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At least 649 records · Page 36Linked to original sources
PubMed1998

[Appendectomy with respect to flat fee and special rate charges. Cost analysis of open and laparoscopic operation].

The introduction of flat charges per case and special fees, first put into effect on Jan. 1, 1996, has lead medical and administrative personnel to rethink how fixed daily hospital rates, costs individually determined by each hospital, and prime costs for hospital and nursing charges will be reimbursed. The amount paid for flat charge cases and special fees (in German Marks) are currently the same nationwide. This applicable system of billing consists of a combination of diagnosis (ICD 9) and the type of therapy administered after each specific operation (ICPM). Between Jan. 1, 1996 and Dec. 31, 1996 we had 78 cases, where detailed personnel and relevant costs were recorded with the aid of three sheets of medical records and two reports for each patient. When comparing expenditures and compensation, there were deficits in 75 cases and surpluses in 3. This existing pressure to cut costs should not be allowed to lead to uncritical medical judgement. The major costs of an operation are for disposable materials, especially for the use of the endo-cutter. Laparoscopic appendectomies, on selected patients in our clinic, has created a deficit when covering costs for open appendectomies. The knowledge we have gained from this now enables us to balance out the deficit.

Aged↗
PubMed1994

What is the learning curve for laparoscopic appendectomy?

When contemplating converting from open to laparoscopic appendectomy, a prudent surgeon should consider the anticipated learning curve. To evaluate this we reviewed our experience with 20 sequential patients representing this transition. We found the learning curve was brief and did not compromise clinical results. A reduction in hospitalization time without a rise in total hospital costs should encourage the experienced laparoscopic surgeon to consider laparoscopic appendectomy as a viable alternative to standard laparotomy in the resection of the acutely inflamed appendix.

Acute Disease↗
PubMed1984

Appendix mass: conservative management without interval appendectomy.

Forty-nine patients had conservative treatment of an appendix mass without interval appendectomy. Five were lost to follow-up within 6 months, and 44 patients were followed for between 6 months and 22 years. In nine patients (20 percent) recurrent appendicitis developed, and six (14 percent) suffered chronic pain not thought to be due to appendicitis. Of the recurrences, 66 percent occurred within 2 years of the initial attack. Barium examination of the cecum was successful in diagnosing two of three additional patients in whom a right iliac fossa mass was not due to appendicitis. The morbidity and expense of routine interval appendectomy was thus eliminated in 80 percent of the patients.

Abscess↗
PubMed1994

Laparoscopic Incidental Appendectomy: Prevention or Therapy?

This retrospective review describes our experience with the benefits of laparoscopic incidental appendectomy performed in association with various gynecologic procedures. Eighty-five women in the reproductive age group (25 to 48 years of age) were included in this study. Indications for laparoscopy included pelvic pain, pelvic adhesions, and possible endometriosis. There was no immediate or late procedure-related morbidity to the procedure. Visible pathology of the appendix was detected in 16.8% of patients. Of grossly normal appendices, histopathologic examination revealed pathology in 42.4% of cases. Our results suggest that because of the high incidence of pathology in this age group of women, incidental appendectomy at the time of laparoscopy may serve both as a preventive and a therapeutic measure.

Journal Article↗
PubMed1999

Appendectomy in pregnancy: the experience of a university hospital.

The files of pregnant patients who underwent appendectomy at our hospital over the period 1977-96 were studied retrospectively. Forty-six patients were operated upon amongst 52 108 deliveries over this period. Of those 27 had uncomplicated acute appendicitis and six had one of the complications of acute appendicitis (a prevalence of 0.063%). Thirteen had normal appendices (71.7% accuracy). Obstetric complications occurred in four patients, with three fetal losses (6.5%). Those with complicated appendicitis had significantly delayed presentation, in-hospital delay and prolonged postoperative stay. Recently we used diagnostic laparoscopy in two patients for diagnosis and to perform appendectomy in one. In conclusion, the incidence of acute appendicitis in pregnancy seems to be the same over the period of gestation and the diagnostic accuracy seems to be related both to the late presentation by the patient and to physician delay. Maternal morbidity and fetal loss are mostly limited to those with complicated appendicitis.

