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PubMed2002

[Acute appendicitis--laparoscopic appendectomy--indications and outcomes].

UNLABELLED: Laparoscopic surgery has been proposed to have diagnostic and therapeutic advantages over conventional surgery. RESULTS: Laparoscopic Appendectomy (LA) is a safe procedure resulting in shorter hospitalization and sooner return to activity. The relative merits of LA and open appendectomy (OA) are evaluated in this review. There were no differences in postoperative analgesia, resumption of oral intake, or morbidity, but laparoscopic appendectomy is associated with longer operating times and increased cost. Laparoscopic appendectomy is a more expensive alternative but offers advantages related to pain relief, length of stay, return to normal activities, or morbidity. CONCLUSION: In those clinical settings where surgical expertise and equipment are available and affordable, diagnostic laparoscopy and LA (either in combination or separately) seem to have various advantages over OA.

Acute Disease↗
PubMedDate not supplied

[The useless appendectomy].

The appendectomy is still the most frequent operation in general surgery, being after performed without complete investigation. Because the appendix, through its lymphoid tissue with implication in the immunoglobuline secretion, has an important role in immunitary system criteria were searched to justify the appendectomy and to reduce the number of useless appendectomies, the proportion of the normal appendices being around 15%. Instead the basic triad-fever over 38 degrees C, parietal reaction and leucocitosis over 10.000/ml--measuring of reactive protein C, echography, CT, laparoscopy and antileucocite antibody labelled with TC99, would contribute to a better selection of patients for appendectomy. Surgeon's responsibility regarding the technique and the moment of operation, oblige him to take the proper decision.

Appendectomy↗
PubMedDate not supplied

Laparoscopic appendectomy: why it should be done.

OBJECTIVE: Notwithstanding its widely perceived advantages, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present work is to illustrate retrospectively the results of a case-control experience with laparoscopic versus open appendectomy carried out at our institution. METHODS: Between January 1993 and November 2000, 555 patients (M:F = 210:345; mean age 25.2 +/- 15 years) underwent emergency or urgent appendectomy, or both. Of them, 322 (52%) were operated on laparoscopically, and 233 (48%) were treated via conventional surgery, according to the presence of a well-trained surgical team. RESULTS: The laparoscopic group conversion rate was 3.1% (10/322) and was mainly due to the presence of dense intraabdominal adhesions. Major intraoperative complications ranged as high as 0.3% (1/322) and 0%, respectively, in the laparoscopic and conventional groups (P=ns). Major postoperative complications were 1.6% (5/312) vs 0.8% (2/243), respectively (P=ns). Postoperative mortality was 0.3% (1/312) and 0.4% (1/243) in the laparoscopic and conventional subsets of patients. Reinterventions were 0.9% (3/322) in the laparoscopic patients versus nil in the open group (P=ns). Minor postoperative complications were observed in 0.6% (2/312) and 6.5% (16/243) of patients, respectively, in the laparoscopy and open surgery groups, and consisted mainly of wound infections (P=0.001). Flatus passage and hospitalization were significantly more rapid among the laparoscopic patients. The greater diagnostic accuracy of laparoscopy allowed the diagnosis of concurrent diseases in 12% (30/254) versus 1.5% (3/199) of patients with histology proven appendicitis treated via laparoscopy versus laparotomy (P<0.01). Similarly, among those patients without gross or microscopic evidence of appendicitis, or both gross and microscopic evidence, concurrent diseases were detected in 57.3% (39/68) of laparoscopic patients versus 8.8% (3/34) in the conventional ones (P<0.01). CONCLUSION: Even if limited by its retrospective nature, the present experience shows that laparoscopic appendectomy is as safe and effective as conventional surgery, has a higher diagnostic yield, causes less trauma, and offers a more rapid postoperative recovery. Such features make laparoscopy a challenging alternative to laparotomy in premenopausal women referred for urgent abdominal or pelvic surgery, or both.

Adolescent↗
PubMed2004

[Is interval appendectomy necessary after conservative treatment of appendiceal masses?].

