Laparoscopic appendectomy is superior to open appendectomy in obese patients

BACKGROUND: There are minimal data comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in obese patients. METHODS: We reviewed consecutive adult patients from 2003 to 2005 who underwent an appendectomy at a University-affiliated teaching hospital. Obesity was defined as a body mass index of 30 or greater. Outcome measures included length of stay, surgical times, intra-abdominal abscesses, wound infections, and hospital charges. RESULTS: There were 116 patients with a mean body mass index of 35. Eighty-five patients underwent LA, 12 were converted to open, 4 of 12 (31%) were perforated. Thirty-one patients underwent OA. Overall, 21 (18%) were perforated. Length of stay for LA was better, 3.4 days versus 5.5 days for OA (P = .02), and wound closure rate was better, 90% for LA versus 68% for OA (P < .01). Other outcome measures were equivalent. CONCLUSIONS: LA is associated with shorter lengths of stay, fewer open wounds, and equivalent hospital charges and intra-abdominal abscess rates; and should be considered the procedure of choice for obese patients with appendicitis.     

Laparoscopic vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.     

Laparoscopic versus open appendectomy in acute appendicitis: A randomized prospective study

Background: Laparoscopic appendectomy is a safe and effective procedure, as both a diagnostic and therapeutic tool. It seems to be more effective than the corresponding open procedure. Aim of this study is to evaluate a group of patients randomly allocated either to laparoscopic appendectomy (LA) or to open appendectomy (OA). Methods: From January 1998 to December 2002, 252 consecutive and nonselected patients, 155 women and 97 men, were randomized either to LA or OA. Recorded data were operative time, postoperative length, of stay and complications. Results: Mean operative time was 45 min (range 30–120) for OA and 36 min (25–60) for LA, mean postoperative stay was 5.5 days (4–12) for OA and 3.4 days (2–8) for LA. Complication occurred in 20 patients (14.5%) for OA and in four patients (2.6%) for LA. Conclusion: We believe that LA is effective in any kind of clinical situation, with low traumatic impact and best comfort for the patient.     

腹腔镜与开腹阑尾切除术的临床比较

目的:比较腹腔镜与开腹手术切除阑尾的优缺点。方法:回顾性分析我院2010年1月1日—2012年3月31日292例行阑尾切除术患者的临床资料,根据手术方法分为单孔法腹腔镜阑尾手术组、多孔法腹腔镜阑尾手术组和开腹阑尾手术组,比较手术时间、出血量、术后排气时间、术后住院时间切口愈合等级及感染率。结果:单孔法腹腔镜阑尾手术组中1例转为多孔法,多孔法腹腔镜阑尾手术组中1例中转开腹,其余患者均完成手术。2例多孔法腹腔镜阑尾手术患者术后并发粘连性肠梗阻,经保守治疗后好转。与传统开腹手术相比,腹腔镜阑尾切除术手术时间短、出血量少、术后排气快、术后住院时间短;对于急性单纯性阑尾炎,单孔腹腔镜手术比多孔法出血更少,瘢痕更小。结论:腹腔镜阑尾切除术对腹部干扰少,单孔法切口更为隐蔽,在熟练掌握手术技术的前提下可以广泛应用。     

Laparoscopic versus open appendectomy

Background: Although laparoscopic appendectomy is widely practiced in developed countries, still there are many questions regarding the advantages and disadvantages of this approach in the treatment of acute appendicitis. Several controlled trials have been conducted, some in favor of laparoscopic appendectomy others not. The aim of this study was to evaluate laparoscopic appendectomy in comparison with open appendectomy, with special emphasis on postoperative septic complications. Methods: For this study, 227 consecutive patients (159 males and 68 females) with a diagnosis of suspected appendicitis between 1995 and 1999 were assigned either to laparoscopic appendectomy (n = 108) or open appendectomy (n = 119). The patients were assigned according to insurance company approval and patient preference. There were no exclusion criteria and no age limits in this study. Results: Wound infection was significantly higher in the open group (incidence, 7.6%) than in the laparoscopic group (incidence, 0%; p < 0.003). Intraabdominal infections were equal in both groups. Hospital stay was significantly shorter in the laparoscopic group (p < 0.046), but operative time was little longer than in the open group (p < 0.002). Conversion to open surgery was necessary in one case. Conclusions: Laparoscopic appendectomy is as safe and effective as the open procedure. It significantly reduces the rate of postoperative wound infection. However, it is still acceptable to perform the open procedure, especially in hospitals without a large amount of laparoscopic experience.     

