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PubMed1967

Appendectomy and biopsy despite inflammatory disease of the bowel.

For many years surgeons have preached against the removal of the appendix when regional enteritis is present. A high rate of fistulization and abscess formation supposedly follows appendectomy in such circumstances. This was not borne out in a series of cases in which appendectomy was carried out despite regional enteritis, granulomatous colitis and ulcerative colitis. Two fistulae occurred in 23 patients. Neither fistula was from the appendiceal stump. Appendectomy is probably a reasonable procedure when enteritis is present, although judgment should be exercised if there is appendicocecal involvement.

Appendectomy↗
PubMedDate not supplied

[Mortality in appendectomy. About an homogeneous series of 5 348 cases (author's transl)].

The authors have reviewed a series of 5 348 cases of appendectomy. They have registered 25 post-operative deaths, of which 22 were due to medical complications and 3 to surgical complications. Surgical complications, which involved a second operation in the early post-operative period, were noted in 31 patients. In over 50 p. cent of the cases, complications have been observed after appendectomies for common appendicitis. Most of the time, they were revealed by an occlusion, a peritoneal syndrome or a setting of intraperitoneal abscesses. In about 50 p. cent of the cases, the post-operative occlusion points to the presence of an abscess, a peritonitis or an hematoma. The most frequent and severe complications are caused by infection. In the present series, an overall mortality of appendectomy of 0.47 p. cent has been observed. In the patients who have to be reoperated, the overall mortality of 6.6 p. cent corresponds to a risk which is 15 times higher.

Abscess↗
PubMed1994

Laparoscopic appendectomy: have we found a better way?

Laparoscopic appendectomy is an attractive option for the surgical treatment of acute appendicitis. When performed by an experienced laparoscopist, the procedure can be accomplished with little variation in time from the standard open technique, provide a superior cosmetic result, shorter hospital stay and a significant reduction in postoperative pain and length of convalescence. In this study a comparison of 42 open appendectomies and 37 laparoscopic appendectomies was made in regard to age, sex, length of stay, cost of stay, and length of convalescence.

Acute Disease↗
PubMed1994

Appendiceal mass: conservative therapy followed by interval laparoscopic appendectomy.

BACKGROUND: Current therapy of patients with appendiceal abscess or phlegmon is in evolution. Controversial areas include initial conservative therapy, drainage of periappendiceal abscesses, and the role of interval appendectomy. OBJECTIVE: To evaluate the safety and efficacy of conservative therapy and of interval laparoscopic appendectomy (ILA). PATIENTS AND METHODS: Patients with signs and symptoms of acute appendicitis and a palpable right lower quadrant mass were included. Abscess/phlegmon was documented with ultrasound or computerized tomography. After initial therapy with antibiotics, patients were discharged to home. ILA was performed 6 to 12 weeks later. RESULTS: Twelve patients were included. Four patients had phlegmonous appendicitis and eight had an abscess, but only four had percutaneous drainage. All patients improved without surgical exploration and were subjected to ILA. ILA was successful in 11 of 12 patients; a median hospital postoperative stay of 1 day was required, and no perioperative morbidity was encountered. All patients returned to routine activities within 2 weeks of surgery. CONCLUSIONS: 1) Initial conservative management of patients with appendiceal abscess/phlegmon is prudent, safe, and effective. 2) Interval laparoscopic appendectomy can be performed safely and effectively.

Abscess↗
PubMed1994

Emergency appendectomies in patients over 80 years.

The outcome of 100 consecutive emergency appendectomies between 1985 and 1991 in octogenarians was compared to an unselected group of equal size, composed of patients between 60-79 and under 59 years. The frequency of appendectomies in the elderly did not increase during the study period. Negative explorations were performed in 28%-33% of the three age groups. The mortality was 0%, 3%, and 7%, and the complication rates 10%, 23%, and 40% in the patients aged under 59, between 60-79, and over 80 years, respectively. Appendiceal perforation was found in 49% of octogenarians, and it was associated with the mortality rate of 21%. In conclusion, patients under 80 years with emergency appendectomy had acceptable low mortality and morbidity rates that were comparable to the results of elective abdominal surgery of the same age, but the octogenarians had higher risk of poor outcome.

Aged↗
PubMed1994

[Laparoscopic appendectomy. Results and complications].