BACKGROUND: This prospective study was conducted to investigate whether interval appendectomy was necessary after successful conservative treatment of appendiceal masses. METHODS: Thirty-seven patients with a diagnosis of appendiceal mass by physical examination and ultrasonography were initially treated conservatively with broad-spectrum antibiotics, anti-inflammatory drugs, and, if required, intravenous fluid treatment. Interval appendectomy was ruled out in 28 patients who responded well to conservative treatment, three of whom were then lost to follow-up. The remaining 25 patients (9 females, 16 males; mean age 25 years; range 17 to 54 years) were monitored for recurrent appendicitis and other causes of appendiceal mass. The mean follow-up period was 35 months (range 6 to 66 months). RESULTS: The mean duration of abdominal symptoms was nine days (range 3 to 20 days). The mean length of hospital stay was 14 days (range 10 to 21 days) in patients who responded to conservative treatment. Recurrent appendicitis developed in three patients (12%; 2 males, 1 female). Two patients who presented with acute appendicitis within six months after discharge and one patient who developed chronic abdominal right lower quadrant pain unresponsive to medical treatment a year after discharge underwent appendectomy. No other complications were seen with conservative treatment. CONCLUSION: We do not recommend routine interval appendectomy in patients who benefit from conservative treatment for an appendiceal mass unless recurrent appendicitis develops.

Adolescent↗
PubMedDate not supplied

Introduction of laparoscopic appendectomy: a retrospective comparison with the open technique.

Laparoscopic appendectomy (LA) is gaining favour as an alternative to the traditional laparotomic technique (OA) despite the persistence of controversy regarding indications, morbidity, hospital stay, costs and surgical time. We present a retrospective analysis of our first three years of experience with the procedure. During this period we performed 235 appendectomies (102 laparoscopic and 133 laparotomic). The conversion rate was 9.7%, due to severe peritonitis, high-grade inflammation and an unfavorable position of the appendix; we found a significantly higher percentage of difficulty due to these factors in the laparotomic procedures. Operating time was similar in the two groups. The rate of associated pathology was higher (22.5% vs 6%) after laparoscopy, but conversion to laparotomy was never necessary for treatment. Early morbidity was limited to 2 patients who underwent laparoscopic appendectomy (1 re-operation for a micro-abscess and 1 conservatively treated haemorrhage), while wound infections (13.5% vs 1.9%) and incisional hernias (0% vs 2.3%) were more frequent in the open procedures. Hospital stay was slightly less in the laparoscopic group (4.0 vs 4.7 days). In our initial experience, laparoscopic appendectomy has shown significant advantages in terms of intraoperative diagnosis of associated diseases and diminished morbidity. We advocate a laparoscopic approach to appendicular disease, reserving conversion to laparotomy for selected cases after exploration.

Adolescent↗
PubMed2004

Laparoscopic appendectomy after 30 weeks pregnancy: report of two cases and description of technique.

Appendicitis and pregnancy are both common conditions, and when they co-exist, both the general surgeon and obstetrician are presented with unique challenges. Acute appendicitis is the most common cause of the acute abdomen during pregnancy, effecting 0.1-0.3 per cent of pregnancies each year. With an estimated 4 million deliveries per year in the United States, there are potentially as many as 12,000 cases of acute appendicitis to be managed by the general surgeon during pregnancy (Eur J Surg 1992;158:603-6; Curr Surg 2003;60:164-73). Laparoscopic appendectomy has become a routine procedure and is now widely performed in North America. Although laparoscopic appendectomy has been discussed during pregnancy, limited data is available on the role of laparoscopic appendectomy in the third trimester of pregnancy. In fact, some authors have advocated a gestational age of 26-28 weeks to be the upper gestational limit for successful completion of laparoscopic surgery (Obstet Gynecol Surg 2001;56:50-9). In this paper, we present two recent cases of successful laparoscopic appendectomy during late pregnancy without immediate complication to mother or fetus and a description of our operative technique.