肥胖患者行腹腔镜与开腹阑尾切除术疗效的对比研究

目的 对比分析肥胖患者行腹腔镜与开腹阑尾切除术的临床效果.方法 回顾性分析2008-2010年因急性阑尾炎在中国医科大学附属盛京医院行阑尾切除术的肥胖患者153例的临床资料.153例中,腹腔镜阑尾切除术92例(其中4例转为开腹),开腹阑尾切除术61例,对两种术式的手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间和住院费用进行比较.计数资料比较采用x2检验,计量资料采用t检验.结果 腹腔镜阑尾切除术组在手术时间、术中出血量、术后排气时间、术后止痛药使用频率、术后主要并发症的发生率、住院时间方面均短于或少于开腹阑尾切除术组,差异有统计学意义(手术时间:t=14.0,P＜0.01;术中出血量:t =19.7,P＜0.01;术后排气时间:t=12.3,P＜0.01;术后止痛药使用频率:t=21.01,P＜0.01;术后主要并发症的发生率:x2=40.138,P＜0.01;住院时间:t=17.3,P＜0.01).两者在住院总花费上的差异无统计学意义(=1.434,P =0.154).结论 肥胖患者行腹腔镜阑尾切除术治疗阑尾炎与开腹阑尾切除术相比具有创伤小、恢复快、并发症少和平均住院时间短等优点,是治疗肥胖阑尾炎患者理想的手术方式.     

Laparoscopic versus open appendectomy for perforated appendicitis

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean ± SD =96.1±43.1 vs. 67.8±32.2 minutes, P<0.01). Return of oral intake was faster in the LA group (3.2±2.4 vs. 5.0±7.0 days, P<0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4±2.8 vs. 6.3±7.1 days, P<0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P<0.01). Hospital stay days were shorter for the LA group (6.3±2.9 vs. 9.3±8.6 days, P<0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.     

腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效分析

目的 比较腹腔镜阑尾切除术(laparoscopic appendectomy,LA)和开腹阑尾切除术(open appendectomy,OA)治疗急性阑尾炎的结果.方法 将2005年5月至2010年5月收治的396例行阑尾切除术的急性阑尾炎病人按手术方法分为LA组和OA组,比较分析两组病人的临床资料.结果 LA组与...     

腹腔镜阑尾切除与开腹阑尾切除术的对比研究及Meta分析

目的比较腹腔镜与开腹阑尾切除术对急性阑尾炎的疗效和手术安全性。方法收集2006年10月至2007年10月问120例急性阑尾炎患者进行前瞻性研究,随机分为两组,分别采用腹腔镜阑尾切除（LA）术式和开腹阑尾切除（OA）术式,对手术时间、术中出血量、术后胃肠功能恢复时间、止痛药物应用时间、开始进食时间、住院天数和术后并发症等指标进行比较分析。并对1996年1月至2008年12月期间的该类前瞻性随机对照研究（RCT）文献进行Meta分析,比较两种术式手术时间、住院天数和并发症等指标。结果本组资料表明,两组手术时间、出血量无明显差异,而LA组肠功能恢复时间、止痛药物应用时间、住院天数明显短于OA组,LA组手术并发症也少于OA组;Meta分析有6组资料纳入,LA住院天数和手术并发症少于OA组,而两组的手术时间无明显差异。结论腹腔镜阑尾切除术具有恢复时间短、术后疼痛轻、住院时间短和并发症发生率低等优点,值得推荐。     

Comparison of Outcomes After Single-Port Laparoscopic Cholecystectomy in Relation to Patient Body Mass Index

Background and Objectives:

Single-port laparoscopic cholecystectomy may contribute to a paradigm shift in the field of laparoscopic cholecystectomy surgery by providing patients with benefits beyond those observed after other surgical procedures. This study was designed to evaluate clinically meaningful differences in operative outcomes between obese and nonobese patients after single-port laparoscopic cholecystectomy.

