We reviewed our experience with same hospitalization resection in the treatment of acute diverticulitis (AD) and compared outcomes with patients admitted for elective resection. From January 1987 through December 1996, 20 patients (Group 1) were admitted with AD and were operated on during the same hospital admission. During that same time period, 22 patients (Group 2) were admitted for elective resection and found to have an abscess intraoperatively. Thirty patients had elective resection with no abscess found (Group 3), and 10 patients were found to have a fistula to adjacent structures during elective resection (Group 4). Demographics and type of procedure done were similar in all groups. Fifteen patients (75%) in Group 1 had an abscess; eight were pericolic, and seven were pelvic. In contrast, all Group 2 abscesses were pericolic (P < 0.001). There was no mortality or major morbidity in any group. Patients in Groups 1 and 4 had higher fluid requirements (not significant), estimated blood loss (P < 0.01), and longer operative times (P < 0.05) when compared with the other groups. Postoperative and total hospital stay was significantly longer in Group 1. We conclude that hospitalized patients with AD who meet indications for surgery can be operated on during the same hospitalization without an increase in morbidity, compared with those patients discharged and later readmitted for elective resection.

Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare the course and postoperative complications between LA and OA. We reviewed the charts of both groups of patients and followed their course in the hospital. Seventy-seven patients who underwent LA with one conversion to the open technique (1.3%) were compared to 84 patients who underwent OA. There was no difference in age and sex distribution. The mean hospital stay was shorter in the LA (32.5+/-10 vs 74.2+/-24 h, p < 0.0001). Parenteral analgesia requirement was higher in the OA group (4.7+/-1.4 vs 2.6+/-2, p < 0.0001). The total cost was higher in the OA group ($11,260+/-4000 vs 7,090+/-3500, p < 0.05). There was no significant difference in the OR time, duration of the procedure, and surgery costs between both groups. Normal appendices removed were similar in both OA and LA groups (23.8 vs 28.9%). There was no difference in the rates of postoperative complications between both groups. We conclude that LA is a viable alternative to OA. It is safe, cost effective, and less invasive than the OA with less pain and shorter hospital stay.

We discuss the clinical presentation and management of a 36-year-old woman presenting with a 12-year history of recurrent hydatid disease, a disease caused by Echinococcus granulosus and other Echinococcal species, which is rarely seen in the contiguous United States. She has had multiple procedures since her diagnosis in 2005 and is still closely being followed for possible disease recurrence.