Laparoscopic Appendicectomy Research Papers - Academia.edu (original) (raw)

BACKGROUND: The first laparoscopic procedures were performed well for over thirty years in Europe. Mostly, these include appendectomy and cholecystectomy. However, in Nigeria and other developing countries, the practice commenced only recently and with encouraging results in many centers. Laparoscopic appendectomy (LA) in the low resource setting remains controversial. AIM: We audit the procedures; highlight the cost-saving technique, and the practical skills transfer model for laparoscopic appendectomy performed at Lagoon Hospitals in Lagos, Nigeria. METHODS: We review the hospital records per case of appendectomy done from January 2012 through December 2016 at the Lagoon Hospitals, Lagos - Nigeria. RESULTS: Two hundred and fifty-eight 258 patients were diagnosed with acute appendicitis (AA) within the study period. (Number - n=97; 37.6%) Patients had open appendectomy (OA). Then (n=16; 6.2%) patients that presented with clinical and radiological diagnosis of complicated AA eventually had an open laparotomy. Meanwhile, (n=145; 56.2%) cases had LA. In the laparoscopy group, (n=4; 1.6%) patients who had initial diagnostic laparoscopy revealed a normal appendix in addition to other operative findings that precluded appendectomy. Subsequently, an estimated (n=141; 54.6%) patients underwent LA, for which conversion to open laparotomy was inadvertently required in (n=2; 0.8%) of these cases. The median time for the LA procedure was higher than that observed for OA (49.5 vs. 34.5 min). Patients in the LA group had a shorter median postoperative stay (1.5 vs. 2.5 days). CONCLUSION: LA reduced the rate of unnecessary appendectomy, and postoperative hospital stays in our patients, potentially reducing crowding in our surgical wards. The complications were very similar to those seen in other facilities elsewhere. LA is safe, average cost, and gradually gaining acceptance among Surgeons in Nigeria. For effective training of qualified surgeons on site, short but repetitive hands-on training sessions has been advocated as appropriate. LA is achievable in resource-constrained settings

- by
- •
- Laparascopic surgery, Laparoscopic Appendicectomy, Appendicitis

Acute Appendicitis remains the most common surgical emergency of the abdomen, and though it can present at any age, usually occurs in children and young adults. Despite tremendous advancements is surgical technique, the peritonisation of the stump of the appendix remains a challenge and is especially more so when the base is perforated, gangrenous, or sloughed out. In these conditions, surrounding tissues are compromised and cannot be relied upon to heal thoroughly, with a high rate of morbidity, including the dreaded fecal fistula. The adjacent cecum, thickened and indurated by the inflammatory process is also liable to ischemia, making the management challenging when the base of the appendix is involved in the pathology, which fortunately is a rare occurrence. Here is reported the case of a young male patient with appendicitis with a sloughed base, and a review of literature regarding the ideal management of the condition.

- by Ashwath Ramji
- •
- Surgery, General Surgery, General surgery clinical research, Vermiform Appendix

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020.

- by Teresa Perra and +1
- •
- Surgery, General Surgery, Cirugia, Chirurgia

Laparoscopic appendectomy has evloved considerably from its origins as an incidental procedure, performed during gynecologic laparoscopy. Many surgeons now use it preferentially to treat acture appendicitis. When the appendix is known, by preoperative studies, to occupy a retrocecal position, it complicates both open and laparoscopic appendectomy. This chapter deals with the choice of approach in this situation.

- by M. Zese
- •
- Surgery, General Surgery, Cirugia, Chirurgia

- by Carlo Feo
- •
- Surgery, General Surgery, Cirugia, Chirurgia

- by Ferdinando Agresta
- •
- Surgery, General Surgery, Cirugia, Chirurgia

Laparoscopic appendicectomy (LA), has failed to gain unequivocal acceptance by the general surgical community as an alternative to open appendicectomy (OA). This is because the early postoperative recovery leading to quicker hospital discharge, which led to the worldwide acceptance of laparoscopic cholecystectomy, has not been universally seen with LA. Moreover, in the majority of the published series of LAs, there seems to be a trend towards an increased incidence of intra-abdominal abscesses. However, laparoscopy is superior to the 'watch and wait' policy where the diagnosis of appendicitis is questionable. Furthermore, since a large incision can be avoided by using the LA technique in obese patients, the incidence of postoperative morbidity can be reduced considerably. Nevertheless, before endorsing routine and widespread use of LA, it is essential that this technique is critically evaluated in well-designed, controlled, randomised trials, showing clearly the major benefits to the patient in terms of quicker hospital discharge, reduced postoperative pain, decreased wound infection and early return to full activities. Laparoscopic appendicectomy will never replace all open appendicectomies, but should become an alternative in certain groups of patients

