Factors leading to long-term hospitalization after laparoscopic appendectomy.

BACKGROUND: Randomized studies demonstrate that laparoscopic appendectomy yields better results compared with open techniques. We sought to identify factors that determine an extended hospital stay among patients undergoing laparoscopic appendectomy. METHODS: This was a prospective study including 669 patients undergoing laparoscopic appendectomy. We analyzed variables that can predict the length of hospital stay. RESULTS: Of 669 patients undergoing laparoscopic appendectomy, 141 stayed in the hospital for > or = 5 days (Group 1), and 97 stayed in the hospital for < or = 1 day after surgery (Group 2). The univariate analysis demonstrated that fever (P<0.0001), nausea and vomiting (P=0.060), leukocytosis (P<0.0001), gangrened or perforated intraoperative appearance of the appendix (P<0.0001), and appendix position behind the ileocecal junction (P<0.001) were related to a longer hospital stay. The multivariate analysis through logistical regression showed that the factors independently and significantly associated with an extended hospital stay were presurgical fever, appendix position behind the ileocecal junction, and intraoperative gangrened or perforated appearance of the appendix. CONCLUSION: Fever, appearance, and position of the appendix are factors related to an extended hospital stay.     

腹腔镜阑尾切除术219例临床应用体会

目的：总结腹腔镜阑尾切除术的临床应用体会。方法：回顾性分析219例接受腹腔镜阑尾切除术的患者资料。结果：219例中，215例行腹腔镜阑尾切除术，4例行腹腔镜阑尾周围脓肿引流术。手术均顺利完成，无1例中转开腹，术后无1例发生切口感染、肠粘连、肠梗阻、腹腔残余脓肿形成等并发症，全部治愈出院。结论：腹腔镜阑尾切除术具有创伤小、恢复快、住院时间短、术野清晰、探查范围广、并发症少等优点，尤其在术前诊断不明确时可弥补开腹阑尾切除术的不足，值得进一步推广。     

小儿阑尾切除术1472例分析

目的 分析l472例小儿阑尾切除术的疗效，探讨小儿阑尾炎的诊治方法。方法 我院1982.8—2002．12行小儿阑尾切除术l472例。其中男l163例，女309例，男：女=3．76：l；平均年龄5．7岁(8天至14岁)，6～14岁973例(66．10％)。急诊手术1164例(79。08％)，择期手术308例(20．92％)，脓肿引流4例(0．27％)，阑尾切除1468例(99．73％)，其中296例(20．1l％)是在先天性巨结肠根治术或Meckel憩室切除术等手术中一并行阑尾切除的。结果 急性阑尾炎阑尾切除术后伤口感染83例(7．4％)，粘连性肠梗阻1l例(0．75％)，阑尾残端瘘3例(0．20％)，腹内脓肿3例(0.20％)，死亡l例(0.07％)。结论 小儿急性阑尾炎误诊率及手术前后并发症率高，小儿阑尾炎应早期诊断及尽早手术治疗。     

腹腔镜阑尾切除术残端包埋技巧及临床应用

目的探讨腹腔镜阑尾切除术（LA）残端包埋技巧及临床应用。方法自2008年1月至2011年2月,行LA86例,采取四针正向浆肌层缝合包埋阑尾残端。结果 86例LA均顺利完成阑尾残端包埋,手术时间22～70min,平均36min,术后住院时间2～5d,平均2.8d,无并发症发生。随访71例,随访时间3～12个月,无腹痛症状及其他并发症发生。结论腹腔镜下四针正向缝合包埋阑尾残端,符合缝合习惯,操作简单,安全可行,容易在临床开展应用。     

De Garengeot hernia with perforated appendicitis and a groin subcutaneous abscess: A case report

