reduction in this complication rate and hence we have conducted this review article to look at the use of laparoscopic appendectomy in the management of complicated appendicitis, with regards to complications and morbidity.

Complicated Appendicitis-An Update : A Narrative Review

Complicated Appendicitis is defined as perforated appendicitis with abscess or mass formation. Its diagnosis and management have been controversial with no consensus on its definition and treatment algorithm. The treatment was initially conservative management, but the current trend is immediate appendectomy by the laparoscopic method. Other areas of controversy include the need for interval appendectomy and the role of percutaneous drainage of appendicular abscess. We have conducted this review article to investigate the definition, diagnosis, and treatment of complicated appendicitis.

Laparoscopic Treatment of Perforated Appendicitis

The most frequent general surgical emergency worldwide is acute appendicitis. Because to its potentially fatal complications, including perforation, it could put patients at danger of death. An appendix that has ruptured frequently results in serious infectious complications as abdominal sepsis, pelvic abscess, and others. Laparoscopic appendectomy for perforated appendicitis raises several questions. In many nations today, laparoscopic treatment of perforated appendicitis is the preferred surgical technique. Aim: This prospective study's objective was to assess the efficacy of laparoscopy in the treatment of complicated appendicitis (perforation). Methods: The study was conducted prospectively during the period from September 2020 to August 2022. The study included 50 individuals who underwent peritoneal lavage after laparoscopic appendicectomy of perforated appendix in the department of Surgery, Lady Reading Hospital, Peshawar. The traditional method, three ports technique was used. Sometimes a fourth port is needed. Telescopic ports are 10 mm in size. The other two ports are 3/5 mm and 5/10 mm, respectively. Unipolar diathermy is a source of energy. Hemostasis and ligation of the appendicular stump are achieved via intra-corporeal knotting, endo-loop, and hemo-clip. Results: The study's age range is 5-70 years, with a mean age of 19 with male predominance. The duration of surgery varies from 30 to 120 minutes, with a mean duration of 65 minutes. Hospital stays range from 48 to 96 hours on average. There were 12 patients with complications, including paralytic ileus was seen in 1(2%), diarrhea in 2(4%), multiple or single (4% and 8%) port infections, and port TB in (4%). Open conversion was seen in 1 (2%) patient due to appendicitis burst haemorrhage. Every complication was treated carefully. Conclusion: Laparoscopy is an excellent method for treating perforated appendicitis. Thus, it is practical, achievable and may be carried out by skilled hands in any centre. That is now regarded as regular operating procedure. Keywords: Laparoscopic appendicectomy, Perforation (burst)

Intra and Postoperative Advantages of Laparoscopy in the Treatment of Complicated Appendicitis.

Aim: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. Material and Methods: In this prospective interventional clinical study we compared the intraoperative data and the postoperative outcome of 77 patients presented with complicated appendicitis, operated with open and laparoscopic appendectomy within a period of 20 months. One surgeon performed all of the laparoscopic procedures and two other senior surgeons performed the open procedures. Results: Operative time was shorter in the laparoscopic group (p = 0.033). Conversion rate was 2.3%. Overall postoperative morbidity was 25.97%. There was one operative revision due to postoperative small bowel obstruction in the laparoscopic group. Appendicular stump leakage occurred in one patient in the open group. One intra-abdominal abscess occurred in the laparoscopic group (p = 0.38). Wound infection occurred only in the open group (p = 0.018). Length of stay was shorter in the laparoscopic group (p = 0.0052). One patient from the laparoscopic group was readmitted. Conclusions: Laparoscopy is a reliable method in the treatment of complicated appendicitis. It offers a shorter operative time, low conversion rate, an acceptable rate of major postoperative complications and a shorter length of stay.

