The road to ambulatory laparoscopic management of perforated appendicitis

Alvarez, Carlos; Voitk, Andrus J.

doi:10.1016/s0002-9610(99)00270-6

Cited by 46 publications

(37 citation statements)

References 18 publications

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“…Reduced lenght of hospital stay is claimed to be one of the major advantages of the laparoscopic approach [21, 30], but our data show only a tendency to a shorter stay after laparoscopic procedures. Nevertheless, other authors also report a lack of differences between groups rendering the results contradictory [17, 29].…”

Section: Discussioncontrasting

confidence: 64%

“…An increase in operating time between 10 and 30 min has been shown in many controlled trials comparing laparoscopic with open appendectomy, but clearly diminishes with growing laparoscopic experience [6, 9]. Obviously, laparoscopic conversion needs additional time, but the conversion rate drops dramatically with increasing experience as has also been reported by others [21]. Moreover, our data do not indicate that patients with laparoscopic conversion came off worse than those who underwent primary open operation.…”

Section: Discussionsupporting

confidence: 60%

“…So far, only a few studies focussing on laparoscopic appendectomy for perforated appendicitis have been published [17, 21, 29, 30]. Frazee and Bohannon [29]analyzed 19 patients.…”

Section: Discussionmentioning

confidence: 99%

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Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Stöltzing

Thon²

2000

Dig Surg

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Aims: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. Methods: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). Results: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). Conclusions: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionsupporting

confidence: 60%

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Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Stöltzing

Thon²

2000

Dig Surg

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“…The technically most challenging situation is a perforated appendix combined with an abscess or in a retrocoecal position. Laparoscopic management is still possible in these cases [18,[23][24][25][26][27], but long operating times and high conversion rates of over 40% have been reported [12,13,18,21,22]. In our study, the median operating time for perforated cases was 48 min for OA (mean 50€14.7 min, n=49) and 53 min (mean 56€22.4 min) for LA (n=43).…”

Section: Discussionmentioning

confidence: 61%

Laparoscopic appendicectomy is associated with a lower complication rate even during the introductory phase

Kapischke

Tepel

Bley

2004

Langenbecks Arch Surg

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“…120.000 Eingriffen pro Jahr hat auch die Appendektomie eine hohe volkswirtschaftliche Bedeutung.Allerdings ist der Anteil der laparoskopisch durchgeführten Eingriffe mit etwa 30-50% deutlich geringer als bei Cholezystektomie [4]. Auch die laparoskopische Appendektomie wird in Deutschland fast ausschließ-lich stationär durchgeführt,wobei die Liegezeit im Mittel 7 Tage beträgt [4].Im Gegensatz dazu wird die laparoskopische Appendektomie in vielen anderen Län-dern zu einem hohen Anteil ambulant bzw.kurzzeitstationär durchgeführt (⊡ Tabelle 2), zum Teil selbst bei schweren Erkrankungsformen wie der Perforation mit Peritonitis [1].…”

Section: Laparoskopische Appendektomieunclassified

Laparoskopische Eingriffe

Feußner

2004

Der Chirurg

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Many laparoscopic operations can usually be performed on an outpatient or at least short-term inpatient basis. Since the postoperative risk is easily estimated and can be determined on the 1st or 2nd postoperative day, it quickly becomes clear whether the healing process will be undisturbed or complications will occur. Prerequisites are comprehensive information to the patient as well as his cooperation and that of his social setting. From a medical standpoint, suitable administrative and infrastructural conditions must be arranged that enable safe, efficient preop preparation and guarantee reliable postoperative care of the patient. The newly begun shift in the German health care delivery system toward outpatient and short-term inpatient treatment must be introduced carefully and step by step, since the resultant reduction in postoperative inpatient care goes hand in hand with reduced patient comfort and without question places a greater burden on the patient's social setting.Clearly, optimal collaboration with local doctors is necessary to accompany this nationwide reduction in hospital stay, and the distribution of responsibility among the various physicians must be clarified. However, independently these elements, the success of outpatient and short-term inpatient laparoscopy still can be guaranteed only by surgeons' high experience and minimal complications.

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The road to ambulatory laparoscopic management of perforated appendicitis

Cited by 46 publications

References 18 publications

Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Laparoscopic appendicectomy is associated with a lower complication rate even during the introductory phase

Laparoskopische Eingriffe

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