The impact of regional reconfiguration on the management of appendicitis

Healy, Donagh; McCartan, Damian; Grace, Pierce A.; Aziz, Aamir; Dermody, F.; Moloney, Mary; Coffey, J. Calvin; Walsh, Stewart R.; Burke, P.

doi:10.1007/s11845-013-1015-x

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…22,23 In an effort to provide a cost-effective service, there has been recent centralization of surgical services in our region -the introduction of a surgical assessment unit, a "surgeon of the week," and a full-time emergency theatre with resultant gradual shift towards daytime operating. 24 However, this has not reduced the rate of negative appendicectomy and the risk of trocar-induced bladder injuries continues.…”

Section: Discussionmentioning

confidence: 99%

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

Nason

Baig²,

Burke

et al. 2015

CUAJ

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55case series AbstractIntroduction: Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. Methods: A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined. Results: During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. Conclusion: Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication. IntroductionAppendicectomy is the most common emergency surgical procedure performed worldwide.1 Laparoscopy plays a valuable role in the management of patients with acute lower abdominal pain. A Cochrane review has recommended laparoscopy and laparoscopic appendicectomy (LA) in patients with suspected appendicitis unless laparoscopy itself is contraindicated or not feasible.2 Minimally-invasive approaches have revolutionized surgery.3 Laparoscopic surgery has well-documented benefits with associated shorter length of stay, quicker return of bowel function, decreased analgesic requirements, lower rates of wound complications, and improved cosmesis.4,5 Furthermore LA is seen as an excellent training opportunity and evidence shows an attainable learning curve.6 LA is a safe procedure for junior trainees to perform; 7-9 however resident involvement in LA has resulted in increased operative time and complications. 10,11The overall rate of major complications following a laparoscopic procedure is about 1.4 per 1000 procedures. 12However, the incidence of port site complications following laparoscopic surgery is around 21 per 100 000 cases.13 Port site complications can be grouped into access-related complications (vascular or visceral injuries) 14 and postoperative complications (wound infection or port site herniation). 15,16Currently, there is little data regarding iatrogenic secondary trocar induced injuries in LA. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. MethodsWe performed a retrospective analysis of LA over a 2-year period (2012)(2013) at a tertiary referral university teaching hospital. Data were obtained from the hospital in-patient enquiry (HIPE) system. The outcomes measured included the incidence of iatrogenic bladder injuries at the time of LA, mode and time of clinical presentation, type of port used, le...

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Section: Discussionmentioning

confidence: 99%

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

Nason

Baig²,

Burke

et al. 2015

CUAJ

View full text Add to dashboard Cite

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“…3 Consolidation or regionalization of surgical care is common in many Western countries and is widely considered to be best practice. [5][6][7] In particular, the regionalization of trauma care has been shown to reduce mortality. 8,9 Moreover, there is consistent evidence that high-volume surgeons/hospitals achieve superior outcomes to lowvolume surgeons/ hospitals (e.g., reduced mortality, adverse events, and/or LOS).…”

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confidence: 99%

Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes

Kreindler

Siragusa

Bohm

et al. 2017

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Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice

et al. 2016

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The impact of regional reconfiguration on the management of appendicitis

Abstract: Background: Reconfiguration of surgical services in the Mid-west in 2009 resulted

Cited by 4 publications

References 14 publications

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes

Magnitude of non-operative surgical emergency admissions; service implications for surgical and radiological practice

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