Journal Article↗
PubMed1988

Chronic atrial appendectomy alters sodium excretion in conscious monkeys.

The purpose of this study is to determine whether chronic removal of atrial appendages alters renal response to volume expansion in the conscious monkey. Chronic bilateral atrial appendectomy (ATX) was performed in six animals. Six additional animals served as sham-operated controls. Monkeys were studied 1-2 wk after chronic surgery. The protocol consisted of three consecutive 10-min urine collections followed by 20% ischemic blood volume expansion (VE) and 120 min of post-VE measurements. In sham animals, VE caused an increase in plasma atrial natriuretic peptide (ANP) levels (48 +/- 7 pg/ml to a peak of 108 +/- 34 pg/ml). Urine flow increased from 0.43 +/- 0.07 to 1.07 +/- 0.24 ml/min, sodium excretion increased from 17.9 +/- 2.6 to 74.9 +/- 12.0 mu eq/min, and fractional sodium excretion increased from 0.67 +/- 0.10 to 2.43 +/- 0.28%. ATX attenuated the increase in ANP (34 +/- 8 pg/ml to a peak of 38 +/- 9 pg/ml) in four of six animals. In these animals, renal response to VE was significantly attenuated. Urine flow increased from 0.21 +/- 0.05 to 0.30 +/- 0.01 ml/min, sodium excretion increased from 19.3 +/- 6.02 to 37.8 +/- 5.05 mu eq/min, and fractional sodium excretion increased from 0.79 +/- 0.08 to 1.43 +/- 0.17%. Renal response of two ATX animals with normal increases in atrial natriuretic factor was similar to the sham group. Effect of volume expansion on mean arterial pressure, central venous pressure, and renal hemodynamics was not altered by ATX. These findings demonstrate that bilateral atrial appendectomy in the monkey attenuates the increase in ANP and reduces renal response to VE.

Animals↗
PubMed1998

An acute scrotum following a laparoscopic appendectomy.

We report a case of a 13-year-old boy who developed an acute left hemiscrotum following a laparoscopic appendectomy for a perforated appendicitis. Laparoscopic techniques have provided surgeons and their patients with effective and less invasive methods to treat illness that previously required open surgery. However, complications can occur with these new surgical modalities. It is incumbent upon the surgeon to carefully document and evaluate these complications, facilitating preventive measures, and allow for a proper and timely diagnosis and treatment plan in the future. Herein, we present a previously unreported urologic complication of an acute scrotum following a laparoscopic appendectomy for a perforated appendicitis.

Adolescent↗
PubMed1988

Simple ligation vs stump inversion in appendectomy.

The records of 886 patients who had appendectomy performed by the same surgeons within a five-year period were used to contrast appendiceal stump inversion vs simple ligation. Our analysis contrasted inversion vs simple ligation techniques as related to postoperative complications, hospital stay, and pathologic diagnosis. Adhesions requiring repeated operation to relieve bowel obstruction occurred in five of 87 patients with acute gangrenous appendicitis treated by inversion. Of 106 patients with acute gangrenous appendicitis treated with simple ligation, postoperative obstruction developed in none. No other statistically significant differences existed between the two techniques. These data suggest that simple ligation is at least as good as and probably better than inversion of the appendiceal stump.

Acute Disease↗
PubMed1991

[Is concomitant preventive appendectomy in childhood justified?].

Appendicitis is an entity without specific symptoms. Multiple false diagnoses result from this, especially in childhood, in pregnancy, and in old age. We discuss whether incidental protective appendectomy is recommended in childhood in small bowel obstructions due to intussusception, comparing the data obtained from 100 children who were appendectomized with those of 32 children who were not.

Adult↗
PubMed1995

The E.A.E.S. Consensus Development Conferences on laparoscopic cholecystectomy, appendectomy, and hernia repair. Consensus statements--September 1994. The Educational Committee of the European Association for Endoscopic Surgery.

