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PubMed2000

[Quo vadis laparoscopic appendectomy?].

The authors evaluated a group of 282 patients subjected between January 1993 and December 1998 to appendectomy, either by the open or laparoscopic route. They compared the period of work incapacity in the two groups to confirm or rule out the fact that after laparoscopic appendectomy the return to work is faster. The results are more favourable in the group of patients operated by the mini-invasive procedure, but even then the period of work incapacity is twice as long, as compared with other countries.

Adult↗
PubMed2000

[Acute renal insufficiency caused by bilateral ureteral obstruction after appendectomy in a 6-year old boy].

A 6-year-old boy developed macroscopic haematuria on the 4th day after appendectomy for acute appendicitis, at which the appendix was found to be perforated. During the next few days the urine secretion decreased and malaise, pain in the lower abdomen, nausea and vomiting occurred. On a management of ample fluid administration, the urine secretion recovered and the symptoms subsided in a few days. In the early postoperative stage after appendectomy in children the possibility should be kept in mind of the development of acute renal insufficiency due to bilateral ureteral obstruction as a result of oedema of the posterior bladder wall, even if by means of ultrasonography only mild to moderate abnormalities are noted. Awaiting decompression by means of the introduction of bilateral ureteric stents, in order to prevent irreversible renal damage, supportive therapy with fluid administration depending on the diuresis seems indicated.

Acute Kidney Injury↗
PubMed1999

Laparoscopic appendectomy for ruptured appendicitis.

We conducted a retrospective analysis to assess the feasibility of laparoscopic appendectomy in cases of ruptured appendicitis. Between August 1993 and April 1998, a total of 328 laparoscopic appendectomies were performed in Min-Shen General Hospital. There were 34 cases of pathology-proven ruptured appendicitis. Patients were divided into three groups according to the operative findings: group 1 (10 cases) consisted of patients with a perforated appendix with local peritonitis, group 2 (15 cases) consisted of patients with perforated appendix with diffused peritonitis, and group 3 (9 cases) consisted of patients with abscess formation around the perforated appendix. Three cases in group 3 were converted to laparotomy and were excluded from this study. Mean age (+/- SD) was 30 +/- 15 years in group 1, 39 +/- 23 years in group 2, and 37 +/- 13 years in group 3. Duration of symptoms was longer in group 3 (4.2 +/-1.2 days) than in group 1 (1.8 +/- 1.3 days) and group 2 (2.3 +/- 1.2 days). There was no difference in operation time among groups 1 (52 +/- 10 min), 2 (64 +/- 13 min), and 3 (67 +/- 16 min). The time of flatus passage after operation was similar in the three groups (group 1, 17 +/- 11 hours; group 2, 21 +/- 12 hours; group 3, 24 +/- 8 hours). Hospital stay was significantly shorter in group 1 (3.0 +/- 1.1 days) than in group 2 (5.1 +/- 2.2 days) and group 3 (4.2 +/- 1.2 days). There were no complications and no readmissions. Our results indicate that the laparoscopic approach is feasible for ruptured appendicitis with local or diffuse peritonitis and in selected cases with abscess formation. However, prospective randomized controlled trials are needed to determine which procedure is to be recommended.

Adolescent↗
PubMed1975

[Technical aspects of appendectomy].

The author suggests a guiding plate for appendectomy that enables a surgeon to make incisions of the anterior abdominal wall in adults strictly in accordance with the demands of the Volkovich-D'yakonov access. Moreover, he suggests a wound spreader for appendectomy, supplied with a grip mechanism, that helps avoiding peritoneal traumas and facilitates suturing of muscles.

Adult↗
PubMed2001

[Video-assisted appendectomy].

BACKGROUND: The acceptability of the classic laparoscopic technique in the treatment of acute appendicitis is slow, probably due to the higher costs of this method compared to the cheaper, efficacious, safe and rapid discharge associated with traditional surgery. METHODS: In order to combine the advantages of the laparoscopic technique with those of traditional surgery, we performed a retrospective study of the safety, efficacy, rapid discharge with return to normal working activities, and the costs in 70 patients referred to our attention with a diagnosis of acute appendicitis and who underwent one trocar appendectomy. This technique consists of positioning a single trocar in an umbilical site and using a 10 mm telecamera with a 5 mm operating canal. Having visualised the appendix and freed it from any synechiae, the distal end is grasped and it is removed through the umbilical trocar. Appendectomy is performed outside using a technique that is similar to traditional surgery. The diagnosis of acute appendicitis was made on the basis of clinical data (pain, leucocytosis, fever, possible resistance in the right iliac fossa).

