Laparoscopic Appendectomy in the Days of COVID-19

Abramov, Roi; Neymark, Mariya; Harbi, Asaf; Gilshtein, Hayim

doi:10.1097/sle.0000000000000952

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…Another possible limitation of the study is that the COVID-19 pandemic occurred during the patient recruitment period, which spanned 2020–2021. During the first stage of the COVID-19 pandemic, there was a significant increase in the rate of complicated appendicitis [ 34 ]. In addition, a PCR test was added to the protocol, which could increase the hours of stay.…”

Section: Discussionmentioning

confidence: 99%

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial

et al. 2022

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Objective To confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis. Summary background data Outpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol. Methods Patients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay. Results Ninety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention. Conclusion Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost. Trial registration: Registration: www.clinicaltrials.gov (NCT05401188) Clinical Trial ID: NCT05401188

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Section: Discussionmentioning

confidence: 99%

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial

et al. 2022

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“…The hospital admission rates have dropped during the quarantine. We evaluated 25 studies related with COVID-19 and AAp, and 23 of these articles reported that there was a 24% (IQR: 15%-39%; min-max: 5.4%-81%) drop in the hospital admissions due to AAp during the quarantine regulations[ 1 - 4 , 10 , 12 , 14 - 22 , 33 - 39 ]. In only 1 of the 25 studies, there was a 7% increase in the hospital admissions[ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…Ten of the 25 studies that were reviewed gave their results regarding negative appendectomy rates. The results of these studies showed that negative appendectomy rates dropped during the COVID-19 pandemic[ 1 , 6 , 13 - 16 , 18 , 33 , 34 , 39 ]. Five of the ten studies stated that this drop showed statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

Akbulut¹,

Tunçer²,

Ogut³

et al. 2022

World J Clin Cases

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BACKGROUND Acute appendicitis (AAp) is the most frequent cause of acute abdominal pain, and appendectomy is the most frequent emergency procedure that is performed worldwide. The coronavirus disease 2019 (COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma. AIM To compare the demographic, clinical, and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods. METHODS The demographic, clinical, biochemical, and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19 (October 2018-March 2020) and COVID-19 (March 2020-July 2021) periods. RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period. Pre-COVID-19 ( n = 154) and COVID-19 ( n = 223) periods were compared for various parameters, and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio (OR): 1.76; P = 0.018], presence of AAp findings on ultrasonography (OR: 15.4; P < 0.001), confirmation of AAp in the histopathologic analysis (OR: 2.6; P = 0.003), determination of perforation in the appendectomy specimen (OR: 2.2; P = 0.004), the diameter of the appendix ( P < 0.001), and hospital stay ( P = 0.003). There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19 (median: 24 h; interquartile range: 34) and COVID-19 (median: 36 h; interquartile range: 60) periods ( P = 0.348). The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status ( P < 0.001). CONCLUSION The present study showed that in the COVID-19 period, the ultrasonographic determination rate of AAp, perforation rate of AAp, and duration of hospital stay increased. On the other hand, negative appendectomy rate decreased. There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

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“…This is the most common surgery that has been done in an emergency in large volume and exposed to all doctors at all healthcare centers frequently. [ 11 12 ] This surgery can improve skills in the laparoscopic mobilization of the bowel, intracorporeal knotting during ligation of the base of the appendix, dissection during handling mesoappendix or retrocecal appendix, and peritoneal lavage in case of an appendicular abscess. [ 13 14 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

Feasibility of safe laparoscopic surgery performed by junior residents without exposure of open appendectomy: A retrospective study

Meena

Badkur

Rodha

et al. 2022

Journal of Family Medicine and Primary Care

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Context: Appendectomy is the most commonly performed surgery in the emergency department. It is very difficult to determine the minimal duration of the learning curve for junior residents to perform safe laparoscopic surgeries. Aim: This study aimed to determine the feasibility of a safe laparoscopic appendectomy performed by junior residents. Settings and Design: A retrospective study was conducted at a tertiary healthcare center from May 2018 to May 2020. Methods and Material: This study reviewed all the data of laparoscopic appendectomy performed by junior and senior residents. Both groups were compared for the patient outcome in terms of complications, conversion to open, intraoperative findings, operative time, postoperative progress, and hospital stay. Statistical Analysis: The data were formulated in an excel sheet and analyzed with SPSS. Mean, median, range, standard deviation, percentages, univariate analysis with χ test and t- test were used. Results: No significant difference was found in operative time (mean [SD], 84.87 [24.73] vs. 86.95 [24.93], P = 0.679), intraoperative complication (9.2% vs. 7.8%, P = 0.769), postoperative complications (34.2% vs. 34.4%, P = 0.984), conversion to open (6.6% vs. 4.7%, P = 0.633), length of postoperative hospital stay (Mean [SD], 2.3 [2] vs. 2.2 [1], P = 0.739), and readmission (4% vs. 3%, P = 0.794). No major intraoperative complications and mortality were found in both groups. Conclusions: Junior residents may be allowed for safe laparoscopic appendectomy under supervision without experience of open appendectomy. The patient’s outcomes may be comparable with surgery performed by well-experienced surgeons. They can improve the basic healthcare system in the future with feasible basic laparoscopic surgery for common diseases.

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Laparoscopic Appendectomy in the Days of COVID-19

Cited by 6 publications

References 20 publications

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

Feasibility of safe laparoscopic surgery performed by junior residents without exposure of open appendectomy: A retrospective study

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