Laparoskopische Appendektomie

Köckerling, F.; Schug-Paß, C.; Grund, Stefan

doi:10.1007/s00104-009-1687-y

Cited by 8 publications

(3 citation statements)

References 20 publications

(12 reference statements)

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“…The majority of appendectomies are undertaken laparoscopically, with evidence demonstrating reduced post-operative pain, a lower rate of wound infection, faster recovery and shorter hospital stay when compared with the open procedure [ 3 , 4 ]. However, the laparoscopic approach is associated with longer procedure times, increased cost and a higher risk of post-operative intra-abdominal abscess formation [ [5] , [6] , [7] ]. Furthermore, appendiceal stump leakage secondary to inadequate stump closure is a recognized complication following laparoscopic appendectomy (LA) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

Makaram

Knight

Ibrahim

et al. 2020

Annals of Medicine and Surgery

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Background Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure. Methods A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies. Results From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure.

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Section: Introductionmentioning

confidence: 99%

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

Makaram

Knight

Ibrahim

et al. 2020

Annals of Medicine and Surgery

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“…Less postoperative pain, reduced wound infections, faster recovery and shorter hospital stay have been shown to be advantageous in laparoscopic compared with open appendectomy. Disadvantages of the laparoscopic operation are, besides longer procedure times, a marginally higher intra-abdominal abscess rate and higher costs [4–6]. Both latter factors are inevitably influenced by the technique of stump closure.…”

Section: Introductionmentioning

confidence: 99%

Appendix stump closure with titanium clips in laparoscopic appendectomy

Rickert

Bönninghoff

Post

et al. 2011

Langenbecks Arch Surg

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PurposeDifferent techniques, including clips, have been used to close the stump in laparoscopic appendectomy. The aim was to investigate the results after application of a newly developed titanium clip for this operation.MethodsFrom June 2008 to February 2010, 104 patients from two different hospitals undergoing laparoscopic appendectomy were included in this prospective study. Closure of the appendix base was generally intended with a titanium double-shanked clip (DS-Clip). The variables of interest were intra-and postoperative complications, operation time and hospital stay. Furthermore, an evaluation of the clip's practicability by the surgeon was performed using a standardised questionnaire.ResultsIn 104 patients screened intraoperatively, four patients had to be excluded as the operating surgeon felt that the clip was not adequate for closing the stump, generally because of severe inflammation of the base of the appendix with involvement of the caecum. One patient developed an intra-abdominal abscess which had to be drained interventionally; no reoperations were necessary. The overall complication rate, the operation time and the hospital stay were well comparable with other devices for appendix stump closure such as staplers, loops or polymeric clips. The practicability of the clip was mainly rated as excellent or good by the operating surgeons.ConclusionThis study suggests that the presented titanium DS-Clip is a safe and cost-effective technique for securing the appendix base in laparoscopic appendectomy. The application is easy and can be learned quickly, making it a good option also for teaching hospitals.

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“…Optimization of the conservative clinical treatment, specially with the use of nasogastric (NG) tube for decompression of the bowel before surgery, and the implementation of pneumoperitoneum using open through trocar introduced away from prior scars allow the completion of a safer laparoscopic procedure (14) . The development of laparoscopic bariatric surgery (15) and the demonstration of favorable results in morbidly obese patients undergoing emergency laparoscopy (12) reinforce the applicability of this approach in the treatment of intestinal obstruction.…”

Section: Discussionmentioning

confidence: 93%

Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction

Ghezzi

Moschetti

Corleta

et al. 2010

Arq. Gastroenterol.

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-Context -Laparotomy is the gold standard treatment of patients with intestinal obstruction without response to clinical management. Nowadays, literature has been demonstrating the feasibility of videolaparoscopy in the treatment of intestinal obstruction. Objectives -To report the clinical-epidemiological profile of patients with intestinal obstruction submitted to surgery and verify the presence of contraindications for laparoscopy. Methods -It was done a observational, descriptive and retrospective study including adults patients with intestinal obstruction submitted to surgery at Hospital de Clínicas de Porto Alegre, RS, Brazil, between January of 2004 and October of 2008. Results -It was included 135 patients in the study, with a total of 126 patients submitted to open surgery and 9 to laparoscopy. There was similar distribution between gender and the mean age was 59 years (SD ± 16.9). The most frequent site of obstruction was the small bowel and the most frequent etiology was adhesions. Among the patients submitted to laparotomy, 75.4% presented with abdominal distention, 68.3% previous abdominal surgery, 11.9% body mass index >30 kg/m 2 , 4.8% coagulopathy and 3.2% hemodynamic instability. Among the 135 patients, only 5 of them presented with none contraindications for videolaparoscopy. Conclusion -The epidemiological findings of this study are similar to the ones of the worldwide literature. Indications of videolaparoscopy in retrospective analyses have the limitation of subjective evaluation of intestinal obstruction, which was included in this study as a relative contraindication to laparoscopy. HEADINGS -Intestinal obstruction. Video-assisted surgery.

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Laparoskopische Appendektomie

Cited by 8 publications

References 20 publications

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

Closure of the appendiceal stump in laparoscopic appendectomy: A systematic review of the literature

Appendix stump closure with titanium clips in laparoscopic appendectomy

Analysis of the videolaparoscopy potentiality in the surgical treatment of the bowel obstruction

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