IntroductionDe Garengeot hernia is rare. Although previous reports have suggested various surgical options according to patient condition, comorbidities, surgeon preference, and clinical findings during surgery, a treatment strategy has not been established.Presentation of caseAn 81-year-old woman presented with an irreducible tender mass that was subsequently diagnosed as an incarcerated femoral hernia with a subcutaneous abscess in the right groin. Intraoperative findings revealed a necrotic and perforated appendix strangulated by the femoral ring for which an appendectomy and herniorrhaphy was performed concurrently through the hernia sac. The subcutaneous abscess cavity was washed thoroughly and a drainage tube was placed within it. The patient recovered uneventfully.DiscussionWe suggest that the approach through the inguinal incision in both appendectomy and herniorrhaphy with drainage may be useful in avoiding intra-abdominal contamination in cases of de Garengeot hernia with subcutaneous abscess.ConclusionHere, we described a case of de Garengeot hernia with a subcutaneous abscess in the groin. Clinicians should consider de Garengeot hernia in patients with a groin hernia, make an early diagnosis, and promptly provide surgical treatment to reduce the risk of complications.     

Umbilical Negative Pressure Dressing for Transumbilical Appendectomy in Childern

Methods:This study was a retrospective chart review of 1377 patients (2–20 years) undergoing laparoscopic appendectomy for acute appendicitis in 2 tertiary care referral centers from January 2007 through December 2012. Twenty-two different operative technique/dressing variations were documented. The 6 technique/dressing groups with >50 patients were assessed, including a total of 1283 patients.Results:The surgical site infection rate of the 220 patients treated with TULAA and application of an umbilical vacuum dressing with dry gauze is 1.8% (95% CI, 0.0–10.3%). This compares to an infection rate of 4.1% (95% CI, 1.3–10.5%) in 97 patients with dry dressing without vacuum. In the 395 patients who received an umbilical vacuum dressing with gauze and bacitracin, the surgical site infection rate was found to be 4.3% (95% CI, 2.7–6.8%).Conclusions:Application of an umbilical negative-pressure dressing with dry gauze lowers the rate of umbilical site infections in patients undergoing transumbilical laparoscopic-assisted appendectomy for acute appendicitis.     

芒硝外敷在腹腔镜阑尾切除术后患者中的临床应用

目的探讨芒硝外敷对腹腔镜阑尾切除术后患者胃肠功能恢复的效果。方法选取2015年1月～2017年2月浙江省立同德医院胃肠外科收住的腹腔镜阑尾切除术患者201例,利用数字表随机分为对照组和治疗组,治疗组101例,对照组100例,对照组腹腔镜阑尾切除术后给予禁食、补液、抗感染、止痛、止血等西医常规治疗,治疗组除常规西医治疗外使用芒硝外敷,对患者各项恢复指标进行对照。结果与对照组相比,治疗组腹痛腹胀缓解时间、肠鸣音恢复时间、首次排便时间、禁食时间和住院时间明显缩短,另外两组患者术前白细胞和超敏C反应蛋白之间差异无统计学意义(P0.05),治疗后,治疗组白细胞和超敏C反应蛋白恢复到正常时的时间低于对照组,治疗组白细胞和超敏C反应蛋白在术后2 d几乎恢复正常,而对照组术后3 d才能几乎恢复正常,差异有统计学意义(P0.05)。结论芒硝外敷能有效的改善腹腔镜阑尾切除术后患者的胃肠道功能,减少肠道细菌移位和感染的发生,促进患者术后的恢复。     

Laparoscopic versus open appendectomy： Which way to go？

AIM： To compare the outcome of laparoscopic versus open appendectomy. METHODS： Prospectively collected data from 293 consecutive patients with acute appendicitis were studied. These comprised of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, complication rate and cost. RESULTS： There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 2 patients （1.5%）. Laparoscopic appendectomy was associated with a shorter hospital stay （2.2 d vs 3.1 d, P = 0.04）, and lower incidence of wound infection （5.3% vs 12.8%, P = 0.03）. However, in patients with complicated disease, intra-abdominal abscess formation was more common after laparoscopic appendectomy （5.3% vs 2.1%, P = 0.002）. The operative time and analgesia requirements were similar in the two groups. The cost of treatment was higher by 370 in the laparoscopic group. CONCLUSION： Laparoscopic appendectomy is as safe and efficient as open appendectomy, provided surgical experience and equipment are available.