Methods:

Data were collected retrospectively from 172 patients who had undergone single-port laparoscopic cholecystectomy performed by the same surgeon at a single medical center between January and December 2011. For the outcome analysis, patients were divided into nonobese and obese patient groups according to their body mass index (<25 kg/m² vs ≥25 kg/m²).

Results:

Demographic and clinical data did not differ significantly between obese patients (n = 65) and nonobese patients (n = 107). In addition, statistically significant differences pertaining to most measured surgical outcomes including postoperative hospital stay, bile spillage, additional port use, and open conversion were not detected between the groups. However, the two groups differed significantly regarding operative time such that nonobese patients had shorter operative times than obese patients (P < .05).

Conclusion:

The results of this study showed that operative time for single-port laparoscopic cholecystectomy was the only difference between obese and nonobese patients. Given this result, body mass index may not be as relevant a factor in patient selection for single-port laparoscopic cholecystectomy as previously thought.     

Laparoscopic appendectomy in pregnancy

Summary 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.Based on a presentation to the XII World Congress of Gynecology and Obstetrics, Rio de Janeiro 1988     

Laparoscopic appendectomy in the elderly

Background This study aimed to compare the outcomes of laparoscopic and open appendectomy among the elderly. Methods Data on 53 elderly patients with a diagnosis of suspected appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 24 had undergone laparoscopic appendectomy (LA) and 29 had undergone open appendectomy (OA). The indications for either method were based on the patient’s choice. Results No statistically significant difference in operative time was found between the LA (70 ± 28 min) and OA (60 ± 22 min) groups. There was no statistically significant difference in lengths of hospital stay between the LA (4.8 ± 3.0 days) and OA (5.0 ± 3.1 days) groups, and there was a statistically significant difference in the postoperative analgesic doses between the LA (0.5 ± 0.3 doses) and OA (1.7 ± 1.5 doses) groups. No conversion of laparoscopic to open surgery was necessary, and no intraabdominal abscesses developed. Conclusion According to this study, LA is as safe and effective as OA for the elderly. Furthermore, it significantly reduces postoperative wound pain.     

Preoperative and postoperative levels of interleukin-6 in patients with acute appendicitis: comparison between open and laparoscopic appendectomy

Background Cytokine interleukin-6 (IL-6) is an early marker of systemic inflammatory response and tissue damage. This study aimed to evaluate the levels of IL-6 after open and laparoscopic appendectomy to compare the degree of surgical stress associated with these procedures.Methods The levels of IL-6 were measured pre- and postoperatively in the plasma of 37 consecutive patients with a diagnosis of acute appendicitis. After preoperative randomization, 22 patients underwent open appendectomy, and 15 patients underwent laparoscopic appendectomy.Results The preoperative concentrations of IL-6 were 7.2 ± 5.6 pg/ml in the open appendectomy group, as compared with 12.1 ± 9.7 pg/ml in the laparoscopic appendectomy group (p < 0.05). The postoperative levels were 16.9 ± 15.7 and 23.2 ± 19.4 pg/ml, respectively. The mean postoperative to preoperative ratio of IL-6 was slightly higher for open (2.7 ± 2.4) than for laparoscopic (2.3 ± 1.6) appendectomy, but the difference did not reach statistical significance.Conclusion The operative stress in open as compared with laparoscopic appendectomy is not reflected by circulating levels of IL-6.     

Laparoscopic appendectomy and minilaparoscopic approach: a retrospective review after 8-years' experience.