Adolescent↗
PubMedDate not supplied

[Laparoscopic appendectomy. State of the art].

The authors present the results of a fact-finding survey on the state of the art of laparoscopic appendectomy in North-Eastern Italy. Over the period from 1991 to 2000 a total of 10,451 laparoscopic procedures were performed. Despite the extensive and increasing use of minimally invasive surgery, only 58% of the surgeons surveyed adopt laparoscopy in the management of suspected acute appendiceal disease. Thirty-six percent of surgeons indicate laparoscopy for all patients, while 60% reserve laparoscopic appendectomy for female patients. Forty-seven point one percent of procedures are performed in an emergency setting (within 6 hours of admission to hospital). The mean conversion rate is 4.9% and is mainly due to the aftermath of inflammation. Major intraoperative complications are of the order of 0.08%, while major postoperative morbidity is 0.6%. Wound infections are reported in 2% of patients. The mean hospital stay is 3 days. The majority of surgeons remove the appendix even in the absence of macroscopic inflammation and convert the procedure in the presence of suspected neoplastic disease found incidentally at surgery. The high diagnostic potential of the laparoscopic approach may well explain the infrequent use of preoperative imaging techniques.

Appendectomy↗
PubMed2003

[Appendectomy--classical or laparoscopic?].

The authors demonstrate on a group of 219 patients, who had in last two years the appendectomy performed, results of care while using open and laparoscopic technique. They compare these depending on chosen parameters, which is the usage of analgetic, the time patients have to stay in hospital after performed operation and comparison of spirometry within specific patients before and after operation. Based on these parameters the authors did not prove clear advantages of laparoscopic appendectomy.

Appendectomy↗
PubMed1992

[Comparison between of acupuncture and epidural anesthesia in appendectomy].

It was a clinic comparative observation of the effects between acupuncture and epidural anesthesia in appendectomy. Eighty patients with appendicitis were randomly divided into two groups, each of 40 Patients. The results were no significant difference between two groups in successful rate. It is convinced that acupuncture on Zusanli points (ST36) has analgesia. There were less respiratory depression, hypotension, cardiac arrhythmia and less amount of liquid infusion needed than that of the epidural block during operation. Furthermore, in the group of acupuncture anesthesia, the intestinal gas excreted earlier, the analgetics and antibiotics administered were less and the rate of the wound infection were reduced after operation. These postoperative effects were significantly better than the controls. As it is of clear-cut effects of anesthesia by acupuncture with main points Zusanli and auxiliary points Hegu (LI4) and less interfered life sign in the operation, thus it is desirable to use acupuncture anesthesia in appendectomy.

Acupuncture Analgesia↗
PubMed1992

Laparoscopic appendectomy: a new opportunity for curing appendicopathy.

It is strongly disputed whether the appendix is indeed the cause of chronic abdominal complaints, even when the pain is situated in the right lower quadrant. In 1976 the introduction of a new operative technique, the laparoscopic appendectomy, offered new insight by making it possible to remove an appendix that is not acutely inflamed through a second insertion in the right lower quadrant by using the open stump method. Between 1976 and 1989, this operation was performed on 1,214 patients in a regional population of about 75,000 people and was successfully performed in 85%. Two subgroups totaling 215 patients showed a success rate of greater than 80% with no major complications; after one year, the patients' scars were almost invisible. This high success rate of a somatic therapy for a so-called psychosomatic disease can be explained by the following possible pathological changes in the appendix: corpora aliena, parasites, kinking, adhesions, obliterations, viral follicular hypertrophy, fibrosis, and neural changes. Most of these conditions are postinfectious. The greater ability of female patients to handle infection results in differences between the two sexes in frequency, development, and behavior of the disease. Laparoscopy alone can reveal a herd of pathologic conditions in patients with pain of unknown origin. With the aid of the laparoscope, appendectomy can be added safely and more patients relieved from chronic abdominal complaints than previously thought possible.

