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PubMed2001

Appendectomy in patients undergoing laparoscopic surgery for pelvic pain.

STUDY OBJECTIVE: To evaluate pathologic findings in appendixes of women undergoing laparoscopic surgery for pelvic pain. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Private practice specializing in gynecologic endoscopic surgery. PATIENTS: One hundred ninety women. INTERVENTION: Prophylactic appendectomy. MEASUREMENTS AND MAIN RESULTS: On pathologic evaluation, 154 appendixes were diagnosed as having one or more abnormal findings, such as endometriosis, carcinoid, chronic appendicitis, periappendicitis, fibrous obliteration, and lymphoid hyperplasia. CONCLUSION: Women undergoing laparoscopic surgery for pelvic pain should be counseled on the high frequency of abnormal findings in the appendix, including endometriosis. Prophylactic appendectomy appears to be a worthwhile consideration in these patients.

Adolescent↗
PubMed1998

Gynecologically indicated single-endoloop laparoscopic appendectomy.

A prospective, observational study was performed to define the laparoscopic appearance of chronic or recurrent appendicitis, and to evaluate a new, simplified technique for laparoscopic appendectomy. Chronic appendicitis was assumed in 42 women with long-term or recurrent lower abdominal pain, and appendectomy was performed when two or all three of the following pathologic changes, which were highly predictive of the diagnosis, were present: vascular injection of appendiceal peritoneum, periappendiceal adhesions, and induration of the appendix. After thorough periappendiceal adhesiolysis, a catgut no. 2 endoloop was placed around the base of the appendix and mesoappendix. The appendix was skeletonized, crushed distal to the ligature, regrasped further distally while simultaneously closing the appendiceal lumen, and cut in the crushed area. It was removed retrograde through the left suprapubic 10-mm port. Iodine was applied to the stump. No major intraoperative or postoperative complications occurred. During mean observation of 12.6 months, 74% of women were free of abdominal pain, 12% had partial relief in a mean of 15.4 months' observation, and 12% experienced no change in abdominal pain. This technique is safe, simple, and effective when chronic or recurrent appendicitis is assumed during diagnostic laparoscopy for chronic lower abdominal pain.

Adolescent↗
PubMed2001

Laparoscopic versus open appendectomy in children: a prospective randomised study.

43 children between the ages of 7 and 15 years with clinical symptoms of acute appendicitis were randomised to an open appendectomy (OA) or a laparoscopic appendectomy (LA). There were 15 acute cases of appendicitis and 5 perforated appendices in the OA group and 17 acute appendicitis, 3 cases of perforated appendices and 3 other diagnoses in the LA group. The operative time was a little shorter in the OA group. There were no differences in hospital stay or the postoperative course of the patients. In the LA group, there were two minor complications, no other complications were seen. When comparing the two surgical methods in the consistent group of patients with non-perforated acute appendicitis no statistical differences were seen in the operative time, hospital stay or in the recovery of the patients between the OA and the LA groups.We conclude that LA has no significant benefit over OA in routine use. In paediatric patients we recommend an open approach for clinically typical acute appendicitis, but there should be no hesitation to choose laparoscopic approach when the clinical diagnosis is unclear.

Acute Disease↗
PubMed2004

Incisional local anaesthesia versus placebo for pain relief after appendectomy in children--a double-blinded controlled randomised trial.

Incisional local anaesthesia is widely used for postoperative pain relief after surgery. We present the results of a double-blinded and randomised controlled study of incisional bupivacaine versus placebo in 68 children undergoing open appendectomy. The trial medicine (0.5 ml/kg) was infiltrated into the subcutis after wound closure. Patients with a weight below 40 kg received a bupivacaine concentration of 0.25 % and the patients above 40 kg a concentration of 0.5 %. During the first 24 hours after surgery the patients in the bupivacaine group received on average 0.065 mg morphine/kg and in the placebo group 0.073 mg/kg. This difference was not statistically significant. The patients in the bupivacaine group tended to experience pain relief for a longer period of time compared to the patients in the placebo group. However, the difference was not significant. In conclusion, the use of subcutaneous infiltration with bupivacaine in the wound after open appendectomy had no significant effect on the use of morphine during the first postoperative day in children.

Adolescent↗
PubMed1989

[Preventive appendectomy in gynecologic surgery. Report of 1,718 cases].

