The “all-in-one” appendectomy: quick, scarless, and less costly

Stylianos, Steven; L, Nichols; Ventura, Nestor; Malvezzi, Leopoldo; Knight, Colin G.; Burnweit, Cathy

doi:10.1016/j.jpedsurg.2011.09.029

Cited by 36 publications

(37 citation statements)

References 11 publications

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“…Although the above mentioned measures are expected to decrease the cost of LA in the near future, we feel that certain other modifications are still needed to make the existing techniques of LA more cost-effective. For example, the results of two ports 15,16 or a single 'all-in-one' port appendectomies are promising, as reported by Visnjic et al and Stylianos et al 11,17 As these studies demonstrate, the cost of a single port appendectomy is less than that of an appendectomy using 3 ports. Similarly, the use of a single ENDOLOOP® or endo stapler, 18 and avoiding the use of harmonic scalpels, are other possible ways to reduce the cost of LA.…”

Section: Discussionmentioning

confidence: 81%

Cost Comparison between Laparoscopic and Open Appendectomies in Children = مقارنة بين تكلفة عمليات إستئصال الزائدة عن طريق فتح البطن و المناظير عند الأطفال

Khan¹,

Al-Balushi²,

Bhatti³

et al. 2013

SQUMJ

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P = 0.32 ،11.7% ‫بالفتح‬ ‫بامل�شت�شفى.‬ ‫إقامة‬ ‫ال‬ ‫فرتة‬ ‫طول‬ ‫أو‬ ‫ا‬ ‫املرا�شة‬ ‫عمان.‬ ‫التكلفة؛‬ ‫وحتليل‬ ‫التكلفة‬ ‫الزائدة؛‬ ‫ا�شتئ�شال‬ ‫الزائدة؛‬ ‫التهاب‬ ‫الكلمات:‬ ‫مفتاح‬ abstract: Objectives: Laparoscopic appendectomy (LA) for children has become very popular and is routinely performed in most health care centres around the world. The cost of surgical procedures is always a concern for patients and health care providers. This study compares, the total cost of open appendectomy (OA) with LA in children who required an appendectomy for acute appendicitis. Suitable and safe cost-effective techniques were also explored to reduce the cost of these procedures. Methods: The medical records of all the children (ranging between 0 and 12 years) at Sultan Qaboos University Hospital in Oman, who required OA or LA from June 2009 to July 2011, were reviewed. Results: LA were performed in 75 patients while OA were done in 34. Patients from the OA and LA groups were age-and gender-matched. The average operative time was 76 minutes for LA and 49 minutes for OA (P <0.001) while the average hospital stay was 3.14 days for LA and 2.15 days for OA (P = 0.08). The average cost of the two procedures was Omani riyals (OMR) 534 for LA and OMR 343 for OA (P = 0.00). The complication rate following procedures was lower in the case of LA, however this was not statistically significant (LA = 8% versus OA = 11.7 %, P = 0.32). Conclusion: LA are costlier procedures than OA, however they are as safe as OA, and do not increase morbidity or the duration of hospital stay. Keywords

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Section: Discussionmentioning

confidence: 81%

Cost Comparison between Laparoscopic and Open Appendectomies in Children = مقارنة بين تكلفة عمليات إستئصال الزائدة عن طريق فتح البطن و المناظير عند الأطفال

Khan¹,

Al-Balushi²,

Bhatti³

et al. 2013

SQUMJ

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“…This technique has been shown to be cost efficient, safe, quick and with excellent cosmetic outcome. 2,6 The latter can be very challenging in obese patients. As described by Knott et al the single site approach is not recommended in obese patients due to a longer operative time, longer length of stay, more doses of postop analgesics and greater costs.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of surgical site infections of the transumbilical laparoscopic assisted appendectomy with extracorporeal amputation of the appendix ranges from 7.4% to 11.1%. 2,6,13 Wound infections after conventional three port laparoscopic appendectomies are less frequent ranging from 0.09 to 3.1%. 14,15 In our study only 1 patient operated by the hybrid technique developed a wound infection (1.4%).…”

Section: Discussionmentioning

confidence: 99%

“…4 In this transumbilical laparoscopic assisted technique, blunt mobilization of the cecum to provide leverage to extracorporealize the appendix is often necessary. 5,6 Cecal mobilization is not typically required during a standard single port appendectomy in an adult. The described technique allows for a completely intracorporeal appendectomy via one single 10 mm umbilical port without the need for cecal mobilization or placement of a spacious multi-access system and it omits the need for exteriorization of the appendix through the umbilicus.…”

Section: Introductionmentioning

confidence: 99%

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Intracorporeal hybrid single port vs conventional laparoscopic appendectomy in children

Karam

Hiuser²,

Magnuson

et al. 2016

Pediatr Med Chir

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Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK ® hem-o-lock ® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes) but did not differ significantly (P=0.19). This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.

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“…Conversely intra-abdominal abscess was reported in 4.1% of patients in laparoscopic group and 0.32% patients of open appendectomy showing consistent results with other studies that show increase intra-abdominal abscess in laparoscopic group. 19,20 A few possible explanations to this may be an increased bacterial contamination, 21,22,23 punctilious irrigation further spreading pathogen in whole abdominal cavity without proper suction especially in case of peritonitis 24 , and inadequate leaning curve. 25 In our study this finding was not statistically significant (p=0.147).…”

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confidence: 99%