The choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated.
To evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis.
Retrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days).
A hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186.
There was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller.
Laparoscopic appendectomy is the gold standard surgical procedure currently performed for acute appendicitis. The conversion rate is one of the main factors used to measure laparoscopic competence, being important to avoid wasting time in a laparoscopic procedure and proceed directly to open surgery.
To identify the main preoperative parameters associated with a higher risk of conversion in order to determine the surgical method indicated for each patient.
Retrospective study of patients admitted with acute appendicitis who underwent laparoscopic appendectomy. A total of 725 patients were included, of which 121 (16.7%) were converted to laparotomy.
The significant factors that predicted conversion, identified by univariate and multivariate analysis, were: the presence of comorbidities (OR 3.1; 95%CI; p<0.029), appendicular perforation (OR 5.1; 95%CI; p<0.003), retrocecal appendix (OR 5.0; 95%CI; p<0.004), gangrenous appendix, presence of appendicular abscess (OR 3.6; 95%CI; p<0.023) and the presence of difficult dissection (OR 9.2; 95%CI; p<0.008).
Laparoscopic appendectomy is a safe procedure to treat acute appendicitis. It is a minimally invasive surgery and has many advantages. Preoperatively, it is possible to identify predictive factors for conversion to laparotomy, and the ability to identify these reasons can aid surgeons in selecting patients who would benefit from a primary open appendectomy.
: Acute appendicitis is the most common surgical emergency in daily practice, and is approached laparoscopically in many centers. Efforts have been undertaken for the development of minimally invasive techniques that reduce tissue trauma and offer improved cosmetic results, one of such being the single-incision laparoscopic surgery (SILS).
: To present a minimally invasive technique for appendectomy (SILS) undertaken with conventional instruments.
: Eleven patients were treated in the emergency care center presenting abdominal pain in the right iliac fossa that was suggestive of appendicitis. Diagnostic investigation was subsequently conducted, including physical examination, laboratory and imaging exams (CT scan with intravenous contrast or total abdominal ultrasound), and the results were consistent with acute appendicitis. Thus, after consent, these patients underwent SILS appendectomy under general anesthesia with three trocars (two 10 mm and one 5 mm), using conventional and optical laparoscopic tweezers (10 mm, 30º). The base and pedicle of the appendix were ligated with titanium LT 400 clips. The procedure occurred uneventfully. Inclusion criteria were absence of diffuse peritonitis, BMI (body mass index) less than 35 and absence of serious comorbidities or sepsis.
: Seven men and four women were operated with average age of 25.7 years and underwent appendectomy through this technique. Mean procedure duration was of 37.2 min. Regarding surgical findings, three had appendicitis in stage 1, four in stage 2 and four in stage 3. All patients improved well, without surgical complications, and did not require conversion to open surgery or conventional laparoscopy technique.
: Appendectomy conducted through Single Incision Laparoscopic Surgery is a feasible and promising technique that can be performed with conventional laparoscopic instruments.
Minilaparoscopy is considered one of the minimally invasive options available for acute appendicitis treatment, although not always employed in less complexity public health services.
Report surgical outcomes of minilaparoscopy use in acute appendicitis treatment.
The study included 21 patients undergoing minilaparoscopic appendectomy with instrumental of 3 mm. The following variables were analyzed: sex, age, body mass index, stage of appendicitis, surgical time, hospital stay, surgical complications, conversion rate to conventional laparoscopy or laparotomy, pain after surgery and aesthetic result.
Twelve men and nine women underwent minilaparoscopic appendectomy. The average age was 27,8 years, the mean BMI was 24,8 kg/m2. The operative time ranged from 33 to 160 min and the average of hospital stay was three days. Among the 21 patients, 20 reported mild pain or no pain in the first postoperative day. The aesthetic result was considered "satisfactory" and "very satisfactory" by 95% of the patients.
The minilaparoscopy is viable technique for treating acute appendicitis with a satisfactory recovery. It combines the benefits of minimally invasive procedures with results similar to conventional techniques.
Appendicitis is one of the most common abdominal emergency. Some predictive scoring systems are recommended to decrease the rate of negative appendectomy.
To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of modified Alvarado score in children who underwent appendectomy.
Four hundred children with initial diagnosis of appendicitis were randomly selected from patients who underwent appendectomy. Modified Alvarado score was used for evaluation of the appendicitis, that was confirmed using histology.
Of modified Alvarado score components, anorexia; nausea and vomiting and rebound tenderness were significantly more common in children with positive appendectomy in contrast to patients with negative appendectomy. Sensitivity, specificity, positive predictive value, and negative predictive value for modified Alvarado score were: 91.3%; 38.4%; 87.7%; and 51.2% respectively.
Alvarado score has high sensitivity but low specificity for diagnosis of acute appendicitis in children.
Desenvolvido por Surya MKT