Abdominal Pain↗
PubMed1992

Pre-operative shaving and wound infection in appendectomy.

The study on the effects of shaving the skin on wound infections after appendectomy was done in 80 patients in 1988 in Siriraj Hospital. Patients were divided randomly into two groups, 40 patients each, a control and an experiment group. The control group had their skin shaved and the experiment group did not. Data showed no difference in: demography, preoperative admission time, interval between skin preparation and surgery, thickness of subcutaneous tissue, operating time, and suture materials. Shaving of the skin resulted in no alteration in bacteria found on the skin, on the walls of the wound before closing. Stitch abscesses were the only wound infection found in 3 patients in each group. It is concluded that skin shaving, though it did not increase wound infection rate, had no beneficial effect on wound infection in appendectomy.

Adolescent↗
PubMed1992

[Abdominal actinomycosis. Actinomycotic abscess 10 years after appendectomy].

A case of actinomycosis of the abdomen ten years after surgery for acute appendicitis is reported. The patient, a 2 1/2 years old girl at the time of operation, presented with acute abdominal pain ten years after appendectomy. Computed tomography (CT) showed a mass in the region of the right psoas muscle. Fine needle aspiration revealed pus which on culture was found to contain Actinomyces israeli. Since surgery is a well known probable cause of abdominal actinomycosis, we must assume the appendectomy and the formation of the actinomycotic abscess to be related. Discovery of an abdominal mass even years after violation of the gastrointestinal tract should arouse suspicion of an abscess involving these otherwise infrequent pathogens.

Actinomycosis↗
PubMed2003

Appendectomy at the time of cesarean section.

The current world literature estimates the incidence of appendicitis in pregnancy at approximately 1 case per 1500 normal deliveries. Observations of one physician and review of records from Saint Anthony Hospital in Oklahoma City have suggested potential benefit to routine examination of the appendix at the time of cesarean section and removal if it appears pathologic. The medical literature was reviewed regarding appendicitis in pregnancy and incidental or indicated appendectomy at the time of cesarean section. Many authors have described difficulties with diagnosis, as well as potential complications of appendicitis in pregnancy. Studies have confirmed the safety of performing incidental appendectomy at the time of cesarean section. The authors, therefore, propose that clinicians visualize and palpate the appendix at all cesarean sections, and remove those with evidence of inflammation or disease.

Appendectomy↗
PubMedDate not supplied

[Minilaparoscopic appendectomy: which indications?].

Laparoscopy has gained widespread acceptance in common surgical practice as a diagnostic and therapeutic tool. Suspected appendicitis is still a diagnostic challenge to the general surgeon. A correct diagnosis is crucial because of the various diseases that may be responsible for the same symptoms, in order to plan the appropriate procedure or avoid an unnecessary laparotomy. Laparoscopy is the only minimally invasive technique to allow at the same time for adequate diagnosis, appropriate treatment and the best abdominal approach. Minilaparoscopy would appear to be a natural further step in the development of this technique. The aim of the present work was to illustrate retrospectively the results of an initial case-control study of minilaparoscopy vs. laparoscopy carried out at our institution. Between January and December 2002 a total of 86 patients underwent emergency and/or urgent appendectomy. Among them, 68 (79%) were operated on laparoscopically (37 [54.4%] with a minilaparoscopic approach and 31 with conventional laparoscopy), while 18 (21%) were treated by laparotomy, as performed by a well-trained surgical team. In the minilaparoscop group we registered no conversions to laparotomy and only one major postoperative complication (intra-abdominal abscess treated laparoscopically). As regards the postoperative period, generally speaking, the patients' conditions (analgesic treatment, flatus, diet, hospital discharge) were broadly the same as in the laparoscopic group. Though limited by its initial retrospective character, the present study shows that minilaparoscopic appendectomy is as safe and effective as classical laparoscopic surgery, and seems to be associated with less trauma and a more rapid postoperative recovery. Such features make minilaparoscopy a challenging alternative to conventional laparoscopy (and, of course, laparotomy) in patients referred for urgent abdominal and/or pelvic surgery.