Adult↗
PubMed2005

Post appendectomy small bowel obstruction.

OBJECTIVE: Postoperative small bowel obstruction is one of the adverse effects of appendectomy but its frequency varies from center to other. This study was conducted to determine the incidence of this complication among our patients who had appendectomy and identify the factors which may increase the risk. METHODS: Case notes of patients who underwent appendectomy from January 1998 to December 2003 in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were reviewed. Patients readmitted for adhesive small bowel obstruction were traced and their clinical data were analyzed. RESULTS: Six hundred and seven patients were eligible for the study. Six patients (1%) developed intestinal obstruction. Frequency of readmission of patients with features of intestinal obstruction ranged from 1-6 (mean of 2 times). CONCLUSION: The incidence of small bowel obstruction after appendectomy is low. The main risk factors were reviewed and measures to avoid them were suggested.

Adolescent↗
PubMed2006

[Results of introduction of laparoscopic appendectomy].

The authors made an analysis of results of appendectomy in 1783 patients. Laparoscopic appendectomy was fulfilled in 1036 of them. Contraindications to laparoscopic appendectomy and possible complications are discussed. Its medical and social-economical advantages are shown (less number of unfounded appendectomies and wound purulent complications, duration of treatment in hospital and temporary disablement).

Adolescent↗
PubMedDate not supplied

A comparative study of routine laparoscopic versus open appendectomy.

OBJECTIVE: We evaluated the outcomes of routine laparoscopy and laparoscopic appendectomy (LA) in patients with suspected appendicitis. This is a retrospective study of the outcomes of patients undergoing laparoscopic appendectomy compared with outcomes for patients undergoing open appendectomy (OA) during the time that LA came into use. METHOD: Results of patients managed with routine laparoscopy and LA for suspected acute appendicitis were reviewed and analyzed. The preoperative and intraoperative findings were recorded. The clinical outcomes were compared with those of patients undergoing OA in the preceding 10 months. RESULTS: During the LA study period, 97 patients (47 men) with the median age of 34 years (range, 18 to 79) presented with clinical features of acute appendicitis. With the exclusion of 5 patients with open operations and 10 patients with other pathologies, 82 patients underwent laparoscopic appendectomy (Group A) for appendicitis. Thirty-one (37.8%) patients had complicated appendicitis (perforated or gangrenous appendicitis). Conversions were required in 6 patients (7.3%). During the OA period, 125 patients (57 men) with the median age of 42 (range, 19 to 79) years were operated on. With the exclusion of 6 patients with other pathologies, 119 underwent OA for acute appendicitis (Group B). Fifty-one (42.9%) had either perforated or gangrenous appendicitis. The median durations of surgery in Group A and Group B were 80 minutes (range, 40 to 195) and 60 minutes (range, 25 to 260), respectively (P < 0.005). Postoperative complication rates were comparable between the 2 groups (13.4% in Group A versus 15.8% in Group B). The median hospital stay for patients in Group A and Group B were 3.0 days (range, 1 to 47) and 4.0 days (range, 1 to 47), respectively (P = 0.037). CONCLUSIONS: We conclude that routine laparoscopy and LA for suspected acute appendicitis is safe and is associated with a significantly shorter hospital stay. Other intra-abdominal pathologies can also be diagnosed more accurately with the laparoscopic approach.

Adolescent↗
PubMedDate not supplied

Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.

Adolescent↗
PubMed1991

[Appendectomy, cholecystectomy, cholelithiasis and colorectal cancer. A retrospective case control study at the Côte-d'Or].