Thirty-four patients (23 females and 11 males) aged 13-71 years had acute appendicitis on both clinical and laparoscopic evaluation. Twenty-eight patients (82%) were treated laparoscopically whereas conversion to open appendectomy was necessary in six patients. Operation time for laparoscopic appendectomy ranged from 25-90 min. (mean 58 min.), and the patients were discharged 1-14 days after the operation (mean 2.8 days). Five patients developed complications, wound infection in one case, intraperitoneal infectious complications in three cases and postoperative fever in one case. Mean convalescence was two weeks. All patients were satisfied with the performed procedure and the cosmetic result and all were doing well one month after the operation, except for one patient who had pain in the right iliac fossa. The initial results of laparoscopic appendectomy are promising.

Acute Disease↗
PubMed1994

Various stapling techniques in laparoscopic appendectomy: 40 consecutive cases.

The applicability and safety of a new operative technique for laparoscopic appendectomy using an automatic stapling device, the Multifire Endo-GIA 30, was evaluated. This instrument, which can be passed through a 12-mm trocar sleeve, compresses the appendix as well as the resting stump, occluding its lumen with three lines of titanium staples and cutting between them. Data from 40 laparoscopic appendectomy patients collected between August 1991 and March 1992 were analyzed prospectively. Using this stapler, the mean operation time was 58.33 min (range, 35-95 min), with no complications or mortality. In 35 cases, an acute, and in one case, a chronic, appendicitis was histologically confirmed; in four cases no inflammation was detected. Our preliminary results suggest that this new stapling device offers a simple and safe method for use in laparoscopic appendectomy.

Acute Disease↗
PubMed1994

Laparoscopic appendectomy: is it worth it?

Data on all laparoscopic appendectomies (LA) were collected prospectively from June 1990 through July 1992 and compared retrospectively with all open appendectomies (OA) done at the same hospital during the same time period. Laparoscopic appendectomies were performed in 29 patients (ages 15-47, mean 25.3 years) and OA in 77 patients (ages 18-71, mean 31.9 years, P < 0.01). Preoperative findings were similar in the two groups. Acute appendicitis was confirmed in 22 (76%) LA and in 57 (74%) OA; of these, 9/22 (41%) LA and 23/57 (40%) OA were gangrenous or perforated. A normal appendix was removed in seven (24%) LA and in 20 (26%) OA. Three patients (10%) required conversion of LA to an open procedure. Operative time was significantly longer for LA (mean 105 minutes) compared with OA (mean 69 minutes; P < 0.001). Postoperative complications requiring further intervention (wound infection or intraabdominal abscess) occurred in three LA (10%) and in 23 OA (30%, P < 0.05). Wound morbidity as measured by number of wounds left open at surgery or opened for infection was significantly less after LA (14% LA, 39% OA, P < 0.001). Hospital stay was significantly shorter after LA (mean 4.2 days) compared with OA (mean 6.3 days; P < 0.05). Hospital charges and professional fees were not significantly different between the two groups. In selected patients, LA is a safe, effective alternative to OA, with fewer complications and shorter hospital stay. In addition, hospital charges are similar, making an investment of more time in the operating yield an outcome equal or superior to OA.

Acute Disease↗
PubMed1993

[Appendectomies. Mac Burney or laparoscopy? (100 cases)].

The authors have compared their early (50 cases) experience on laparoscopic appendectomy for acute appendicitis with a control group treated by open approach. A teaching period is necessary to reduce the converting rate to an open procedure from 22% to 6% p = 0.05 and to obtain an equal median anesthesia time (39 vs 40 mn+/-16) ns). The mean post operative stay for open operation was 5-8 (range 3-23) days and for the laparoscopic route 3.3 (range 1-8) days (p < 0.005). The wound infection rate was 16% (n = 8) for open/ and 0% for laparoscopic appendectomy p = 0.001. The results suggest that emergency laparoscopic appendectomy should be explored further as an alternative to open surgery for acute appendicitis.

Adolescent↗
PubMed1995

Complete two-handed laparoscopic appendectomy: report of 100 cases.

A complete two-handed technique for laparoscopic appendectomy is described. From April 1992 to July 1994, 100 patients with suspected acute appendicitis were selected to undergo this approach. This technique allows the surgeon to manipulate instruments with both hands for dissecting, transecting and removing the appendix. The appropriate placement of three cannulas in the lower abdominal midline makes this technique possible. Monopolar cautery is used to dissect the mesoappendix and to cauterize the appendicular vessels. Two ligatures are placed at the junction of the appendix with the cecum. The appendix is clamped at its base by ratchet forceps and is extracted along with the forceps immediately after transection. None of the patients selected for this procedure required conversion to open appendectomy. Postoperative complications occurred in four patients, two with umbilical wound infections and two with intra-abdominal abscesses; 12 patients had perforated appendicitis. The results of this study suggest that a complete two-handed laparoscopic appendectomy can be safely and successfully accomplished in patients with suspected acute appendicitis.

