Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children

Backgraound: Open appendectomy (OA) has been the treatment of choice for acute appendicitis since its introduction by Mc-burney in 1884. Laparoscopic appendectomy(LA) though widely practiced, has not gained universal approval. LA was first described in 1983. Some early studies showed equivocal results about benefit of LA. Recent studies showed overall benefit in favour of LA. So far no such a large study was done in any Bangladeshi hospital. So, we decided to do this study with a view to evaluate the therapeutic benefit of LA by comparing with conventional OA . Materials and methods: We collected data of 763 appendectomies done in Jahurul Islam medical college hospital from July 2007 to June 2012 for a period of 5 years. Out of them 448 had conventional OA and 315 had LA. We compared the mean operation time, time of first oral feeding, narcotic analgesic requirement, duration of post operative hospital stay. Results: We found that mean operation time was 33±5.8 minute and 37± 7.5 minute in LA and OA respectively. Duration of post operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting. Conclusion: Our study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stay and less requirement of narcotic analgesic.

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“…No difference in mortality or major complication rate was observed between LA and OA among children 9 . Nine of our patients were above 60 years.…”

Section: Discussionmentioning

confidence: 94%

Laparoscopic vs Open Appendectomy : A Comparative Study

Islam¹,

Pasha²,

Rahman³

et al. 2014

Bangla J. Endosurg.

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“…Therefore, many authors recommend that entry sites resulting from the trocars sized 10 mm or above should be closed [5, 7, 8]. In some studies, it was recommended that the trocar defects with a size of 10 mm or below should be repaired in the presence of some risk factors such as advanced age, obesity, diabetes and long lasting interventions [9, 10]. All hernias observed in our study originated from the 10 mm-long trocar sites in the umbilical region, while no hernia was observed in 5-mm trocar entry sites.…”

Section: Discussionmentioning

confidence: 99%

Causes of asymptomatic trocar site hernia: How can it be prevented?

Dinçel

Başak

Göksu

2016

North Clin Istanbul

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OBJECTIVE:The aim of this study is to evalute risk factors which trigger the development of trocar site hernia after elective laparoscopic cholecystectomy operation and to discuss what needs to be done to prevent it.METHODS:Patients operated with laparoscopic cholecystectomy between 2011 and 2013 were evaluated. Patients were called back for follow-up visit at 12 month after operation. Physical and ultrasonographic examinations were performed at follow-up. Factors that facilitate development of trocar site hernia were investigated.RESULTS:One hundred and ninty patients were operated during the study period. One hundred and thirty-two patients who had been examined at follow-up period were included in the study. Mean age of the patients was 50.64±11.86 (18–76) years and female/male ratio was five. Trocar site hernia was detected in four patients at umblical trocar site. One of these patients had chronic obstructive lung disease, two of them had diabetes and three of them had obesity. Advanced age and obesity were found to be statistically significant in patients having trocar site hernia (p value: 0.007, and 0.008, respectively).CONCLUSION:Development of trocar site hernia after laparoscopic surgery may be prevented by repair of trocar site in patients taken into consideration risk factors such as advanced age and obesity.

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“…No difference in majority of complications in OA and LA children. 6 21 patients were around 60 years of age. No special problem was encountered during operating these patients.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of laproscopic versus open appendicectomy

Patil¹,

Patil²

2016

Int Surg J

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Background:Open appendicectomy (OA) has been the treatment of choice for acute appendicitis since its introduction in 1884. Since its initial description in 1983, laproscopic appendicectomy (LA) has struggled to prove its superiority over the open technique. This is in contrast to laproscopic cholecystectomy over open cholecystectomy. Some early studies showed equivocal results about benefits of LA. Recent studies showed overall benefits in favour of LA. So we have done comparative study with the aim to compare the safety and benefits of LA over OA.Methods: We have studied data of 753 appendicectomies done in Dr. D.Y. Patil Medical College Kolhapur from July 2011 to June 2016 for a period of 5 years.Results:We found mean operation time 32±5.7 minute and 36±7.4 minute in LA and OA. Duration of postoperative stay was 1.2 days shorter in LA group. LA required 1.1 less shots of analgesics. Oral feeding was resumed 21 hours earlier in LA as compared to OA.Conclusions:Our study found that LA is effective and safe procedure irrespective of age, sex and BMI of the patient. It requires less operative time, has minimal complications, less hospital stay, less narcotic analgesics requirements, early return of bowel movement and the advantage of diagnosing the concomitant pathologies.

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Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children

Abstract: Meticulous suturing of all layers (particularly the peritoneum) even in small incisions (2 mm) is recommended to prevent omental protrusion at trocar site in children up to 5 years of age.

Cited by 35 publications

References 19 publications

Laparoscopic vs Open Appendectomy : A Comparative Study

Laparoscopic vs Open Appendectomy : A Comparative Study

Causes of asymptomatic trocar site hernia: How can it be prevented?

Comparative study of laproscopic versus open appendicectomy

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