Several studies have shown that there might be a relationship between previous history of appendectomy or cholecystectomy and the subsequent risk of colorectal cancer. In order to investigate these hypotheses, a case-control study was set up to compare the history of appendectomy and cholecystectomy as well as the presence of cholelithiasis in patients with colorectal carcinoma vs patients with gastric carcinoma. The study was performed in the 727 patients included in the Registry of Digestive Cancers of the Côte d'Or and treated at the Dijon University Hospital during the period 1981-1987. These patients were well matched to those of the whole registry population for sex, age, stage, and residence distributions. In females, in comparison to the gastric cancer patients, a personal history of appendectomy was more commonly observed in case of right colonic cancer (odds ratio: 3.5; P less than 0.01) and a personal history of cholecystectomy in case of left colonic cancer, in particular when considering only those earlier than 10 years (odds ratio: 3.2; P less than 0.05). In contrast, the risk of rectal cancer was lower in case of a cholecystectomy performed more than 10 years earlier (odds ratio: 0.2; NS) and in case of cholelithiasis (odds ratio: 0.4; P less than 0.05). In males, there was no difference between cases and controls as for the proportion of appendectomies, cholecystectomies or cholelithiasis. These observations are consistent with the hypothesis that the appendix as a lymphoid organ plays a protective role in colon carcinogenesis, in particular in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Appendectomy in primary and secondary staging operations for ovarian malignancy.

Appendectomy was performed at primary or secondary staging operations in 100 patients with ovarian malignancies. Of 80 patients who underwent appendectomy at the time of their primary surgery, 25 (31.2%) had appendiceal metastases. Among 47 patients who were believed to have disease limited to the pelvis at the time of surgery--stage I (N = 34), II (N = 7), IIIA (N = 5), and those designated stage IIIC solely on the basis of microscopic para-aortic nodal metastasis (N = 1)--the appendix was involved with disease in only two patients (4.3%). However, among 33 patients with advanced disease--stage IIIB (N = 6), IIIC except those designated IIIC solely on the basis of microscopic paraaortic nodal metastasis (N = 19), and IV (N = 8)--the appendix was involved with disease in 23 patients (69.7%) (P less than .001). Poorly differentiated tumors and serous histologic cell types more frequently metastasized to the appendix (64, 15, 6, and 8% for grades 3, 2, and 1 and borderline histology, respectively; P less than .001; and 48, 13, and 8% for serous, endometrioid, and mucinous; P less than .001). Of 20 patients who underwent appendectomy at their secondary staging procedure, two had metastases. Metastatic disease in the appendix was microscopic in nine of 27 patients. Because the frequency of appendiceal metastasis is similar to that of other metastatic sites in stages I and II ovarian cancer, it should be removed at primary staging procedures. Appendectomy should also be performed in patients with advanced ovarian malignancies if it contributes to cytoreduction or at the time of secondary staging procedures.

Appendectomy↗
PubMed1990

[Clinical approaches to improvement of appendectomy effects under acupuncture anesthesia].

Appendicitis is a commonly and frequently encountered disease in surgery department. Appendectomy under acupuncture anesthesia (A.A) is save and effective, easy and economical, and helpful to recover with no side effects to patients, organism. This manipulation of anesthesia is worth applying and popularizing. Though appendectomy is a small-scale operation in clinical practices, it also has three crucial difficulties to be resolved during the process of operations. It is of great practical significance to popularize the operations under A.A. that the crucial difficulties--incomplete anesthesia, muscular tension and pulling reaction of viscus are to be probed into and overcome. Since 1970, we have had about 2000 cases of appendectomy under A.A., in which there were 1622 cases with rather detailed medical records. The clinical effects have been analysed and the experiences have been summed up from success and failure. The steps we conferred are as follows: 1. strict selection of the cases; 2. point selection and needle manipulation based on differentiation of symptoms and signs of TCM; 3. reasonable utilization of adjuvants; 4. maintenance of best needling sensation; 5. maintenance of relatively fixed groups of surgeons and assistants; and 6. improvement of operative technique. This is a valid way to have operative effect achieved. we have adhered to the 6 aspects mentioned above since 1982 and improved the success rate of appendectomy under A.A. The rate of success reached 96.6% in which the rate of excellent result (Grade I) was 39% and the rate of good result (Grade II) 57.9%.

Acupuncture Analgesia↗
PubMed1989

Clip appendectomy.