- by Muhammed A Memon
- •
- Laparoscopic Appendectomy, Laparoscopic Appendicectomy

Arguments have been made to support both removing and leaving in situ a macroscopically normal appendix. Treatment strategies however rely on the inability of surgeons to assess pathology. This multi-centre study suggests that surgeons' judgements of the intra-operative macroscopic appearance of the appendix is inaccurate. a b s t r a c t Background: Convincing arguments for either removing or leaving in-situ a macroscopically normal appendix have been made, but rely on surgeons' accurate intra-operative assessment of the appendix. This study aimed to determine the inter-rater reliability between surgeons and pathologists from a large, multicentre cohort of patients undergoing appendicectomy. Materials and methods: The Multicentre Appendicectomy Audit recruited consecutive patients undergoing emergency appendicectomy during April and May 2012 from 95 centres. The primary endpoint was agreement between surgeon and pathologist and secondary endpoints were predictors of this disagreement. Results: The final study included 3138 patients with a documented pathological specimen. When surgeons assessed an appendix as normal (n ¼ 496), histopathological assessment revealed pathology in a substantial proportion (n ¼ 138, 27.8%). Where surgeons assessed the appendix as being inflamed (n ¼ 2642), subsequent pathological assessment revealed a normal appendix in 254 (9.6%). There was overall disagreement in 392 cases (12.5%), leading to only moderate reliability (Kappa 0.571). The grade of surgeon had no significant impact on disagreement following clinically normal appendicectomy. Females were at the highest risk of false positives and false negatives and pre-operative computed to-mography was associated with increased false positives. Conclusions: This multi-centre study suggests that surgeons' judgements of the intra-operative macro-scopic appearance of the appendix is inaccurate and does not improve with seniority and therefore supports removal at the time of surgery.

This case report is about a 35 year old female who came with a classic picture of appendicitis,
underwent laparoscopic appendicectomy for the same; immediate post operative period was uneventful and she was discharged. But 1 day after her discharge she returned. The patient had developed abdominal pain+vomiting along with swelling and tightness in the abdominal wall. Investigations revealed necrotising fasciitis and pericarditis. Laparoscopic appendectomy is considered to be a safe procedure in general. Infact nowadays almost all appendicectomies are laparoscopic appendicectomies because of the advantages associated with laparoscopic surgery. But it can be seen from this case that laparoscopic surgery can also cause morbidity due to complications such as intestinal obstruction, gas collection in abdominal muscles (necrotising fascitis) and a pericarditis.

INTRODUCTION The use of polymeric clips in securing the appendiceal stump has been increasingly reported as a viable alternative to current methods in emergency laparoscopic appendicectomy. We evaluated the operative outcomes following the use of pol-ymeric clips versus endoscopic ligatures. The primary endpoint was operative time, with secondary outcomes including complications, inpatient stay, and cost analysis. MATERIALS AND METHODS Operative records were retrospectively analysed to identify patients undergoing laparoscopic appendi-cectomy between January 2014 and June 2015. Data collected included age, gender, body mass index, duration of surgery, length of hospital stay, antibiotic use, preoperative haematological and biochemical parameters, 30-day readmission rate and complications. RESULTS A total of 125 patients were included within the study, with 78 within the endoloop group and 47 in the polymeric clip group. There were no differences in age, gender, body mass index, hospital stay, antibiotic use, 30-day readmission rates or postop-erative complications. Operative time was significantly reduced in the polymeric clip group (59 vs. 68 minutes, P = 0.00751). The use of polymeric clips cost £21 compared with £49 for endoloops per operation, which rose to £70 if both clips and endoloops were used during the procedure. DISCUSSION Polymeric clips are a safe, viable and economical method for securing the appendiceal stump during laparoscopic appendicectomy. The clinical significance of nine minutes of reduced operating time in the polymeric clip cohort warrants further study with an adequately powered randomised controlled trial.