Transition Towards Laparoscopic Appendicectomy at a UK Center Over a 7-Year Period

Ventham, NT; Dungworth, Jessica C; Benzoni, Carlo

doi:10.1097/sle.0000000000000017

Cited by 7 publications

(3 citation statements)

References 24 publications

(17 reference statements)

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“…Appendicitis is a common general surgical emergency. Increasingly, a laparoscopic approach is used [ 1 ]. Removal of a normal appendix found intra-operatively has been a controversial topic with studies arguing for both proceeding with appendicectomy when a ‘normal’ appendix is found versus leaving the normal appendix [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

et al. 2021

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Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

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Section: Introductionmentioning

confidence: 99%

A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

et al. 2021

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“…1 Within the UK, laparoscopic appendicectomy remains the mainstay of treatment in patients with acute appendicitis with the majority performed by surgical registrars. 2,3 There is wide variation in technical steps and equipment used during a laparoscopic appendicectomy between trainee surgeons. This is dependent on a multitude of factors including grade of surgical trainee, equipment available, operative difficulty and presence of complicated appendicitis.…”

Section: Introductionmentioning

confidence: 99%

Current technical surgical practice of emergency appendicectomy: a cross-sectional survey of surgical registrars in the UK

Currow

Patel

Askari

et al. 2020

annals

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Introduction Appendicectomy remains one of the most commonly performed procedures in general surgery. The aim of this study was to explore variation in operative techniques of an appendicectomy among surgical registrars in England. Materials and methods An anonymised survey was sent out to surgical registrars in the UK via email and social media. Subgroup analyses were performed comparing respondents based on their level of seniority and subspecialty background. Results A total of 168 respondents completed the survey, of whom 77.4% (130/168) were specialty trainees years 3–8 and 44.6% (75/168) were colorectal trainees. The majority (98.8%) preferred a laparoscopic approach to appendicectomy. Overall, 73.2% opted to use diathermy to divide an uninflamed mesoappendix. Half of respondents (50%) preferentially used diathermy to control the appendicular artery, followed by 44% preferring use of metal or polymeric clips. The appendicular stump was most often secured with Endoloops (85.7%) when removing a macroscopically uninflamed appendix but less readily used in the visibly inflamed appendix (75.6%, p = 0.01). Colorectal and upper gastrointestinal registrars were more likely to use diathermy on the mucosa of the appendix stump compared with other subspecialties (p = 0.03). The majority (82.1%) of respondents extracted the appendix via a retrieval bag. Regarding skin closure, most respondents (69%) adopted absorbable subcuticular sutures. Preferential duration of postoperative antibiotic use following appendicectomy for complicated appendicitis varied among the respondents. Conclusion There are similarities and differences across surgical registrars in terms of technical practice in appendicectomy, partially attributed to prior experience and training.

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“…Acute appendicitis is one of the most common surgical conditions and urgent appendicectomyis recommended and practiced for more than 100 years 1,2 . McBurney's appendicectomy by an open muscle splitting technique was the gold standard surgical procedure in acute appendicitis until recent development of minimal invasive surgery 1 .…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Appendicectomy in All Benign Pathologies of the Appendix: A retrospective study

Ratan

Alam

2018

Bangladesh Crit Care J

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Background: Acute appendicitis is one of the most common surgical conditions and urgent appendicectomyis recommended and practiced for more than 100 years1,2. McBurney's appendicectomy by an open muscle splitting technique was the gold standard surgical procedure1. Laparoscopic appendicectomy (LA) is gaining popularity since 1987. But this new technique has a longer learning curve and requires expensive equipment (high capital investments).The aim of this study was to ascertain the generalizability of this novel procedure when appendicectomy is indicated.Method: This study was done over a period of six years in BIRDEM. Between March 2010 to February 2016, all consecutive cases of Laparoscopic appendicectomy was selected for the study. Operation was performed under general anaesthesia using standard three puncture technique. After the procedure all resected specimen was sent for histopathology.Result: Laparoscopicappendicectomy was attempted in 113 patients, 57(50.4%) female and 56(49.6%) males. Mean age of the patients were 35.2 years and ranged from 5 to 65 years. Laparoscopicappendicectomy was performed in emergency basis in 102(90%) due to acute appendicitis, gangrenous appendix, perforated appendix or appendicular abscess. Eleven patients (10%) underwent elective surgery due to interval appendicectomy, mucocole of appendix, incidental appendicectomy. The most common indication for laparoscopic appendicectomy in this series was acute appendicitis (62%). Only one patient (<1%) had to be converted to an open appendicectomy due to injury to caecal wall. There was no peri-operative mortality in this series. Hundred and five patients (93%) weredischarged in lessthan 24 hours of surgery and seven (6%) within 48 hours of surgery after removal of intrabdominal drain. Follow-up period was one month to two years.Conclusion: All the advantages of laparoscopy are well applied in laparoscopic appendicectomy. Morbidity, mortality and conversion rate came down to a minimum with time and experience. Hence laparoscopic appendicectomy should be the procedure of choice when appendicectomy in indicated.Bangladesh Crit Care J September 2018; 6(2): 80-83

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Transition Towards Laparoscopic Appendicectomy at a UK Center Over a 7-Year Period

Abstract: We describe a change in practice towards laparoscopic appendicectomy for the treatment of acute appendicitis over a 7-year period. Furthermore, laparoscopic appendicectomy is associated with acceptable morbidity rates.

Cited by 7 publications

References 24 publications

A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

Current technical surgical practice of emergency appendicectomy: a cross-sectional survey of surgical registrars in the UK

Laparoscopic Appendicectomy in All Benign Pathologies of the Appendix: A retrospective study

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