Acute appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year experience in an Emergency Surgery Unit

Abstract

clinical practice gold standard in the activity of a general emergency unit with a variety of senior surgeons with different skills on the basic laparoscopy. Study designThe present institutional retrospective cohort study included patients who have been preoperatively evaluated in case of emergency and scheduled for appendectomy within 24 hours after recovery.The main goal is to evaluate if the laparoscopic appendectomy on the whole is an advantageous procedure in a team consisting in senior surgeon who are mostly dedicated at a different kind of surgery, having different skills in laparoscopic surgery, and if those different skills affect the results. We performed a review of available data of patients who underwent appendectomy during the period in which the data of the surgical procedures were registered in the institutional electronic database (Intranet). MethodsThe present retrospective study was carried out from January 2010 to June 2016 in the Unit of General and Emergency Surgery of the "Policlinico P. Giaccone" -University of Palermo (Italy) and concerned the appendectomies performed by 6 senior surgeons working at the Unit during the whole period of observation. The activity of the surgeons that turned up successively in the team, and those who came out was excluded from this study. We included the appendectomies carried out with the conventional three-port laparoscopic approach or the Mac Burney incision for the conventional open approach. The midline xiphoid-pubis incision and the umbilicuspubis laparotomy were excluded if carried out as firstchoice approach. On the contrary, these were taken into consideration if a standard (laparotomic/laparoscopic) technique was converted to an open technique through a wide abdominal access (s).The surgeons were classified with a generic descriptor-based grading (Table 1), related exclusively to general laparoscopic skills and accepted by mutual consent of all operators (11). It should be underlined that the three "skilled" surgeons attended, during their career, a formal course of laparoscopy, on the other hand (contrary) the surgeons classified as "level 3" did not. The severity of acute appendicitis was classified according to the Disease Severity Score described by Garst et al. (12), reported on the Table 2. The surgical procedures were the conventional laparotomic appendectomy performed through a Mac-Burney incision or the three-port laparoscopic approach. The conventional, laparotomic approach was performed with a 2-5 cm long Incision along a Langer line at the junction of lateral one-third and medial twothird of right anterior superior iliac spine and umbilicus. Then, the superficial abdominal fascia is incised. Once the lateral margin of the rectum abdomen muscle is visualized it is medially retracted and the deep fascia incised, or rectum muscle is incised along the direction of its fibers. Then, the external oblique muscle is also incised and transversalis fascia visualized. After this fascia and the peritoneum were incised, the appendix is localized an...

Efficacy of Preoperative Imaging Features and Blood Tests in Predicting the Increased Risk of Conversion in Laparoscopic Appendectomy Surgery

“…The lifetime risk of acute appendicitis in an adult population ranges from 7% to 8%, and 10% of the patients having symptoms of acute appendicitis usually resulting in the removal of a normal appendix [1,2]. Laparoscopic appendectomy (LA) deserves to be a gold standard, and has been widely accepted in acute appendicitis with decreased postoperative ache, short postoperative fasting period, rapid duration of recovery, shorter hospital stay, early resumption of normal activity, and superior cosmetic outcomes [3]. The decision to convert from laparoscopy to the open approach usually depends on preoperative parameters, skills of the surgeon, technical troubles or intraoperative complications, including bleeding, iatrogenic bowel injuries, and other complications.…”

De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia

“…A hernia sac can contain any of the intra-abdominal contents. Femoral hernia containing appendix accounts for only 0.5-5% of all femoral hernias [6][7][8].…”

Retrospective analysis of operative time and time to discharge for laparoscopic vs robotic approaches to appendectomy and cholecystectomy

“…2 Supporting this, a review of discharge data for 20% of acute appendicitis patients in the USA (43,757 patients) was conducted by Guller et al; when compared with the McBurney open appendectomy, the laparoscopic approach was shown to have a shorter length of stay and fewer hospital morbidities. 3 However, it was not until 2016 when the laparoscopic appendectomy was o cially established as the gold standard of care by Guerico et al and others. 4 In 2008, the rst robotic appendectomy was described by Akl et al as an incidental appendectomy during an elective pelvic gynecological surgical procedure.…”