Hospitalization time after open appendectomy by three different surgical techniques

Abstract

BackgroundThe choice of surgical technique to approach the appendicular stump depends mostly on skill and personal preference of the surgeon or on the protocol used in the service, and the influence of this choice in hospitalization time is not evaluated.AimTo evaluate the relation between surgical technique and postoperative hospitalization time in patients presenting with acute appendicitis.MethodsRetrospective analysis of 180 patients who underwent open appendectomy. These where divided into three groups according to surgical technique: conventional appendectomy (simple ligation of the stump), tobacco pouch suture and Parker-Kerr suture. Data where crossed with hospitalization time (until three days, from four to six days and over seven days).ResultsA hundred and eighty patients with age from 15 to 85 years where included. From these, 95 underwent conventional technique, had an average hospitalization time of 3,9 days and seven had complications (surgical site infection, seroma, suture dehiscence and evisceration). In 67 patients, tobacco pouch suture was chosen and had average hospitalization time of 3,7 days and two complications (infection and seroma). In 18 Parker-Kerr suture was made, with average hospitalization time of 2,6 days, with no complication. Contingency coefficient between the variables hospitalization time and technique was 0,255 and Cramér's V was 0,186.ConclusionThere was tendency to larger hospitalization time and larger number of complications in conventional appendectomy, whereas in patients where Parker-Kerr suture was performed, hospitalization time was significantly smaller.

Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Increasing Incidence of Complicate Appendicitis, Severity and Length of Hospitalization

“…Length of hospitalization was significantly higher in the COVID-19 group. The increased cases of complicated appendicitis and the advanced staging of the inflammatory process influenced the hospitalization (53). At multivariate analysis, appendicular abscess and plasma levels of C reactive protein seemed to be the major factors influencing hospitalization (53,54).…”

Stump Invagination Versus Simple Ligation in Open Appendicectomy: A Systematic Review and Meta-Analysis

“…Thus, some surgeons recommend double-burying the stump by means of a pursestring suture, z-stitch, or a tobacco pouch after ligation and transfixation of the appendiceal stump as a seromuscular encircling suture about 0.5 to 1 cm distal to the appendix base. [15][16][17] The reasons given for using SI are safety against ligature slippage from the stump, blowout of the appendiceal stump, decreased risk of peritonitis from spillage of pathogens in the stump, decreased incidence of postoperative wound infections, improved healing by formation of granulation tissue, and collagen from the serosal layer of the cecum. 18 There are many studies showing that SL is superior to SI.…”

Evaluation of laparoscopic appendectomy proficiency in the management of acute appendicitis based on anatomy and pathologies

“…5,7,8 Regarding the controversy of laparoscopic appendectomies, it is also mentioned that laparoscopic appendectomy has some disadvantages, such as long operative time and the possibility of serious complications, In this retrospective study, laparoscopic appendectomies were performed on 148 cases of acute appendicitis from March 1 st , but generally accelerates postoperative early recovery to shorten hospitalization. [7][8][9] The other idea in these controversies is that laparoscopic appendectomy for complicated appendicitis is feasible and safe. It is associated with less postoperative pain, lower incidence of infectious complications, and reduced length of hospital stay when compared with patients who had an open appendectomy.…”

“…It is associated with less postoperative pain, lower incidence of infectious complications, and reduced length of hospital stay when compared with patients who had an open appendectomy. 9 The patients who had previous surgery should be considered as a risk population for complications of gas gangrene which had been cited and recorded by laparoscopic surgeries and advice close monitoring of cardiac rhythm during insufflation of carbon dioxide. 10,11 Anyhow by the time the previous abdominal surgeries, which thought as a limiting border for laparoscopic procedures, had found no any negative effect on the laparoscopic appendectomy as proved by a study which manifested that previous abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis.…”

“…13 On the other hand, some other studies give no any advantages o r s u p e r i o r i t y o f l a p a r o s c o p i c appendectomy. 9,11,13,14 This study aimed to prove or resolve controversial concepts regarding laparoscopic appendectomy management of acute appendicitis depending on anatomical and pathological findings according to global management rules and our locality demands. 2014, to April 20 th , 2015.…”