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PubMed1991

Laparoscopic appendectomy in children: report of 465 cases.

The authors present a retrospective analysis of 465 pediatric laparoscopic appendectomies. The ages of these patients ranged from 3 to 16 years, with a mean age of 10 years. The diagnosis of acute appendicitis was based on one or more of the following: the initial or repeated physical examination, abdominal radiographs, leukocyte blood count, and ultrasonography. On gross examination, 90% of appendices appeared inflamed, while on microscopic examination, 93% showed evidence of acute inflammation. There was a 3.6% incidence of minor intraoperative incidents and a 3.0% postoperative complication rate with 1.3% of patients requiring a subsequent laparotomy or repeat laparoscopic procedure. There were no deaths. The advantages of laparoscopic appendectomy include easy and rapid localization of the appendix, regardless of its location, the ability to explore the entire abdominal cavity through the same laparoscopic portals used for appendix removal, the ability to lavage completely the contaminated peritoneal cavity, a reduction in the incidence of intraperitoneal abscesses, and a probable reduction in postoperative adhesions. In addition, laparoscopic appendectomy is associated with less cutaneous scarring and a more rapid return of intestinal function and normal activities. In our experience, these results are better than those obtained with classical surgery.

Acute Disease↗
PubMedDate not supplied

Minilaparoscopic appendectomy for acute appendicitis.

BACKGROUND: Minilaparoscopic appendectomy for appendicitis is not a well-established procedure. This approach provides less abdominal wall trauma, fewer complications, and excellent cosmetic results. Our aim was to show the feasibility and safety of the minilaparoscopic approach. METHODS: Minilaparoscopic appendectomy was performed in 37 patients. Two 2.2-mm trocars were used to manipulate a 2.2-mm, 0-degree laparoscope and for grasper access. A 5-mm trocar was used for the ultrasonic scalpel. RESULTS: No deaths occurred. In 3 patients (8%), appendectomy was aborted due to pathology of the ovary. Conversion to the open approach occurred in 2.7% of patients. The average operating time was 34 minutes (range, 15 to 80), and the median length of hospital stay was 1.2 day (range, 1 to 5). CONCLUSIONS: The minilaparoscopic approach a) has the same advantages as the conventional laparoscopic approach in terms of better diagnostic accuracy and safety; b) a low incidence of complications; and c) yields excellent cosmetic results.

Acute Disease↗
PubMedDate not supplied

Interval laparoscopic appendectomy for appendicitis complicated by pylephlebitis.

BACKGROUND: Although rare, portal mesenteric venous thrombosis and pylephlebitis remain potential life-threatening sequelae of ruptured appendicitis in children. Treatment recommendations from recent reports have included urgent exploratory laparotomy with appendectomy, prolonged intravenous antibiotic therapy, and anticoagulation for up to a year. METHODS: This report describes successful management of pylephlebitis and mesenteric venous thrombosis complicating ruptured appendicitis with intravenous antibiotics and anticoagulation followed by interval laparoscopic appendectomy. RESULTS: A previously healthy 5-year-old girl was diagnosed with ruptured appendicitis complicated by pylephlebitis and mesenteric venous thrombosis at the time of presentation. She was treated with intravenous antibiotics and anticoagulated for 3 months. She subsequently underwent interval laparoscopic appendectomy. At 3-year follow-up, she is healthy without evidence of adverse sequelae. DISCUSSION: This is the first reported case of successful, minimally invasive management of ruptured appendicitis complicated by mesenteric venous thrombosis and pylephlebitis. CONCLUSION: Similar treatment of other children with this rare presentation seems reasonable.

Anti-Bacterial Agents↗
PubMed1991

Laparoscopic appendectomy.

In October 1989 the author began a study of laparoscopic appendectomy. This paper presents the preliminary results in 21 patients. Laparoscopy was carried out for diagnosis and 12 patients underwent laparoscopic appendectomy. The morbidity, length of hospital stay and time lost from work was reduced in all 12 patients. The author describes the technique of laparoscopic appendectomy and recommends that only experienced laparoscopists should carry out this procedure.

Adolescent↗
PubMed1991

[Laparoscopic appendectomy].

Laparoscopic techniques have extended into the operative field of surgery. Appendectomies can be performed laparoscopically. The diagnosis of appendicitis is established and the inflamed organ removed directly. The laparoscopic technique reduces the incidence of unnecessary appendectomies and corresponding morbidity. Compared with conventional appendectomy, laparoscopy leads to less post-operative pain and inability to work. We discuss the first nine patients we treated in this way.

Adult↗
PubMedDate not supplied

[Intra-peritoneal appendectomy by celioscopy. Preliminary results of a new technique].

