Introduction Acute appendicitis is the commonest surgical emergency during pregnancy. The aim of this study is to evaluate the outcomes between antibiotic therapy and appendectomy in the management of uncomplicated appendicitis during gestation. Methods From January 2015 to April 2019, there were 2174 emergency appendicitis diagnosed in the University of Hong Kong‐Shenzhen Hospital. Among them, 54 pregnant women were diagnosed with acute uncomplicated appendicitis and the clinical records were reviewed. Clinical demographics and outcomes including gestational age at delivery, mode of delivery, birth weight, APGAR score at 1 minute, fetal loss and overall length of stay were compared between the operation group and the antibiotic treatment group. Results The baseline characteristics showed no statistically significant difference between the two groups (P > .05). In the appendectomy group (n = 20), one patient had wound infection while none of the patients in the antibiotic therapy group (n = 34) experienced any complication. In the antibiotic treatment group, appendicitis recurred in one patient during pregnancy and in two patients after deliveries, which were all treated with appendectomy. The mean hospital stay of the antibiotic treatment group was shorter than that of the appendectomy group, but there was no significant difference (4.94 ± 2.6 days vs 6.25 ± 3.5 days, P = .540). There was no difference in gestational age at delivery, mode of delivery, birth weight and APGAR scores between the two groups (P > .05). Conclusions For acute uncomplicated appendicitis during pregnancy, antibiotics treatment is a safe and feasible option.
Background In single-port laparoscopic percutaneous extraperitoneal closure, hydrodissection is commonly used. Although hydrodissection makes the operation easier, it can cause shock and twist the vas deferens. The aim of this study was to investigate whether the reverse puncture technique could be used instead of hydrodissection.Methods Between March 2019 and January 2021, 132 children with inguinal hernias underwent single-port laparoscopic percutaneous extraperitoneal closure using the reverse puncture technique. The double-hook core needle with a suture was used to puncture the abdominal cavity along the lateral border of the internal ring under single-port laparoscopic vision. The suture was left in the abdominal cavity. The needle was then passed through the gap between the vas deferens / spermatic vessels and the peritoneum along the medial border of the internal ring to capture the end of the suture. The suture was tied in the extraperitoneal space after it was brought out of the abdominal wall.Results The 132 patients, 106 males and 26 females, had an average age of 2.71 ± 2.18 years. Sixty patients were chosen for bilateral surgery, with 57 of them having contralateral patent processus vaginalis. The average operating time for unilateral and bilateral cases was 9.9 ± 2.1 and 15.4 ± 3.3 minutes, respectively. One patient had a recurrence during the 9 to 24 month follow-up period (0.7%).Conclusions For the treatment of pediatric inguinal hernias, single-port laparoscopic percutaneous extraperitoneal closure utilizing the reverse puncture technique provides a simpler and safer option.
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