In the period between 1965-1986 with a collective sum of 5369 gynecological laparotomies, the appendix was removed as a preventive measure in 1718 cases (32%). In all these cases, the recovery period proceeded without any complications. The results of the histological studies on the appendices showed an acute appendicitis in 136 cases (7.9%). In 1118 cases (65.1%) a chronic appendicitis was found, with differing severity of fibroid scarring, including total obliteration. In 96 cases (5.6%), there was evidence of carcinoid, mucocele, and endometriosis. Only 368 appendices (21.4%) were normal morphologically. The large percentage of histopathological findings confirms, that the appendix--being a rudimentary lymphatic organ--appears to be predestined for inflammatory changes. For this reason, the risk of illness and death from appendicitis remains, especially for older people. It is usually possible, to perform a prophylactic appendectomy under optimal conditions and we experienced, that this additional operation does not increase the risk to the patient. We consider, that the routine practice of the prophylactic simultaneous appendectomy during gynecological laparotomies is justified, providing, that the contra-indications mentioned are observed.

Adult↗
PubMed1993

New morphological findings in so-called negative appendectomies.

Appendices of children operated on because of clinical signs of acute appendicitis and presenting normal histological findings were revised by means of special assays. These findings were then compared with appendectomies during abdominal surgery, catarrhal and early phlegmonous appendicitis. We found pathological changes of the epithelium and the lymphatic tissue in more than two thirds of the specimens originally classified as normal. Therefore the term of "negative appendectomy" has to be redefined.

Acute Disease↗
PubMed1994

Laparoscopic versus open appendectomy in children--comparative study of 403 cases.

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.

Adolescent↗
PubMed1986

Appendectomy and the risk of tubal infertility.

We studied the importance of a history of appendectomy for appendicitis in 279 women with laparoscopically or surgically diagnosed tubal infertility and a control group of 957 fertile women. After controlling for the effects of age, use of an intrauterine device for contraception, a history of pelvic inflammatory disease, and other potential confounding variables, we found that no excess risk of tubal infertility was associated with a simple appendectomy without rupture. However, when the operation was reportedly for a ruptured appendix, the relative risk of tubal infertility was 4.8 (95 percent confidence interval, 1.5 to 14.9) for women who had never been pregnant and 3.2 (95 percent confidence interval, 1.1 to 9.6) for women with one or more previous pregnancies. We conclude that the early diagnosis and treatment of suspected appendicitis in girls and women of reproductive age may reduce the incidence of tubal infertility resulting from the sequelae of a ruptured appendix.

Adult↗
PubMed2003

Residual appendicitis following incomplete laparoscopic appendectomy.

Growing popularity of laparoscopic interventions must bring along a thorough knowledge of possible complications inherent to the laparoscopic technique. With these two cases of residual appendicitis following incomplete appendectomy, the authors want to warn for this complication. Surgeons should be aware of residual appendicitis as a possible cause of acute abdomen at any time following a laparoscopic appendectomy.

Adolescent↗
PubMedDate not supplied

A plea for incidental appendectomy in pediatric patients with malignancy.

The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.

Adolescent↗
PubMed2002

Laparoscopic appendectomy for acute and recurrent appendicitis: retrospective analysis of a single-group 5-year experience.

BACKGROUND AND PURPOSE: Twenty years after the first report of laparoscopic appendectomy (LA), its role in the treatment of appendicitis is still under debate. We report herein a retrospective analysis of our cases of LA in the last 5 years, during which we adopted a policy of an almost uniform laparoscopic approach on a rather selected population composed mainly of women with acute or recurrent lower quadrant abdominal pain. PATIENTS AND METHODS: Laparoscopic appendectomy was performed on 33 male and 98 female patients. The mean age at operation was 25.7+/-11.4 years (range 11-59 years). Acute appendicitis with localized or diffuse peritonitis was present in 34 cases. In the remaining 97 patients, the operation was performed for acute or recurring symptoms of lower quadrant abdominal pain. RESULTS: There were no conversions to open surgery. The operating time was 45+/-17 minutes (range 30-110 minutes). The pathology examination of the removed appendices showed acute appendicitis in 34 cases and chronic inflammation in the remaining 97 patients. In one case, histology revealed a coexisting mucinous carcinoid that extended to the perivisceral fat, and a completion right hemicolectomy was performed. Complications were minor in most cases. Reoperation for deep abdominal abscess or hematoma was required in three cases. The mean hospital stay was 2.59+/-1.58 days (range 24 hours-11 days). CONCLUSION: In our hands, LA has proven to be safe and effective. The laparoscopic operation has significant advantages in terms of lower invasiveness and better diagnostic capability. It is especially useful in women of child-bearing age, in whom it may be considered the procedure of choice.