BACKGROUND: This is a presentation of our 8-year experience in laparoscopic appendectomy, showing complications and results to determine the advantages and efficacy of laparoscopy. METHODS: We used this technique from December 1990 to December 1998 on 282 consecutive and non-selected patients (169 females and 113 males) with an average age of 24 years (range 5-86 years). All patients were suffering from sub-acute appendicitis or chronic appendicopathies, except for 84 (29.7%) cases of acute appendicitis and 25 (8.9%) cases of gangrenous appendicitis with peritonitis. All patients with suspected appendicitis were evaluated with a laparoscopic exploration. RESULTS: In 39 patients (13.9%), appendectomy was performed along with 19 enucleated or endocoagulated ovarian cysts, 8 adhesiolyses, 6 transperitoneal hernioplasties (4 right and 2 left), 2 cholecystectomies, 2 excisions of a Meckel diverticulum, 1 aspiration and suture of a right tubal pregnancy and 1 electrodesiccation of pelvic endometriosis. Thirty-five patients (12.5%) revealed the presence of a gynecological-type pathology. We performed 2 (0.7%) conversions to open exploration and experienced 6 (2.1%) complications, of which only 1 (0.35%) was a major complication: a delayed hemoperitoneum (1 liter), re-operated elsewhere, the cause of which was not identified. We performed 4 (1.4%) relaparoscopies for retrocecal abscess (three patients with primary gangrenous appendicitis and peritonitis presenting with an abscess in the right iliac fossa and in one patient with widespread intestinal adhesions with primary acute appendicitis). No patient with a diagnosis of a normal appendix developed an intraperitoneal abscess. Mortality was non-existent. The postoperative course, which was subjectively better than in cases operated in the traditional way, was, on an average, 2 days (range 1-18 days) for appendectomies carried out with the traditional laparoscopic technique and 1 day for appendectomies carried out with the minilaparoscopic technique (6 patients). CONCLUSION: We believe that the laparoscopic technique can handle any type of clinical situation, as it can cure several pathologies during the same session with minimal trauma and maximum benefit for the patient. The advantages of a minilaparoscopy approach are based on its low invasiveness and small surgical wounds.     

Laparoscopic versus open appendectomy in children: a randomized controlled trial from a developing country

Background

Acute appendicitis is a common surgical emergency. This study was conducted to compare the outcome in terms of duration of surgery, length of hospital stay, and wound infection rate following laparoscopic versus open appendectomy in children with acute appendicitis.

Laparoscopic appendectomy in children after the learning curve.

OBJECTIVES: Despite its increasing popularity, several recent studies comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in children have failed to demonstrate significant improvements in patient outcomes. Many series include the "learning curve," wherein surgeons inexperienced with laparoscopic techniques compare their results with results with OA with its extensive history. This study was designed to investigate outcomes in pediatric appendectomy patients managed by surgeons with extensive laparoscopic experience. METHODS: We preformed a retrospective review of 197 consecutive children undergoing appendectomy for presumed acute appendicitis from January 2002 through May 2004 at a university-affiliated community hospital by pediatric and general surgeons with extensive laparoscopic surgical experience. RESULTS: The study included 117 patients who underwent LA and 80 who underwent OA. Of 122 acute appendicitis cases, mean operating times were 47 minutes (LA) and 48 minutes (OA). The LA group (n=71) had a faster return to full diet (17.6 h vs. 28.6 h, P=0.0008), and shorter postoperative length of stay (LOS) (1.06 d vs. 1.66 d, P<0.0001) compared with the OA group (n = 51). Complication rates, time on intravenous (IV) antibiotics, and IV opiates were similar among the 2 groups. Complicated appendicitis cases (LA, n=34; OA, n=26) were similar with regard to LOS, return to normal bowel function, complication rate and time on IV antibiotics and opiates, but was associated with an increased operation time (LA, 65 min; OA, 51 min, P=0.02). CONCLUSIONS: Following the completion of the laparoscopic surgery learning curve, LA has a comparable operation time and results in a decreased postoperative LOS, and faster return to normal bowel function compared with OA in children with acute nongangrenous, nonperforated appendicitis.     

Laparoscopic versus open appendectomy: the risk of postoperative infectious complications.