Acute Disease↗
PubMed1995

[Post-appendectomy fistulas of the cecum. Apropos of 22 cases].

Appendicitis, usually a benign disease, can have its prognosis worsened in case of postoperative fistula. The latter occurs rarely after open appendectomy (0.133%), but accounts for 10% of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period (January 1970 to December 1993). The aim of these retrospective study was to precise their clinical features, to evaluate paraclinical examinations in diagnosing these complications and to give guidelines for their treatment. Fistulas occurred at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perforated) or appendectomy quoted as technically difficult. Location of the appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the aspect of the drainage fluid in 14 cases. Diagnosis workup of the fistula associated plain abdominal radiograph and abdominal ultrasonography (n = 22). Fistulography (n = 6) confirmed the clinical diagnosis of fistula, showing the leaking in all cases. Medical treatment was attempted first in 14 cases and was successful in 11 cases with a healing time from 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases because of medical treatment failure: one patient died and 5 patients underwent re-operation (right colectomy in 3 cases, bypass in 1 case and re-drainage in 1 case). Fistulography in our experience, is highly reliable and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modality. Surgery must be contemplated in case of established external fistulas, and of purulent or faecal fistulas. Nevertheless, prognosis remains poor (50% re-operation rate).

Adolescent↗
PubMed1997

Is wound infiltration with anesthetic effective as pre-emptive analgesia? A clinical trial in appendectomy patients.

OBJECTIVE: To assess the efficacy of wound infiltration with local anesthetic in reducing postoperative pain after a muscle-splitting incision for appendectomy. DESIGN: A double-blind, placebo-controlled, randomized clinical trial. SETTING: The Royal Columbian Hospital, a university-affiliated community hospital. PARTICIPANTS: Forty-three patients scheduled to undergo emergency appendectomy were randomized into treatment (21) and control (22) groups. Five patients were excluded from the treatment group. INTERVENTIONS: Local anesthetic infiltration of the wound before incision (treatment group) and saline infiltration (control group). MAIN OUTCOME MEASURES: Postoperative analgesic requirements, pain assessment by visual analogue scale and length of hospital stay. RESULTS: No significant difference in analgesic use was seen between the 2 groups, as measured at 3 stages (Mc = control mean [standard deviation], Mt = treatment mean [standard deviation]): (a) in the recovery room, intravenous morphine use was Mt = 6.6 mg [8.6] v. Mc = 10.1 mg [7.2]; (b) in the first 2 postoperative days, intramuscular meperidine use was Mt = 309 mg [181] v. Mc = 278 mg [125] on day 1 and was Mt = 121 mg [132] v. Mc = 97 mg [128] on day 2; (c) in the final 5 days of follow-up, oral analgesic use was Mt = 11 [17] tablets v. Mc = 21 [16] tablets (acetaminophen with codeine). Pain assessments at rest, on a scale of 1 to 10, were found to be no different between groups, ratings being Mt = 4.7 [2.1] v. Mc = 4.5 [2.0] on day 1. Length of hospital stay averaged 3.0 days in both groups. CONCLUSIONS: Infiltration with local anesthetic before incision does not pre-empt postoperative pain from a muscle-splitting incision used for appendectomy.

Adolescent↗
PubMed1998

A minimally invasive technique of appendectomy using a minimal skin incision and laparoscopic instruments.

To take advantage of the laparoscopic procedure, a new minimally invasive technique of appendectomy for nonobese and uncomplicated appendicitis is presented. Initially, diagnostic laparoscopy is performed through a minimal skin incision (microceliotomy) 1.5-2.0 cm in length in the right lower abdomen to rule out other disease. Then an appendectomy is performed using conventional surgical instruments under direct vision through the previous skin incision. There were 18 women and 12 men in this series. The mean age was 22.6 years. Pathologic findings of the appendix were: 2 normal, 13 catarrhal, 10 suppurative, and 5 gangrenous type. The mean operation time was 30.7 min. The mean frequency of postoperative analgesic requirement (nalbuphine 0.2 mg/kg) was 0.9 times. The mean hospital stay was 4.1 days (range, 2-7 days), and the duration until return to full activity was 7.6 days (range, 5-14 days). There was no mortality or morbidity. This appendectomy technique is a useful method for minimizing the postoperative pain and operative scar, thus allowing the patient an early return to full activity.