Adolescent↗
PubMedDate not supplied

Laparoscopic appendectomy in a female patient with situs inversus: case report and literature review.

BACKGROUND: Situs inversus is an uncommon condition caused by a single autosomal recessive gene of incomplete penetration. A potential diagnostic dilemma can occur in the young female patient with a history of situs inversus who presents with pelvic pain. METHODS: A 32-year-old multiparous patient with a known history of situs inversus presented with complaints of pelvic pain. A medical history and full physical examination were indicative of possible endometriosis. RESULTS: The patient underwent an operative laparoscopy, which revealed stage II pelvic endometriosis based on the American Fertility Society Revised Classification for Endometriosis (R-AFS), with appendicular and periappendicular adhesions involving the cecum. Ablation of endometriosis and an appendectomy were performed. CONCLUSION: The authors believe the laparoscopic approach to an appendectomy is ideal in a patient with situs inversus and should be performed at the time of laparoscopy performed for another reason.

Adult↗
PubMed2004

[Effect of appendectomy as an etiological factor in tubal sterility].

In our retrospective study we try to find out the correlation between appendectomy and development and severity of tubal sterility. We analyzed 342 HSG and the results of 210 following diagnostic laparoscopies. The results show direct connection between complicated appendectomy and the stage of development of tubal sterility.

Adult↗
PubMedDate not supplied

[Appendiceal tumors. Clinicopathologic review of 5,307 appendectomies].

INTRODUCTION: Appendix tumors are unusual, accounting for 0.4% of all gastrointestinal- tract malignancies. Although rare, the spectrum of malignant disease is complex and has led to confusion with regard to accurate description of the natural history of these tumors. Consequently, many errors in diagnosis and treatment have occurred. OBJECTIVE: Our aim was to analyze incidence and clinic-pathologic behavior of appendiceal tumors. METHODS: Our study type was retrospective, observational, longitudinal, and descriptive, and was conducted at a secondary-care-level hospital. From a single care center, a histopathologic database of 5,307 appendectomies, all appendiceal tumors, was identified and case notes were reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 10-year period (5,307 appendectomies), 31 patients (0.58%) with appendiceal tumors were identified: 11 had carcinoid tumors, 18 benign, and two patients had malignant tumors. Acute appendicitis was the most common presentation (79.1%), and 20.3% were normal appendices. Patients with appendiceal tumor included 23 females and eight males with mean age of 48 years. Ninety seven percent of patients had preoperative diagnosis of acute appendicitis. CONCLUSIONS: Appendiceal tumors are uncommon and most commonly present as acute appendicitis. Macroscopic suspicion during surgery is the most important point to make the best decision.

Adolescent↗
PubMedDate not supplied

Management of wound infection after appendectomy: are parenteral antibiotics useful?

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix.

Administration, Cutaneous↗
PubMed2005

Efficacy of laparoscopic appendectomy in appendicitis with peritonitis.

Laparoscopic appendectomy (LA) is safe and effective in cases of peritonitis, perforation, and abscess. We investigated our conversion rate and clinical outcomes in this patient population, as well as preoperative factors that predict operative conversion. A retrospective nonrandomized cohort of 92 patients underwent LA for acute appendicitis with peritonitis, perforation, or abscess at our institution between 1997 and 2002. Thirty-six of the 92 were converted to open appendectomy (OA), yielding a conversion rate of 39 per cent. The presence of phlegmon (42%), nonvisualized appendix (44%), technical failures (8%), and bleeding (6%) were reasons for conversion. Preoperative data had no predictive value for conversion. CT scan findings of free fluid, phlegmon, and abscess did not correlate with findings at the time of surgery. Total complication rates were 8.9 per cent in the LA group as compared to 50 per cent in the converted cohort. Postoperative data showed LA patients stayed 3.2 days versus 6.9 days for converted patients (P = 0.01). LA patients had less pneumonia (P = 0.02), intra-abdominal abscess (P = 0.01), ileus (P = 0.01), and readmissions (P = 0.01). LA is safe and effective in patients with appendicitis with peritonitis, perforation, and abscess, resulting in shorter hospital stays and less complication.

Adult↗