BACKGROUND: Despite the reported advantages of laparoscopic appendectomy (LA), ongoing debate exists about a possible increase in postoperative infectious complication rates especially intraabdominal infections and wound infection, unless wound protection is utilized. METHODS: All consecutive appendectomies (open and laparoscopic) performed over 4 months were included in this prospective study. Demographic details, operative time, time to conversion, infective postoperative complications, and delay in discharge were recorded. The patients were divided into 2 groups, laparoscopic (LA) and open appendectomy (OA). RESULTS: A total of 134 appendectomies were performed, 80 in the LA group and 54 in the OA group. Twenty-six (19.4%) appendices were perforated at the time of operation. The median patient age was 24 years (range, 7 to 63). Patients included 71 females and 63 males. Operating time in the LA group was longer with a median duration of 51.3 minutes (range, 35 to 100) compared with 40.6 minutes (range, 30 to 95) in the OA group. An extraction bag was used in 59/71 (83%) LA patients. Wound infection was recorded in 6 patients (5/54 in OA and 1/80 in LA). The site of wound infection was the port of specimen extraction in the laparoscopic group, and an extraction bag was not used. Wound infection delayed hospital discharge by an average of 2 days. Intraabdominal abscess formation complicated the outcome in 2 patients (1 in the LA group and 1 in the OA group). CONCLUSION: Wound infection is less common in LA than in OA, and an extraction bag is recommended. Intraabdominal infection rates do not appear to be increased, though the numbers in this study are relatively small. The longer operating time is minimal given the better results, and LA is the optimal approach to the diagnosis and management of acute appendicitis.     

Laparoscopic appendectomy using a clip applier

Summary The diagnostic worth and therapeutic value of laparoscopic surgery are known for ovarian cysts and ectopic pregnancies. Diagnosis of appendicitis is difficult, and laparoscopy is useful in these cases. The present study was done to assess the feasibility, efficacy, and advantages of a new laparoscopic appendectomy technique. Between August 1,1989, and July 31,1990, patients exhibiting right pelvic pain associated with fever were divided into three groups according to the pre-operative diagnosis: appendicitis, pelvic inflammatory disease (PID), and diagnostic doubt between appendicitis and PID. An intra-peritoneal appendectomy was performed if the diagnosis was not PID. Via three suprasymphyseal trocars, the appendix was exposed and the mesoappendix was coagulated. The appendix stump was closed using a clip applier (Ethnor T1300). In all, 20 patients underwent laparoscopic appendectomies. The mean duration of the procedure was 36.5 min; in no case was laparotomy necessary. There were no post-operative complications, and digestive transit returned on the 2nd day post-surgery. Both patients and nurses appreciated the technique. The subjects experienced comfortable post-operative periods and gained aesthetic advantages. The operative procedure could be completed on each attempt. We conclude that this technique is sure, quick, and easily reproducible in young patients presenting with right pelvic pain associated with fever.     

Laparoscopic cholecystectomy: relationship of pathology and operative time.

OBJECTIVE: Controversy exists regarding the use and timing of laparoscopic cholecystectomy in the treatment of both acute and chronic cholecystitis. Acute advocates claim to avoid fibrosis and potential dissection injuries, whereas chronic proponents avoid poor visualization due to edema and possible conversion. This study of both acute and chronic cholecystitis cases examines the relationships between pathology, operative time, and outcome of laparoscopic cholecystectomy. METHODS: A retrospective review of medical records and pathology of acute (n = 9) and chronic (n = 62) laparoscopic cholecystectomy cases, performed by 2 surgeons from 1995 to 1999 was undertaken. Using multiple regression techniques, the relationship between operative time and age, sex, race, presenting symptoms, and degree of pathologic cholecystitis was evaluated. RESULTS: One case of acute gangrenous cholecystitis required conversion. None of the chronic cases required conversion. In single variable analysis, abnormal liver function tests, chronic inflammation, wall thickness, and number of stones were each predictive of longer operative time. However, in the multiple regression, abnormal liver function tests were the only clinical factor that remained a predictor of operative time (16 minutes longer, P = 0.05). Time from presentation to operation had no effect on operative time. Twelve patients had preoperative endoscopic retrograde cholangiopancreatography, and 4 had choledocholithiasis (acute n = 1, chronic n = 3). Two chronic patients required postoperative endoscopy for a cystic duct leak (n = 1) and choledocholithiasis (n = 1). The adjusted average operative time for acute and chronic cases was similar (93 versus 74 minutes, P > 0.05). CONCLUSION: Laparoscopic cholecystectomy can be done safely for both acute and chronic cholecystitis with similar operative times. Abnormal liver function tests are associated with longer operative time. Time lapse between presentation and operation has no effect on operative time or outcome.