Role of Laparoscopy in Complicated Appendicitis in Children

Background: Appendicitis is one of the most common surgical emergencies among children. Approximately 30% of children present to the hospital with complicated appendicitis, which is associated with higher morbidity than simple appendicitis. Controversy exists in the treatment of complicated appendicitis in the pediatric age group. The goal of this study was to review the results of laparoscopic surgery in complicated appendicitis in terms of safety, efficacy, and complicationsMaterials and Methods: A retrospective observational study was conducted in a tertiary care hospital in Bangalore from 2015 to 2020 over a period of 5 years. All children who underwent laparoscopic surgery for complicated appendicitis (perforated, gangrenous, and mass) were included in the study. Thorough history with respect to symptoms and their duration were recorded followed by general and abdominal examination. Routine blood investigation and imaging were done before surgery. Intraoperative data regarding the type of complication, presence or absence of fecolith, and position of appendix were documented. Postoperatively duration of stay and complications were analyzed. Results: Sixty cases were included in the study. The mean age of presentation was 10.11 ± 0.855 years. Of 60 children, 53 were males and 7 were females. The mean operative time was 55.8333 ± 4.806 min. The rate of conversion from the laparoscopy to open surgery was 11.5%. The mean time of duration of intravenous antibiotics was 4.2778 ± 0.446 days. The mean time for starting of oral feeding was 2.8333 ± 0.307 days. The mean duration of hospital stay was 5.11 ± 0.545 days. Wound infection in the immediate postoperative period was seen in 6.6% of the children. No long-term complications were noted. Conclusion: Laparoscopic appendectomy (LA) for complicated appendicitis is safe and effective. Therefore, it should be the first choice for cases of complicated appendicitis in children.

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

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

Evaluation of Laparoscopic Appendectomy In Complicated Appendicitis

Background: The role of laparoscopy in treatment of complicated appendicitis is increasing. Objective: The study goals to assess the role of laparoscopy in complicated appendicitis. Patient and Methods: This prospective case series study involved 40 patients with complicated appendicitis who submitted to laparoscopic appendectomy and were assessed concerning operative time, postoperative outcome as regard analgesia use, duration of hospital stay, back to usual oral feeding and postoperative complications in department of general surgery at Al Hussein university hospital and Ahmed Maher Teaching Hospital, from September 2019 to May 2020. Results: 40 patients submitted to laparoscopic appendectomy for complicated appendicitis. Mean age of all considered patients was 28.4 ± 9.7 years with a minimum age of 18 years and maximum age of 53 years, there were 14 males (35%) and 26 females (65%) in the considered patients. Of the 40 patients, perforated appendix cases were 18, gangrenous appendix cases were 10, appendicular abscess cases were 8 and appendicular mass cases were 4 cases. Conversion to open technique was done in 2 cases (5%), postoperative hospital stay was two days in 10 patients (25%), 3 days in 14 patients (35%), 4 days in 12 patients (30%) more than 5 days in 4 patients (10%) and 2 patients had prolonged stay (converted to open surgery patients) and postoperative complications in 12 cases (30%) as fever, intra-abdominal collection, ileus and wound infection. Conclusion: Laparoscopic appendectomy remains a safe and efficient technique in treatment of complicated appendicitis. Keywords: Appendicitis, Complicated appendicitis, Laparoscopic appendectomy.

A Standardized Protocol for Nonoperative Management of Complicated Appendicitis in Children Reduces Resource Utilization.