Activities of Daily Living↗
PubMedDate not supplied

Laparoscopic appendectomy and cholecystectomy during pregnancy: six case reports.

BACKGROUND: Pregnancy was once considered a contraindication to laparoscopic cholecystectomy and appendectomy. The progression of laparoscopic techniques has resulted in a continued reassessment of laparoscopic procedures during pregnancy. There still exists some controversy as to the safety of laparoscopic procedures during pregnancy. This paper reviews our series of six pregnant patients treated laparoscopically for appendicitis and cholecystitis. METHODS: Charts were reviewed of all pregnant patients who underwent laparoscopic cholecystectomy or appendectomy at St Clare's Hospital Schenectady, New York between 1992 and 1996. Six patients were identified. Patients and obstetricians were contacted to investigate the results of the pregnancy. RESULTS: All patients and fetuses survived the procedure. Two patients delivered prematurely but remote from the operative procedure. All infants were healthy postpartum. One patient underwent an elective abortion as she had planned. The abortion was remote from the surgical procedure. CONCLUSION: Our series adds to the growing evidence that laparoscopic cholecystectomy and laparoscopic appendectomy can be performed safely during pregnancy.

Adult↗
PubMed1998

[Importance of appendix stump management in laparoscopic appendectomy].

In laparoscopic appendectomy several variants of technique have been proposed. In a randomized prospective trial we compared three common techniques: 1. application of two endoloops, 2. application of two endoloops and additional manual stump sinking 3. application of endo-cutter. The study included 150 patients, 50 each per technique. The application of two endoloops with additional manual stump sinking as well as the cutter technique were associated with a low risk for complications. In contrast, appendectomy by two endoloops without stump sinking was associated with a higher risk for local complications. The manual stump sinking requires a high level of manual experience, whereas the cutter technique can be learned rapidly by surgical residents. Therefore, we recommend the cutter technique as standard procedure, because it allows laparoscopic appendectomy to be performed with high reliability by experienced surgeons as well as by novice surgical residents.

Appendectomy↗
PubMed1998

[Deferred appendectomy in a case of appendiceal mass].

The treatment of acute appendicitis when appendix is technically impossible to remove, remains controversial. The clinical case of a 12-years-old child diagnosed of acute appendicitis in which appendectomy was not initially performable is presently described. After treatment with antibiotics, he was submitted to appendectomy five months later. Operative and pathologic findings in this second laparotomy prove the predisposition of the patient to a second acute appendicitis, and uphold the preventive attitude, the interval appendectomy.

Acute Disease↗
PubMed1998

[Effect of ultrasonic diagnosis and incidence of appendectomy and laparoscopy].

A total of 330 of 409 patients with suspected acute appendicitis were examined by ultrasound, and an appendectomy was performed in 146 patients. The negative appendectomy rate was 7% with preoperative ultrasound (n = 72) compared with 31% without (n = 74). Laparoscopy did not reduce the negative appendectomy rate, but was useful in patients with opposing clinical and sonographical findings.

Abdomen, Acute↗
PubMed1999

Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy.

We performed a meta-analysis to determine whether laparoscopic or open appendectomy gives better outcomes for patients with suspected acute appendicitis. Studies were selected from the MEDLINE database, personal files, and meeting abstracts. Eleven of 21 randomized controlled trials were included in the meta-analysis. Pooled effect size estimates were calculated using a random effects model. Laparoscopic appendectomy reduced time to full functioning by 5.48 days (95% confidence interval [CI] 3.70 to 7.26; p < 0.001), improved postoperative pain at 24 hours measured by a visual analog scale from 0 to 10 by 1.19 points (95% CI -2.14 to -0.24 points; p=0.014), and decreased the absolute risk for wound infection by 3.2% (95% CI -5.6% to -0. 8%; p=0.009). Operating time was increased by 17.12 min (95% CI 14.19 to 20.03; p < 0.0001). There was no difference between the two surgeries for length of hospital stay, readmission rate, and intra-abdominal abscess formation. Laparoscopic appendectomy improves patient outcomes.

Appendectomy↗