Acute Disease↗
PubMed2002

Laparoscopic appendectomy by ultrasonically activated scalpel in acute appendicitis: preliminary report.

BACKGROUND AND PURPOSE: Laparoscopic appendectomy (LA) is increasingly being used in treating acute appendicitis. New instruments such as the ultrasonically activated scalpel (UAS) have been introduced for most laparoscopic procedures. We evaluated the use of UAS in the performance of LA, as the potential of this instrument in this type of surgery remains to be defined. PATIENTS AND METHODS: Three patients with acute right lower abdominal pain were managed by the laparoscopic approach. Once the diagnosis of acute appendicitis was established, laparoscopic appendectomy was performed with the UAS. RESULTS: The mean operative time was 42.3 minutes (range 32-49 minutes). There were no complications related to the treatment with UAS of either the vascular pedicle or the appendicecal stump. No electrosurgical coagulation, clips, loops, or endostapler was used in any patient. CONCLUSIONS: Total LA performed with UAS is feasible. Use of the UAS may make dissection and resection of the appendix easier, helping to reduce the mean operative time.

Acute Disease↗
PubMed1997

Laparoscopic appendectomy: a viable alternative approach.

Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare the course and postoperative complications between LA and OA. We reviewed the charts of both groups of patients and followed their course in the hospital. Seventy-seven patients who underwent LA with one conversion to the open technique (1.3%) were compared to 84 patients who underwent OA. There was no difference in age and sex distribution. The mean hospital stay was shorter in the LA (32.5+/-10 vs 74.2+/-24 h, p < 0.0001). Parenteral analgesia requirement was higher in the OA group (4.7+/-1.4 vs 2.6+/-2, p < 0.0001). The total cost was higher in the OA group ($11,260+/-4000 vs 7,090+/-3500, p < 0.05). There was no significant difference in the OR time, duration of the procedure, and surgery costs between both groups. Normal appendices removed were similar in both OA and LA groups (23.8 vs 28.9%). There was no difference in the rates of postoperative complications between both groups. We conclude that LA is a viable alternative to OA. It is safe, cost effective, and less invasive than the OA with less pain and shorter hospital stay.

Acute Disease↗
PubMed2005

Laparoscopic appendectomy in pregnancy.

BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.

Adult↗
PubMed1991

Laparoscopic appendectomy for acute appendicitis: indications and current use.

Laparoscopic evaluation was performed in 43 consecutive patients with right lower abdominal pain and preoperative diagnosis of possible appendicitis. Patients with generalized peritonitis and evidence of perforation of the appendix were not considered for laparoscopy. Visualization was sufficient for making a diagnosis in 97.7% of the cases. In 95%, laparoscopic findings were compatible with the pathology report. Thirty-five patients underwent successful laparoscopic appendectomy with neither intraoperative nor postoperative complications. No further surgery was required; slightly elevated temperatures in 6 patients responded to treatment with antibiotics, and there were no wound infections. Laparoscopic appendectomy is minimally invasive and results in less postoperative pain and morbidity and fewer adhesions and other long-term sequelae than conventional laparotomy. It is associated with superior cosmetic results, a shorter hospital stay, and faster return to normal activities. This experience suggests that if there is no evidence that the appendix is perforated or that generalized peritonitis exists and if qualified physicians and adequate facilities are available, patients presenting with right lower quadrant abdominal pain and possible appendicitis are best evaluated and treated with laparoscopic technique.

Acute Disease↗
PubMed1992

Incidental appendectomy during laparoscopic cholecystectomy.

An operative experience of three patients who underwent incidental laparoscopic appendectomy during laparoscopic cholecystectomy is presented. The technique and indications are discussed. The authors conclude that incidental laparoscopic appendectomy is possible and safe with existing incisions performed in gallbladder surgery. However, well-controlled prospective studies should be performed prior to wide application of this technique.

Adult↗
PubMed1995

Laparoscopic appendectomy: three-puncture technique with suspension of the appendix in nineteen cases.

Nineteen laparoscopic appendectomies by the same general surgeon are reported, using three trocar sites and suspending the appendix along the right lower quadrant trocar. This approach provides a fourth access site to the appendix without an additional port. Once the position of the appendix is stabilized, the two available ports are used to dissect around the base of the mesoappendix and place a silk ligature with extracorporeal ligating technique. All 19 procedures were completed by endoscopic means and without the use of endoscopic stapling devices, even when the mesoappendix was markedly swollen and edematous. The technique is presented here as an alterative method when performing laparoscopic appendectomy.

Appendectomy↗