Search

Perforation rate remains stable [ABSTRACT FROM AUTHOR]

The article presents the results of a clinical trial on elective laparoscopic appendicectomy for chronic right lower-quadrant pain. It shows that the removal of the appendix from patients with such abdominal pain is more likely to improve the pain than leaving the appendix in situ. It concludes that the right lower abdominal pain syndrome can be treated successfully by elective appendicectomy in properly selected cases.

Background: The effectiveness of various appendiceal stump closure methods has not been evaluated systematically. The aim of this study was to compare the morbidity of stump closure by stapling or use of endoloops. Methods: A non-concurrent cohort study of prospectively acquired data was performed. The primary outcome variable was the rate of intra-abdominal surgical-site infection. Secondary outcome measures were complications, duration of intervention, hospital stay, rate of readmission to hospital and the difference in direct costs of the operation. Results: Staples were used in 60·5 per cent and endoloops in 39·5 per cent of 6486 patients operated on for suspected appendicitis between January 1995 and December 2003. Among 4489 patients with acute appendicitis the rate of intra-abdominal surgical-site infection was 0·7 per cent in the stapler group and 1·7 per cent in the endoloop group ( P = 0·004). The rate of readmission to hospital was 0·9 and 2·1 per cent respectively ( P = 0·001). Conclusion: Application of a stapler for transection and closure of the appendiceal stump in patients with acute appendicitis lowered the risk of postoperative intra-abdominal surgical-site infection and the need for readmission to hospital. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Compares recovery after laparoscopic (LA) and open appendicectomy (OA) for confirmed appendicitis, carried out by experienced surgeons in an educational setting. Lack of significant difference between LA and OA in time to full recoveryl Complication rate; Median hospital stay; Trend toward better physical activity noted after the laparoscopic procedure.

Summary Background Laparoscopy in patients with a clinical suspicion of acute appendicitis has not gained wide acceptance, and its use remains controversial. Methods In a randomized controlled trial of laparoscopic versus open appendicectomy, 583 of 828 consecutive patients consented to participate. Three hundred and one patients were allocated to open appendicectomy and 282 patients to laparoscopy, 65 of whom required conversion to open appendicectomy. Length of stay in hospital was the primary endpoint, while operating time, postoperative morbidity, duration of convalescence and cosmesis were secondary endpoints. Results Intention-to-treat analysis revealed an equally short hospital stay in the two groups (median 2 days). The median time to return to normal activity (7 versus 10 days) and work (10 versus 16 days) was significantly shorter following laparoscopy. Laparoscopy was associated with fewer wound infections (P < 0·03) and improved cosmesis (P < 0·001), but the operating time was longer (60 versus 40 min). Laparoscopy was associated with more intraperitoneal abscesses (5 versus 1 per cent) but, adjusted for a greater number of gangrenous or perforated appendices in this group, the difference failed to reach statistical significance. Conclusion Hospital stay was equally short, whereas laparoscopic appendicectomy was associated with fewer wound infections, faster recovery, earlier return to work and improved cosmesis. [ABSTRACT FROM AUTHOR]

Reports on a study by K. Dyas and colleagues that aims to develop and validate a scoring system based on laparoscopic appendicectomy (LA) to assess technical surgical performance. Significance of the assessment of surgical competence to correlate objective assessment of skills training with clinical performance; Description of LA; Details of the five key stages of the procedure; Efficacy of the scoring system on LA to assess surgical trainee ability and competency.

Compares the negative appendectomy rate (NAR) throughout Wales. Confirmation of negative appendectomies; Measurement of NAR in males and in females; Variability of NAR.

Studies the value of inspection of the appendix mucosa during surgery. Comparison on the surgeon's opinion on the state of the appendix compared with subsequent histological diagnosis; On-table diagnostic accuracy of opening the appendix compared with external inspection only; Data indicating that opening the appendix upon removal does not improve the accuracy of on-table diagnosis.