To standardize care and reduce resource utilization, we implemented a standardized protocol (SP) for the nonoperative treatment of complicated appendicitis. We conducted a prospective, historically controlled, study of patients <21 years with complicated appendicitis managed nonoperatively using an SP from January 2017 to November 2018. The primary outcomes included length of stay (LOS), antibiotic days, peripheral inserted central catheter (PICC) utilization, discharge on intravenous antibiotics, and predischarge imaging. Secondary outcomes were protocol adherence and the rates of adverse events (AE) including return to emergency department (ED), readmission, failure of nonoperative treatment, and interval appendectomy complications. Protocol adherence was 67.9%. In total, 741 children were treated for appendicitis of which 58 (30 pre-SP and 28 post-SP) were treated nonoperatively for complicated appendicitis at presentation. Patients were well matched for age, admission white blood cell, sex, body mass index, race, and the proportion requiring percutaneous drainage. After implementing the SP, fewer children had PICCs (100.0 vs. 57.1%, p ≤ 0.001), fewer were discharged on intravenous antibiotics (90.0 vs. 42.9%, p < 0.001), and total antibiotic days were reduced (14.0 vs. 10.0, p = 0.006). There was no difference in LOS (5.5 vs. 6.0 days, p = 0.790) or the proportion undergoing ultrasound (36.7 vs. 39.3%, p = 0.837) or computed tomography scan (16.7 vs. 3.6%, p = 0.195) prior to discharge. There were nonsignificant trends toward reduced AEs (46.7 vs. 35.7%, p = 0.397), returns to ED (40.0 vs. 28.6%, p = 0.360), and readmissions (26.7 vs. 17.9%, p = 0.421). The proportion failing nonoperative treatment (10.0 vs. 3.6%, p = 0.612) and experiencing complications of interval appendectomy (3.3 vs. 3.6%, p = 0.918) were not significantly different. Implementing an SP for treating complicated appendicitis nonoperatively reduced resource utilization without negatively affecting clinical outcomes.

小児複雑性虫垂炎における治療法の検討 ―治療成績とinterval appendectomy脱落予測因子を踏まえて―

小児複雑性虫垂炎における治療法の検討 ―治療成績とinterval appendectomy脱落予測因子を踏まえて―

Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.

Does peritoneal lavage influence the rate of complications following pediatric Laparoscopic Appendicectomy in Children with Complicated Appendicitis? A Prospective Randomized Clinical Trial

BackgroundThere is ongoing debate concerning the use of peritoneal irrigation in the setting of complicated appendicitis (CA) in children. Our aim was to conduct a prospective randomized controlled trial for the treatment of CA during a laparoscopic appendicectomy in children. MethodsFollowing ethical approval (REC10138B), pediatric patients (≤16 years old) were recruited from a single institution over a 3-year time period (2015–2018). Randomization occurred following intraoperative diagnosis of CA to either peritoneal lavage (PL) or suction only (SO). Primary outcome was the length of stay (LoS), and secondary outcomes were the presence of a postoperative intraabdominal abscess (IAA), wound infection (WI), or adhesive small bowel obstruction (ASBO). Data are reported as number of cases (%), median (range), odds ratio [OR] and analyzed using t-test and Fisher's exact test. A p-value ≤0.05 was considered significant. ResultsA total of 100 pediatric patients were recruited into the trial. Sixteen were excluded owing to either recruitment or protocol violations, and therefore a total of 86 underwent final analysis: 44 PL and 42 SO. There was no significant difference in the LoS: 5.7 (PL) vs 5.6 (SO) days, p = 0.75. Only 1 IAA occurred in the PL group: 1/44(2.3%) vs 0/42(0%), p = 1.0. There was 1 ASBOs in the PL group (2.3%, p = 1.0) and no WIs in either of the groups. ConclusionThis prospective randomized control trial has revealed equivalence in techniques for the treatment of complicated appendicitis. It has also revealed a low complication rate following pediatric LA with either PL or SO. Type of studyRandomized controlled trial. Level of evidenceLevel I.

A clinical comparison of laparoscopic versus open appendectomy for the treatment of complicated appendicitis: historical cohort study