The diagnostic and therapeutic value of laparoscopic surgery is known for ovarian cysts and ectopic pregnancies. The diagnostic of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess the feasibility, the efficacy and the advantages of a new technique of laparoscopic appendectomy. From August 1, 1989 to July 31, 1990 the women seen for pelvic pain have been divided in three groups: appendicitis, pelvic inflammatory disease (PID) and doubt. Intra peritoneal appendectomy has been performed if the laparoscopic diagnosis was not PID. Via three supra symphyseal trocars the appendix has been exposed and his meso coagulated. The appendix stump has been closed with a clip applicator (Ethnor T1300). Thirty-one women have been involved in this study. Twenty women had a laparoscopic appendectomy. Mean operation time was 36 minutes. In no occasion laparotomy was necessary. There was no post-operative complication and stool was obtained on the second post operative day. Patients and nurses appreciation was excellent. This operative procedure was possible in each attempt. This technique is sure, quick and easily reproducible. Comfortable post operative period and esthetic advantage have been noticed by the women. This operation has been possible in each attempt. This technique is sure, quick and easily reproducible.

Appendectomy↗
PubMed1990

[Laparoscopic appendectomy--alternative therapy in all stages of appendicitis?].

1989 we reported on our first series of 277 laparoscopic appendectomies. This technique was introduced by Semm in 1982. We acquired this procedure in 1987 and modified this operation-technique for surgical routine. We could demonstrate that laparoscopic appendectomy can be performed in chronic, acute and even in peracute cases. We introduce the facts of 500 laparoscopic appendectomies.

Appendectomy↗
PubMed1991

Appendectomy during pregnancy: a Swedish registry study of 778 cases.

Data from three Swedish health care registries--the Medical Birth Registry, the Registry of Congenital Malformations, and the Hospital Discharge Registry--were linked for the 9-year period 1973-1981 to identify women who had appendectomy during pregnancy and their offspring, and to determine several pregnancy outcomes (gestational duration, birth weight, perinatal mortality, and congenital anomalies). Among the 720,000 deliveries during this period, 778 were complicated by appendectomy (one in 936), and the diagnosis of appendicitis was confirmed in 64% of the cases (one in 1440). Significant findings included: 1) an increase in the risk of delivery the week after appendectomy when the operation was performed after 23 weeks' gestation, with no further increase if the pregnancy continued beyond 1 week; 2) a decrease in mean birth weight of 78 +/- 24 g with more infants than expected weighing less than 3000 g; 3) an increase in the number of live-born infants dying within 7 days of birth; 4) no increase in the number of stillborn infants; and 5) no increase in the number of congenitally malformed infants.

Adult↗
PubMed1990

[Appendectomy à froid; a superfluous operation?].

A retrospective study was made of the course of the disease of 69 patients who during an uninterrupted period had been admitted with the diagnosis of acute appendicitis with infiltrate. After the usual conservative treatment, elective appendectomy à froid was scheduled for a few months later. On completion of the study, 61 of the 69 patients had been operated. Three patients had been operated on earlier than planned, because of recurrent abdominal complaints, while two patients had developed acute appendicitis. Two patients proved to have a carcinoma of the colon, one a carcinoid and three, an encapsulated abscess. Of the 61 patients operated on, 43 had no symptoms at the time of the appendectomy à froid. The authors advise no longer to perform appendectomy à froid; however, in patients over 40 years of age the possibility that a malignancy is causing the abdominal symptoms should be excluded.

Appendectomy↗
PubMed1990

Appendiceal calculi and fecaliths as indications for appendectomy.

This study was done to determine the association between appendiceal fecaliths or appendiceal calculi and the presence of acute appendicitis. We retrospectively reviewed the medical records of all patients from 1977 through 1986 who underwent appendectomy for a clinical diagnosis of acute appendicitis (group 1, 2,331 patients) or who underwent appendectomy either incidentally or during colectomy for nonappendiceal pathologic factors (group 2, 1,066 patients). Fecaliths were six times more common than calculi, but calculi were more often associated with perforated appendicitis or periappendiceal abscess (45 per cent) than were fecaliths (19 per cent). Appendiceal fecaliths and calculi appear to play a role in the pathogenesis of acute appendicitis and are associated with complicated appendicitis (perforation and abscess). Appendectomy should be considered for patients in whom an appendiceal calculus is recognized incidentally.

Acute Disease↗
PubMed1989

Incidental appendectomy at cesarean section: a prospective study.

In conclusion, the present study describes a controlled series and demonstrates the safety of incidental appendectomy at cesarean section. A slight increase in operative time accompanied appendectomy group, but the length of hospital stay and postoperative morbidity were not different. It's our recommendation that at cesarean section if the abnormal appendix is found, appendectomy should be done. Normal appendix can also be removed whenever the opportunity presents in non-risk patients.

Adult↗
PubMed1987

A comparative study of cefotetan and metronidazole against metronidazole alone to prevent infection after appendectomy.

The role of metronidazole in reducing the incidence of infectious complications after appendectomy has been established, but the value of an additional antibiotic to act against aerobic pathogens remains controversial. Patients who received 2 grams of cefotetan intravenously at the time of appendectomy and those who did not were compared for the incidence of infection. All patients received 1 gram of metronidazole per rectum preoperatively and every 12 hours for five days postoperatively. Infection occurred in three patients who received cefotetan and 16 of those who did not (p less than 0.01). We conclude that a single dose of cefotetan, an antibiotic which is effective against aerobic and anaerobic organisms, produces a significant reduction in the incidence of infection when added to metronidazole in the management of patients after appendectomy.

