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Backgrounds/Aims: It was the aim of this study to evaluate the role of ultrasonography (US) and clinical observation in non-pregnant women of reproductive age with suspected appendicitis. Methods: In a prospective cohort study, US was performed in 234 women with suspected appendicitis. Based on US findings and clinical assessment, 3 patient categories were established. Group A: unequivocal signs – laparoscopy (regardless of US results); group B: equivocalsigns – positive US – laparoscopy; group C: equivocal signs – negative US – observation. US results were compared with surgery, observation and follow-up as the reference standard. Results: The percentages of macroscopically infected appendices at laparoscopy in groups A, B and C were 76, 55 and 5%, respectively. Group A: US was false negative in 27 of 128 women (21%) and false positive in 12 of 40 women (30%). Group B plus C: US was false negative in 3 of 9 women (33%) and false positive in 5 of 57 women (9%). Forty-six of 55 patients (84%) completed observation. Conclusion: Because of a high false-negative rate, US as a sole imaging tool is of limited value both in women with unequivocal and equivocal signs of appendicitis. Observation is safe in women with equivocal signs of appendicitis.

Background: Laparoscopic total mesorectal excision (TME) is being used in rectal cancer more frequently. The aim of this study was to analyze the differences in short-term outcomes between open and laparoscopic TME. Methods: In this nonrandomized consecutive study, the short-term outcomes of 100 patients undergoing TME for proven rectal cancer were analyzed. Results: Two groups of 50 patients underwent an open or laparoscopic TME for rectal cancer. Both groups were comparable. Laparoscopic surgery took longer to perform (250 vs. 197.5 min, p < 0.01), but was accompanied by less blood loss (350 vs. 800 ml, p < 0.01). Enteric function recovered sooner after laparoscopy. The numbers of major and minor complications were comparable between both groups, although fewer patients had major complications in the laparoscopic group (6 vs. 15 patients, p = 0.03). Hospital stay was shorter for patients who underwent a laparoscopic abdominoperineal resection (10 vs. 12 days, p = 0.04). Median follow-up was 17 months for the laparoscopic group and 22 months for the open group. Survival analyses between the groups showed no statistical difference in disease-free and overall survival. Conclusion: This study shows that laparoscopic TME for rectal cancer is a safe and feasible technique with some short-term benefits over open TME.

Background: Complications after major abdominal surgery (MAS) are associated with increased morbidity and mortality. Rising costs in health care are of increasing interest and a major factor affecting hospital costs are postoperative complications. In this study, the costs associated with complications are assessed. Methods: Retrospective cohort study of 399 consecutive patients that underwent MAS. Analysis of total costs for hospital stay, complications and treatment was performed, including bootstrapping; allowing for subtraction of data with 95% confidence intervals. Results: For a single patient who underwent MAS the average costs, adjusted for ASA-classification and surgery type, adds up to EUR 8,584.81 (95% CI EUR 8,332.51 - EUR 8,860.81) in patients without complications. EUR 15,412.96 (95% CI EUR 14,250.22 - EUR 16,708.82) after minor complications, and EUR 29,198.23 (95% CI EUR 27,187.13 - EUR 31,295.78) after major complications (p < 0.001). Conclusion: The results provide an insight into the scope of hospital costs associated with complications. Major complications occur in 20% of patients undergoing MAS and account for 50% of the total costs of care. Implementation of a protocol aimed at early diagnosis and treatment of complications might lead to a decrease in morbidity and mortality, but also prove to be cost effective.

Laparoscopic total mesorectal excision (TME) is being used in rectal cancer more frequently. The aim of this study was to analyze the differences in short-term outcomes between open and laparoscopic TME.In this nonrandomized consecutive study, the short-term outcomes of 100 patients undergoing TME for proven rectal cancer were analyzed.Two groups of 50 patients underwent an open or laparoscopic TME for rectal cancer. Both groups were comparable. Laparoscopic surgery took longer to perform (250 vs. 197.5 min, p0.01), but was accompanied by less blood loss (350 vs. 800 ml, p0.01). Enteric function recovered sooner after laparoscopy. The numbers of major and minor complications were comparable between both groups, although fewer patients had major complications in the laparoscopic group (6 vs. 15 patients, p = 0.03). Hospital stay was shorter for patients who underwent a laparoscopic abdominoperineal resection (10 vs. 12 days, p = 0.04). Median follow-up was 17 months for the laparoscopic group and 22 months for the open group. Survival analyses between the groups showed no statistical difference in disease-free and overall survival.This study shows that laparoscopic TME for rectal cancer is a safe and feasible technique with some short-term benefits over open TME.