Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Miyo, Masaaki; Urabe, Shoichiro; Hyuga, Satoshi; Nakagawa, Takuro; Michiura, Toshiya; Hayashi, Nobuyasu; Yamabe, Kazuo

doi:10.1002/ags3.12277

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…An alternative minimal invasive surgical method is single-incision laparoscopy, in which all instruments and the laparoscope are inserted through a multi-channel portal placed at the umbilicus [43]. Miyo et al study claims that Single-site laparoscopic interval appendectomy (SLIA) for severe complicated appendicitis after conservative treatment to restrict inflammation can be safe, feasible, and less invasive than appendicectomy and offers all the advantages of minimally invasive surgery despite its disadvantage of prolonging the hospital stay [44]. A 2017 systematic review showed that laparoscopic appendectomy, compared with open one, reduced the risk of surgical site infection, length of hospital stay, and time to oral intake without increasing the rate of intra-abdominal abscess [45].…”

Section: Therapymentioning

confidence: 99%

Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Mekakas¹,

Nagorni²,

Tablaridis³

2022

Doubts, Problems and Certainties About Acute Appendicitis

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By surgeon’s perspective, complicated appendicitis is defined as perforated appendicitis, periappendicular abscess, gangrenous appendicitis or peritonitis, noted on radiological studies upon hospital admission, operative reports or pathology results of the surgical specimen. Despite that this clinical condition is truly common in everyday surgical routine, its causes and risk factors are still unclear. Some parameters have been associated with complicated appendicitis, like older age, type 2 diabetes, symptoms for longer duration, appendicoliths/fecaliths, delays in surgery after onset of symptoms and after admission. Furthermore, currently, there is no standard diagnostic algorithm for complicated appendicitis. To be specific, radiological findings lack sensitivity, intraoperative assessment may overestimate it while, histopathological examination is regarded as more specific diagnostic method. In addition, the optimal treatment for complicated appendicitis remains controversial between an immediate surgical operation (laparotomy/laparoscopy) or a trial of nonoperative management. Hereby, by reviewing the current literature, we would aim to clarify the risk factors and the diagnostic procedure of complicated appendicitis as well as to compare the operative management with the conservative one according to the type of complicated appendicitis, the success rate and the postoperative complications.

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Section: Therapymentioning

confidence: 99%

Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Mekakas¹,

Nagorni²,

Tablaridis³

2022

Doubts, Problems and Certainties About Acute Appendicitis

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Section: Discussionmentioning

confidence: 99%

“…The treatment options for acute appendicitis have diversified to include antibiotic treatment, emergency surgery, and interval appendectomy, and the advantages and noninferiority of each treatment have been reported in previous studies. 3,[7][8][9] WSES guideline which was published in 2020 recommended nonoperative treatment in the patients with uncomplicated acute appendicitis. However, the success of the nonoperative approach requires careful patient selection and exclusion of patients with gangrenous acute appendicitis, abscesses, and diffuse peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Examination of factors related to pathological severity and microperforation in patients undergoing surgery for acute appendicitis

Sekiguchi¹,

Matsuyama²,

Koh³

et al. 2022

Adv in Digestive Medicine

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Patients suffering from appendicitis with severe pathological findings or microperforation have a poor prognosis. Therefore, when selecting treatments, it is critical to clarify the factors related to histopathological severity and the presence of microperforation in cases diagnosed as mild appendicitis. We retrospectively collected data from 357 consecutive patients diagnosed with acute appendicitis based on symptoms such as fever, physical findings, blood tests, and imaging findings who underwent surgery at the Higashiosaka City Medical Center between January 2016 and December 2020. We investigated the predictors of pathological severity and the presence or absence of microperforations.Of the 335 patients, 252 (75%) had clinically mild appendicitis. In the multivariate analysis, diameter of the appendix ≥10.9 mm (P = .0013) and C-reactive protein ≥5.0 mg/dl (P = .0011) were related to gangrenous appendicitis, with odds ratios of 2.67 (95% confidence interval: 1.23-5.80) and 3.88 (95% confidence interval: 1.71-8.77), respectively. On the other hand, the presence of an appendicolith (P = .0083) and duration from onset to surgery ≥2 days (P = .0033) were related to microperforation, with odds ratios of 6.82 (95% confidence interval: 1.64-28.4) and 3.73 (95% confidence interval: 1.21-12.4), respectively. Patients with gangrenous appendicitis or microperforation had higher rates of postoperative complications, including more cases of Clavien-Dindo classification III and longer hospital stays (P < .05).

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“…The probabilities of clinical improvement, recurrence, and complicated appendicitis with NOM were obtained from the Salminen et al [ 13 ]. The probabilities of selecting open or laparoscopic appendectomy or medical or surgical management of complicated appendicitis were obtained from observational studies [ 10 , 31 , 44 – 47 ].…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness analysis of nonoperative management versus open and laparoscopic surgery for uncomplicated acute appendicitis in Colombia

Guevara-Cuéllar

Rengifo-Mosquera

Parody-Rúa

2021

Cost Eff Resour Alloc

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Background Traditionally, uncomplicated acute appendicitis (AA) has been treated with appendectomy. However, the surgical alternatives might carry out significant complications, impaired quality of life, and higher costs than nonoperative treatment. Consequently, it is necessary to evaluate the different therapeutic alternatives' cost-effectiveness in patients diagnosed with uncomplicated appendicitis. Methods We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18–60 years with a diagnosis of uncomplicated AA from the payer´s perspective at the secondary and tertiary health care level. The time horizon was 5 years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed. Methods We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18–60 years with a diagnosis of uncomplicated AA from the payer’s perspective at the secondary and tertiary health care level. The time horizon was five years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed. Results LA presents a lower cost ($363 ± 35) than OA ($384 ± 41) and NOM ($392 ± 44). NOM exhibited higher QALYs (3.3332 ± 0.0276) in contrast with LA (3.3310 ± 0.057) and OA (3.3261 ± 0.0707). LA dominated the OA. The ICER between LA and NOM was $24,000/QALY. LA has a 52% probability of generating the highest NMB versus its counterparts, followed by NOM (30%) and OA (18%). There is a probability of 0.69 that laparoscopy generates more significant benefit than medical management. The mean value of that incremental NMB would be $93.7 per patient. Conclusions LA is a cost-effectiveness alternative in the management of patients with uncomplicated AA. Besides, LA has a high probability of producing more significant monetary benefits than NOM and OA from the payer’s perspective in the Colombian health system.

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Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Cited by 11 publications

References 23 publications

Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Complicated Appendicitis: A Surgical Controversy Concerning Risk Factors, Diagnostic Algorithm and Therapeutic Management

Examination of factors related to pathological severity and microperforation in patients undergoing surgery for acute appendicitis

Cost-effectiveness analysis of nonoperative management versus open and laparoscopic surgery for uncomplicated acute appendicitis in Colombia

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