Adolescent↗
PubMed1987

[Neurogenic appendicopathy--long-term results following appendectomy].

The neurogenic appendicopathy is a disease which is caused by proliferation of nerve fibres and hyperplasia of endocrine cells in the submucosa of the appendix. It is to be diagnosed surely only histologically. 28 patients in which appendectomy specimens solely changes of neurogenic appendicopathy type were present have been traced. Following statements can be made: 1. The disease is curable in 96% by simple appendectomy. 2. Concerning this diagnosis about 60% of so-called "negative" appendectomies will find a reasonable explication. 3. At the same time a facultative precurser disease of appendiceal carcinoid tumor is removed.

Adolescent↗
PubMed1986

[Appendectomy and cancer--an epidemiological evaluation].

From Jan. 1958 to June 1983, all in-patients with gastric cancer, breast cancer and carcinoma of colon and rectum (as cancer group), and with cerebral hemorrhage (as control group) in our hospital were epidemiologically investigated in order to evaluate the relation between previous appendectomy and cancer incidence. Patients who had appendectomy more than three years before diagnosed named appendectomized (APP). In cancer group, out of 1,119 patients, 98 (8.76%) were APP, but in the control, only 14 (3.50%) of 400 patients were APP (P less than 0.001). As to cancer location, the ratio of APP were 9.47% (48/507) in patients with gastric cancer (P less than 0.001), 7.07% (21/297) in patients with carcinoma of colon and rectum (P less than 0.05) and 9.21% (29/315) in patients with breast cancer (P less than 0.01). As to sex, the ratio of APP, for the male were 9.82% (46/438) in cancer patients, while 4.47% (8/179) in the control (P less than 0.05), and for the female, were 8.08% (55/681) in cancer patients, while 2.71% (6/221) in the control (P less than 0.01). As to age, the ratio of APP was higher in various age groups of cancer than the control, but only in the 50-59 age group, the difference was significant (P less than 0.05). It shows that the ratio of APP in all cancer groups are significantly higher than those in the controls. The authors support the concept--appendectomy may influence the subsequent cancer risk, and deem it well worth to further investigate.

Adult↗
PubMed1986

Appendectomy at cesarean section: a prospective study.

Appendectomy was performed on 40 consecutive consenting patients undergoing elective cesarean section in a clinic population. The control group consisted of all other patients undergoing elective cesarean section during the period of study. The populations were similar. Clinical infection, blood loss, gastrointestinal tract recovery rates were equal in both groups. Appendectomy added 15 minutes to the operation time and extended the hospital stay by about one-half day. There were no wound infections or serious morbidity. A fifth of the appendixes removed were abnormal, including two with inflammation and one with a carcinoid tumor. Prophylactic appendectomy does not seem to add to the risk of elective cesarean section.

Anesthesia↗
PubMed1986

[Early operation of acute appendicitis--risk in unnecessary appendectomies].

The authors have analysed their own surgical patients, with the view to establishing the rate of unnecessary appendectomy. Any operation is accompanied by a certain risk, including appendectomy. Hence, unnecessary interventions should be avoided. Complications usually concomitant with appendicitis may occur, as well, in the wake of unnecessary appendectomy. Yet, they are much more common, when an operation had been delayed.

Acute Disease↗
PubMed1985

Appendectomy during pregnancy.

Twenty-nine patients suspected of having appendicitis while pregnant had appendectomies, and 20 patients had appendicitis. Right lower quadrant pain and tenderness of less than 24 hours duration with nausea and vomiting, a fever of 38 C or less, and a leukocyte count of more than 15,000 were the more common findings in patients with appendicitis. Right lower quadrant pain and tenderness of more than 24 hours' duration, fever of more than 38 C, and a leukocyte count of less than 15,000 were more common findings in patients with idiopathic right lower quadrant pain or such pain associated with urinary tract infection. Neither fetal nor maternal death or complication occurred. The use of antibiotics and progestational agents appeared to be a matter of choice and did not appear to influence fetal or maternal outcome. These data support the concept that peritonitis rather than appendectomy is the cause of fetal and maternal death and complication in pregnant women suspected of having appendicitis and further argue for early appendectomy in such patients.

Adolescent↗
PubMed1979

Interval appendectomy. A retrospective study.

79 patients were admitted with a periappendicular abscess at the Surgical Organic Department, Randers Centralsygehus in a 5-year-period from April 1, 1970 to April 1, 1975. Appendectomy à froid was not made on 9 patients. A questionnaire in 7 patients showed no recurrence after an observation period of an average 2.4 years. Appendectomy à froid was made on 70 patients with a complication rate of 13%. The operation could be regraded as quite unnecessary in 14%. Therefore appendectomy à froid cannot be recommended as a routine operation, but all patients ought to be controlled until the palpable mass has disappeared, and only in cases of doubt and in symptomatic cases the patients ought to be operated. All patients over a certain age, 40 years for instance, ought to have performed a colon X-ray with double contrast or coloscopy to exclude a coecal cancer.

Abscess↗