Background Acute appendicitis is the most common non‐obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta‐analysis assessing the safety of laparoscopic appendicectomy in pregnant women. Methods A meta‐analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random‐effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). Results Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31–2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27–0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD −0.07; 95% CI −0.43 to 0.30, P = 0.71) or hospital length of stay (SMD −0.34; 95% CI −0.83 to 0.16, P = 0.18). Conclusion In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.
Background: The incidence of colorectal cancer (CRC) in younger adults (<50 years old) is rising worldwide, at a rate of 1% per annum since mid-1980s. The clinical concern is that younger adults may have more advanced disease leading to poorer prognosis compared to their older cohort due to lack of screening. Therefore, the aim of this study is to assess the incidence and short-term outcomes of colorectal cancer in younger adults. Methods: This is a retrospective study from a prospectively maintained bi-national database from 2007 to 2018. Results: There were 1540 younger adults diagnosed with CRC, with a rise from 5.8% in 2007 to 8.4% in 2018. Majority had lower American Society of Anaesthesiologists (ASA) scores (89%), rectal cancers (46.1%) and higher tumour stage (65.4%). As a consequence, they were likely to have higher circumferential resection margin positivity (6%, P = 0.02) and to receive adjuvant chemotherapy (57.1%, P < 0.001) compared to their older cohort. Multivariate analysis showed disadvantaged socioeconomic status (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.37-7.94, P < 0.001) and increasing tumour stage (OR 14.9, 95% CI 1.89-116.9, P < 0.001) were independent predictors for circumferential resection margin positivity whereas being female (OR 0.71, 95% CI 0.53-0.95, P = 0.02), higher ASA score (OR 175.3, 95% CI 26.7-1035.5, P < 0.001), urgent surgery (OR 2.75, 95% CI 1.84-4.11, P < 0.001) and anastomotic leak (OR 5.02, 95% CI 3.32-7.58, P < 0.001) were predictors of inpatient mortality. Conclusion: There is a steady rise in the incidence of colorectal cancer in younger adults. Both physicians and younger adults should be aware of the potential risk of colorectal cancer (CRC) and appropriate investigations performed so not to delay the diagnosis.
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