BackgroundAppendectomy is one of the most common operations. Laparoscopic appendectomy (LA) is considered first-line treatment, but the use of LA for treatment of complicated appendicitis remains controversial. Here, we performed a retrospective analysis to compare clinical outcomes between patients treated with LA and those who underwent open appendectomy (OA).MethodsData for 179 patients who underwent an operation for the treatment of complicated appendicitis at our hospital between 2011 and 2017 were retrospectively analyzed. The selection included 89 patients who underwent a conventional appendectomy and 90 patients who were treated laparoscopically. Outcome measures such as mean operative time, blood loss, time until oral intake duration of hospital stay, and postoperative complications were analyzed. Logistic regression analysis was performed to determine the concurrent effects of the examined factors on the rate of postoperative complications.ResultsThe mean ages of patients in the OA and LA groups were 50.17 ± 22.77 and 50.13 ± 25.84 year. Mean operative times were longer in the LA group than OA (10.2.56 ± 44.4 versus 85.4 ± 43.11 min; p = 0.009). The duration of hospital stay was shorter for the LA group (9.61 ± 5.57 versus 12.19 ± 8.4; p = 0.016). There were no significant differences in return to consumption of oral intake between the LA and OA groups (2.03 ± 1.66 versus 2.48 ± 2.17; p = 0.123). Multivariable analysis found that the rate of postoperative complications was significantly reduced for the LA group, in comparison with the postoperative-complication rate of the OA group (16.7% versus 27%; odds ratio 0.376; 95% CI 0.153–0.923; p = 0.0327).ConclusionsThese results suggest that LA is a safe and efficient operative procedure that provides clinically beneficial advantages in comparison with OA. Thus, when possible, appendectomy for complicated appendicitis should be attempted using a laparoscopic approach.Trial registrationRetrospectively registered.

Complicated appendicitis during pregnancy

To analyze incidence, diagnosis and treatment of complicated appendicitis in pregnant women and to determine the optimal surgical approach. Retrospective cohort analysis included 338 pregnant women who underwent appendectomy in 2012-2016. Complicated appendicitis (abscess, local or common peritonitis and their combinations) was diagnosed in 22 cases. The main perioperative variables (duration of the disease, time of surgery, length of hospital-stay, incidence of wound complications, etc.), clinical and laboratory symptoms, results of ultrasound diagnosis and pregnancy outcomes were analyzed. Statistical analysis was carried out in Stata 14.2. Fisher's exact test, Mann-Whitney-Wilcoxon's U-test and multivariate regression analysis were used to compare data. The incidence of complicated appendicitis in pregnant women was 6.51%. There are no clinical symptoms which would be significantly more common in complicated appendicitis during pregnancy. Complicated course prolongs surgery and hospital-stay, however duration of postoperative analgesia depends on surgical technique as a rule. There were 27% of laparoscopic interventions that is lower compared with women with uncomplicated appendicitis. The percentage of conversions was higher too. Clinical diagnosis of complicated appendicitis during pregnancy even by using of ultrasound is not satisfactory and requires the involvement of other objective methods, such as MRI. Laparoscopic intervention is not contraindicated in pregnant women with complicated appendicitis and determine better treatment outcomes than open surgery.

Zhu's trocar placement in laparoscopic appendectomy in the treatment of complicated appendicitis

To evaluate the feasibility and efficacy of Zhu's trocar placement (ZTP) in laparoscopic appendectomy (LA) in the treatment of complicated appendicitis. Clinical data of 139 complicated appendicitis patients undergoing LA at the First Affiliated Hospital of Wenzhou Medical University from June 2013 to December 2017 were retrospectively analyzed. ZTP-LA group comprised 59 cases and its procedure was as follows: 10 mm umbilical trocar was used as lens port; 12 mm trocar at crossing point of umbilical hole horizontal line and right midclavicular line was used as main operating port; 5 mm trocar at the crossing point of horizontal line 0-3 cm below umbilicus and right anterior axillary line was used as assist operating port with the drainage function for Douglas fossa and right iliac fossa; The operator and the assistant stood on the right side and the left side of the patient respectively. Traditional three-port group comprised 80 cases (8 cases converted to laparotomy, 72 cases enrolled finally) and its procedure was as follows: 10 mm lens port below umbilicus; 10-12 mm main operating port at lateral border of left lower rectus abdominis; 5 mm assist operating port above pubis; The operator and the assistant stood on left side of the patient. The operative time, time to oral semi-fluid, postoperative hospital stay, cost during hospitalization, and postoperative morbidity of complication were compared between two groups. Baseline data such as gender, age, WBC count, percentage of leukocyte, pathological finding and type were not significantly different between two groups(all P>0.05). The conversion rate in ZTP-LA was significantly lower than that in traditional three-port group [0%(0/59) vs. 10.0%(8/80),χ²=4.552,P=0.033]. Compared with traditional three-port group, ZTP-LA group showed shorter operative time [(47.8±20.1) minutes vs. (66.0±27.3) minutes, t=4.383,P<0.001], shorter time to oral semi-fluid [(35.0±20.7) hours vs. (59.3±32.8) hours, t=5.158,P<0.001], shorter postoperative hospital stay [(4.1±1.6) days vs. (5.5±2.2) days, t=4.162, P<0.001], lower postoperative morbidity of complication [3.4% (2/59) vs. 18.1%(13/72), χ²=6.879, P=0.009], lower incidence of postoperative intra-abdominal abscess [0%(0/59) vs. 11.1%(8/72), χ²=5.179, P=0.023], lower incidence of paralytic ileus [1.7%(1/59) vs. 12.5%(9/72), χ²=3.946, P=0.047] and less cost during hospitalization[(13 585±2909) yuan vs.(16 861±5334) yuan, t=4.463, P<0.001]. ZTP-LA is safe, feasible and effective with advantages of faster recovery and less cost in the treatment of complicated appendicitis.

The efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children

Objective To evaluate the efficacy of single or double-antibiotic regimen for the treatment of complicated appendicitis in children, with the purpose to guide the rational use of antibiotics in clinic. Methods Six hundred and sixty-three patients with acute appendicitis admitted to the department of pediatric surgery in Jinhua Municipal Central Hospital between March 2011 and February 2015.One hundred and seventy-two of 663 patients with complicated appendicitis which confirmed by intra-operative macroscopic or post-operative pathological examination were eligible for the study.These patients were divided into two groups based on the regimen of their postoperative antibiotics: single or double-antibiotic regimen(treatment group, n=66); triple antibiotics regimen(control group, n=106). Demographic data, blood routine test and C-response protein(CRP), length of hospital stay, postoperative complications and duration of antibiotic treatment were recorded and statistically analyzed. Results There was no difference between the treatment group and control group with respect to age distribution, blood routine examination and CRP, length of hospital stay, duration of antibiotic treatment or postoperative complications.Although the number of patients changed of antibiotics on the basis of bacterial culture of pyogenic fluids in treatment group were more frequently than those in the control group(7/66 vs.1/106), the therapeutic effective rate of changed of antibiotics was 100% in both two groups.The culture positive rate of peritoneal fluids was 72.09% (124/172), the most common pathogens were escherichia coli(80.15%, 105/131), pseudomonas aeruginosa(5.34%, 7/131)and klebsiella pneumonia (3.05%, 4/131). The results of bacterial culture of peogenic fluids showed no difference in both two groups. Conclusion Children with complicated appendicitis can be managed effectively with single or double broad-spectrum antibiotics after appendectomy, and it may be beneficial to guide the rational use of antibiotics and decrease the irrational use of multi-antibiotics combination in clinic. Key words: Children; Appendicitis; Complicated; Antibiotic drug; Therapy

Laparoscopic versus open appendectomy in children with complicated appendicitis

Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open appendectomy in the treatment of complicated appendicitis in children. Patients and methods: During the period from October 2012 to March 2016, 390 children with acute complicated appendicitis diagnosed clinically and with laboratory and available imaging studies were operated. LA performed for 200 cases and open conventional appendectomy for 190 cases. Three ports technique was used in laparoscopic cases. The operating table is shifted in Trendelenburg position and towards the left side. The surgeon stands on the left side of the patient. The appendicular mesoappendix was secured using electro cautery. The base was secured by extracorporeal ties and the appendix was retrieval within the umbilical port. The wounds were closed. Open appendectomy was done through McBurny incision as the traditional approach. Results: A total of 390 children diagnosed with acute complicated appendicitis were operated. The mean age was 12.04 years in group A and 12.2 in group B. There were 260 were boys and 130 were girls. The mean operative time in the laparoscopic group was 56.4 min; while in the conventional group was 63.42 min. Conclusion: LA was a suitable, effective and safe procedure in complicated cases that did not involve the base. It was associated with lower complications rate with all the advances of minimal invasive surgery when compared to the conventional open appendectomy. Keywords: appendectomy, children, complicated, laparoscopic

Comparison of clinical outcome of laparoscopic versus open appendectomy for complicated appendicitis.