The clip appendectomy is an alternative to the classical suture appendectomy. The use of a new polymer clip facilitates this technique. During pelvic reconstructive surgery an appendectomy may be indicated when suspected appendiceal pathology (such as endometriosis) could adversely affect the surgical outcome. Clip appendectomy can reduce the operative time without increasing morbidity.

Appendectomy↗
PubMed1987

Appendectomy in South African inter-ethnic school pupils.

In 1984-1985, prevalences of appendectomy in inter-ethnic series of South African school pupils of 16-18 yr were: rural blacks, 0.5%; urban blacks, 1.0%; Indians, 2.6%; coloreds (Eur-African-Malay), 2.2%; Afrikaans whites, 13.4%; and English whites, 9.9%. Corresponding respective annual incidences per 1000 pupils of 10-19 yr were: 0.3, 0.6, 1.9, 1.7, 9.8, and 7.8. Thus, appendectomy is rare or infrequent in all except the white populations. Peak occurrence was postpubertal. There was no consistent sex bias. Dietarily, mean daily fiber intake was relatively low in all groups, 17.9-26.1 g. While the percentage of energy from fat intake was low in blacks, 16.3-22.3%, it was much higher in the other populations, 32.7-39.5%. Clearly, factors other than diet are involved in regulating frequency of appendectomy. While mortality is negligible and morbidity slight, elucidation of causation and prevention of the disease is desirable since subsequently appendectomy patients are at greater than average risk to certain cancers.

Adolescent↗
PubMed1988

Is incidental appendectomy a safe practice?

In an attempt to determine the safety of appendectomy performed as an incidental procedure, the authors reviewed 853 operations (458 hysterectomies and 395 cholecystectomies) performed by five surgeons at one hospital between 1981 and 1984 and compared the results in 35% of the patients who underwent incidental appendectomy with those in the remainder. Factors studied were operative time, postoperative stay, postoperative fever and leukocytosis, the need for intravenous fluids, parenteral analgesia and antibiotics, and infectious complications. Most of these variables differed between individual surgeons, but the addition of incidental appendectomy did not significantly alter any variable for an individual surgeon or for the group as a whole. Incidental appendectomy seems to be a safe practice and one that does not alter the outcome of hysterectomy or cholecystectomy but does protect against subsequent appendicitis.

Appendectomy↗
PubMed1982

The incidence of acute appendicitis and appendectomy. An epidemiological study of 971 cases.

The incidence of acute appendicitis was studied in a well defined population. Results from 971 appendectomies performed on suspicion of appendicitis, comprising 955 primary and 16 interval operations, were collected over a four-year period. Appendicitis was diagnosed in 657 cases and the mean yearly incidence was 1.16 per thousand. The incidence in males was 1.33 per thousand versus 0.99 for females. The difference was statistically significant (p = 0.0002). The mean yearly incidences of appendectomies were 1.72 per thousand for males and 1.71 for females. The highest incidences of both appendicitis and appendectomies for both sexes occurred in the second decade of life (2.34/1,000 and 3.63/1,000 per annum, respectively). Slight increases in the frequencies of appendicitis and appendectomies were noticed in the very old patients. There were no differences between the results of this study and other recent comparable reports. Compared with earlier studies there was no marked decline in the incidence of appendicitis.

Acute Disease↗
PubMed1981

Incidental appendectomy?--Yes.

A consecutive group of 100 patients over the age of 40 years, who were operated upon for histologically proven acute appendicitis, were reviewed. Although there were no deaths, 36 had complications, of which 30 were related to wound infection. Thirty-one patients were found at operation to have perforation. Of these 100 patients, 13 could have had their appendices removed previously at the time of an elective laparotomy. The morbidity of incidental appendectomy was reviewed in 200 randomly selected patients, also over the age of 40 years, who underwent either elective hysterectomy or cholecystectomy. Half had an incidental appendectomy and the other half did not. The indication for appendectomy was the preference of the surgeon. There was no important difference in operative or postoperative problems in the two groups of patients. The authors conclude that incidental appendectomy is a worthwhile and safe procedure unless there are specific contraindications.

Acute Disease↗