Under the mandate of the Educational Committee of the European Association of Endoscopic Surgery (E.A.E.S.), three consensus development conferences (CDCs) were performed in order to assess the current status of the endoscopic surgical approaches for the treatment of cholelithiasis, appendicitis, and inguinal hernia. Consensus panels for the different disease states (10-13 members each) selected by the education committee on the basis of members' clinical expertise, academic activity, community influence, and geographical location weighed the evidence on the basis of published results according to the criteria for technology assessment: feasibility, efficacy, effectiveness, economy. Draft statements were prepared, discussed by the panels, and presented at plenary sessions of the 2nd European Congress of the E.A.E.S. in Madrid September 15-17, 1994. Following discussions final consensus statements were formulated to provide specific answers for each topic to a minimum of the following questions: 1. What stage of technological development is the endoscopic surgical procedure at (in September 1994)? 2. Is endoscopic surgery safe and feasible? 3. Is it beneficial to the patients? 4. Who should undergo endoscopic surgery? 5. What are the training recommendations? Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. Laparoscopic appendectomy is presently at the efficacy stage of development, because most of the data on feasibility and safety originate from centers with special interest in endoscopic surgery: it is not yet the gold standard for acute appendicitis. Endoscopic hernia repair is presently a feasible alternative for conventional hernia repair if performed by experienced endoscopic surgeons. It appears to be efficacious in the short-term. The full text of the consensus panel's statements is given in this publication.

Appendectomy↗
PubMed1990

Laparoscopic appendectomy in pregnancy.

Since 1982 we have operated on more than 150 patients using the laparoscopic appendectomy technique. Our complication rate was 0.75% and the patients included six pregnant women in all stages of pregnancy. There were no complications in this group of six women.

Adult↗
PubMed1983

[Appendectomy - tenets of a century].

A small hospital reports on the results of 1302 appendectomies: all degrees of morbidity of the appendix and all patient ages are represented. There were only 2 deaths (0.15%), which also illustrates the very satisfactory success rate in the 16 "urgent early relaparotomies" (only 1 of 11 patients died). Richly demonstrated by case reports, it deals with diagnostic, indicative, and intraoperative problems and finally broaches the subject of "suppurative pylethrombophlebitis" secondary to acute appendicitis, including the question about its fateful course.

Abscess↗
PubMed1993

[Laparoscopic appendectomy as a routine procedure].

At the Gynaecology Department of the Bethesda Hospital, 100 patients undergoing a laparoscopic appendectomy were recruited for a prospective study. The first ten patients received no antibiotic, the second ten were given a three-day course of cephazolin, the third ten were treated with a combination of sulbactam and ampicillin and the remaining 70 received cefuroxime. There were no significant differences between the four groups in the mean operating time, the intraoperative complication rate or in the degree of inflammation as classified by the histological examination. The reduced rate of postoperative complications defined as pyrexia > 38 degrees C, elevated WBC and peritoneal irritation for more than two days, showed the advantage of antibiotic prophylaxis with cefuroxime with respect to single parameters and overall complication rates. There were no intraoperative or severe postoperative complications.

Adolescent↗
PubMed1991

Colonoscopic appendectomy: report of a case.

A persistent appendix occurred after inversion appendectomy. Colonoscopic removal was straightforward and would appear to be the treatment of choice in this unusual circumstance.

Adult↗
PubMed1992

Technical modification to laparoscopic appendectomy.

An alternative technique for laparoscopic appendectomy is described. The isolated appendix is exteriorized through the trocar wound, ligated, and resected. The cecum is then returned to the abdomen.

Appendectomy↗
PubMed1977

Cecal changes following appendectomy.

The appearance of the cecum was followed from two days to 18 months after appendectomy in a series of 12 patients. The changes were often discrete and well defined. The typical localized deformation of the medial aspect of the cecum due to the invaginated appendiceal stump disappeared in half of the patients while its size was not reduced in the other half of the patients. The localized deformation was rather constant in size and measured approximately 2 X 2 cm.

Adolescent↗
PubMed1996

Ureteral injury during appendectomy.

A case is described of a patient whose right upper ureter had been injured during appendectomy. The defect was too long so we performed ileal substitution for ureter.

Adolescent↗