Laparoscopic appendectomy is now the treatment of choice in uncomplicated appendicitis. To date its importance in the treatment of complicated appendicitis is not clearly defined. From January 2005 to June 2013 a total of 1762 patients underwent appendectomy for the suspected diagnosis of appendicitis at our institution. Of these patients 1516 suffered from complicated appendicitis and were enrolled. In total 926 (61%) underwent open appendectomy (OA) and 590 (39%) underwent laparoscopic appendectomy (LA). The following parameters were retrospectively analyzed: age, sex, operative times, histology, length of hospital stay, 30-day morbidity focusing on occurrence of surgical site infections, intraabdominal abscess formation, postoperative ileus and appendiceal stump insufficiency, conversion rate, use of endoloops and endostapler. A statistically significant difference in operative time was observed between the laparoscopic and the open group (64.5 vs. 60min; p=0.002). Median length of hospitalization was significantly shorter in the laparoscopic group (p<0.000). Surgical site infections occurred exclusively after OA (38 vs. 0 patients). Intraabdominal abscess formation occurred statistically significantly more often after LA (2 vs. 10 patients; p=0.002). There were no statistical significances concerning the occurrence of postoperative ileus (p=0.261) or appendiceal stump insufficiencies (p=0.076). The laparoscopic approach for complicated appendicitis is a safe and feasible procedure. Surgeons should be aware of a potentially higher incidence of intraabdominal abscess formation following LA. Use of endobags , inversion of the appendiceal stump and carefully conducted local irrigation of the abdomen in a supine position may reduce the incidence of abscess formation.

A Comparative Study between the Outcome of Laparoscopic Appendectomy and Open Appendectomy in Children

Background: Laparoscopic surgery for acute appendicitis in children has been proposed to have advantages over conventional surgery.Introduction: Appendicitis is the most common surgical emergency in childhood. 1 For decades, Open appendectomy (OA) has been the standard treatment for all forms of appendicitis with excellent results.2 Since its description in the early 1980s, laparoscopic appendectomy (LA) became an acceptable approach for simple appendicitis in children.3, 4, 5However, its role in the treatment of complicated appendicitis is controversial. Today, in developed countries about 8% of the population is appendectomized for acute appendicitis during their lifetime.7Materials and method: We are conducting a prospective comparative study with the intention to observe the outcome of 60 purposively selected patients of acute appendicitis in the Department of Pediatric Surgery, Dhaka Medical College &amp; Hospital (DMCH), Dhaka, over a period of 12 months from October, 2013 to October, 2014. The patients are going to be divided into 2 groups by random sampling- Group A- OA Group (patients underwent open appendectomy) and Group B- LA Group (patients underwent laparoscopic appendectomy) for uncomplicated appendicitis. Children up to 14 years are planned to be selected as study subjects. All children are subjected to investigate for white blood cell (WBC) count, plain X- ray KUB region, urine R/E, preoperatively and to observe the amount of analgesics in postoperative pain management and cosmesis on first week, first month, and third month of operation. Structured questionnaire is used to collect information regarding pain, fever, other association preoperatively and operative procedure, duration of operation, per operative findings and post operative follow up. Informed written consent from parents or legal guardian is taken after describing the study objectives. Ethical clearance has been sought from the Ethical Committee of Dhaka Medical College.Results: Total 23 patients are studied till now, 16 in LA group and 7 in OA group. From this limited data we have seen that there is apparently minimum difference between two groups of study population regarding postoperative outcomes.Conclusion: This is an on-going study. Definite conclusion could not be drawn at this preliminary stage. Laparoscopic appendectomy for uncomplicated appendicitis in children is feasible and safe. It is associated with a significantly less use of post operative pain killer, lower incidence of wound infection, and reduced length of hospital stay when compared with patients who had open appendectomy.J. Paediatr. Surg. Bangladesh 5(1): 25-29, 2014 (January)

Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients.

Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors. We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group). The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05). Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.