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The increased intra-abdominal pressure during laparoscopic surgical procedures was reported to be a factor in the development of gastroesophageal reflux. This study evaluated the presence of gastroesophageal reflux and associated factors using 24-h pH monitoring in children undergoing laparoscopic appendectomy.Children who underwent laparoscopic surgery for presumed acute appendicitis between June 2017 and June 2018 were included in the study. After pre-operative endotracheal intubation, pH catheters were placed for 24-h esophageal pH monitoring. Relationships between gastroesophageal reflux and procedure time, pre-operative fasting time, age, weight, and body mass index (BMI) were evaluated.A total of 60 pediatric patients were included in the study. Their mean (SD) age was 11.82 (3.71) years (range, 4-17 years). The mean (SD) body weight was 41.27 (16.72) kg (range, 15-90 kg) and the mean (SD) BMI were 17.96 (4.37). The mean pre-operative fasting time was 15.52 (12.1) h, while the mean operative time was 38.42 (17.96) min. Lower age and weight were significantly associated with the presence of post-operative gastroesophageal reflux (p0.05). Mean procedure time, mean pre-operative fasting time, and BMI were not significantly associated with intra- or post-operative gastroesophageal reflux (p0.05).The lack of a significant relationship between mean procedure time and gastroesophageal reflux suggests that the mean duration of the laparoscopic procedures performed in this study is safe in terms of gastroesophageal reflux. The results also indicate that young age and low weight should be considered risk factors for gastroesophageal reflux in pediatric patients undergoing laparoscopic appendectomy.

Appendicitis is the leading cause of surgical admission in most hospitals in Nigeria and the removed appendix, a frequent surgical specimen in most routine histopathological laboratories in Nigeria. The aim of this study is to audit the appendectomy procedures in Benue State University Teaching Hospital. Sixty-two appendices removed for acute appendix in Benue State University Teaching Hospital, Makurdi, Nigeria middle belt, over an 8-year period were analyzed. Twenty-eight (45%) were found to be normal, while 29 (46%) showed histopathological evidence of acute inflammation. There were 5 (9%) cases of unusual pathologies which include a case each of metastatic adenocarcinoma and chronic granulomatous inflammation (2% each) and 3 (5%) cases of schistosomiasis. The Negative Appendectomy Rate (NAR) was 27% in females compared with 18% in males. Adult (>16 years) represented 29% of the NAR. The overall NAR was 45%. The NAR in this study is considerable higher when compared with existing literature. In a poor resource center like Benue State University Teaching Hospital, due diligence in taking detailed history coupled with good clinical examination cannot be over emphasized. The use of a combination of Total Leukocyte Count (TCC) and C-Reactive Protein (CPR) in every patient may help in reducing NAR, though it’s definitely going to be impossible to eradicate it.

Background despite the modern life and the availability of knowledge, the prevalence of people who have had appendectomy procedures is increasing these days in Saudi Arabia in the previous years for multiple different risk factors. Knowing the prevalence of people who underwent appendectomy procedure in Saudi Arabia and comparing it with other countries could provide useful information about these risk factors and how to avoid them.Objectives: This study was done to collect information upon and investigate the prevalence people under went appendectomy procedure in Saudi Arabia.Methods: A cross-sectional study was carried out on 864 participants from different social media platforms to investigate the prevalence of people who have had an appendectomy procedure in Saudi Arabia from February to April 2018.Results: 41.1% of the participants knew some information about appendicitis, 8.1% of the participants have had an appendectomy procedure, 33.3% of the participants who had an appendectomy procedure suffered from post-surgery complication, 29.7% of the participants suffered from gastrointestinal diseases. Recently, 41.4% of the participants do not eat food rich in fibers and 37.7% of the participants have a positive family history of appendectomyConclusion: Atthe end of this study, there were an increased number of people who have had an appendectomy procedure in Saudi Arabia.

ObjectiveTo explore geographic variations in Irish laparoscopic and open appendectomy procedures.DesignAnalysis based on 2014–2017 administrative hospital data from public hospitals.SettingCounties of Ireland.ParticipantsIrish residents with hospital admissions for an appendectomy as the principal procedure.Main outcome measuresAge and gender standardised laparoscopic and open appendectomy rates for 26 counties. Geographic variation measured with the extremal quotient (EQ), coefficient of variation (CV) and the systematic component of variation (SCV).Results23 684 appendectomies were included. 77.6% (n= 18,387) were performed laparoscopically. An EQ of 8.3 for laparoscopy and 10.0 for open appendectomy was determined. A high CV was demonstrated with a value of 36.7 and 80.8 for laparoscopic and open appendectomy, respectively. An SCV of 14.2 and 124.8 for laparoscopic and open appendectomy was observed. A wider variation was determined when children and adults were assessed separately.ConclusionsThe geographic distribution in rates of appendectomy varies considerably across Irish counties. Our data suggest that a patient’s likelihood of undergoing a laparoscopic or open appendectomy is associated with their county of residence.

Objective Despite the recent increase in the use of laparoscopic appendectomy procedures to treat acute appendicitis, laparoscopic appendectomy is not necessarily the best treatment modality. The aim of this study is to examine the value of laparoscopic intracorporeal knotting and glove endobag in terms of various parameters and in terms of reducing the costs related to laparoscopic appendectomy procedures. Material and methods Seventy-two acute appendicitis patients who underwent laparoscopic appendectomy and open appendectomy surgery were enrolled in the study and were evaluated prospectively. The patients were divided into two groups: group 1 was treated with laparoscopic appendectomy using laparoscopic intracorpreal knotting and glove endobag (n=36) and group 2 was treated with open appendectomy (n=36). The two groups were statistically compared in terms of preoperative symptoms and signs, laboratory and imaging findings, operation time and technique, pain score, gas and stool outputs, duration of hospital stay, return to normal activity, and complications. Results No statistically significant differences were found between the groups in relation to gender, age, body mass index, or pre-operation findings, which included loss of appetite, vomiting, time when pain started, displacement of pain, defense, rebound, imaging methods, and laboratory and pathology examinations (p>0.05). Moreover, there were no differences between the groups with respect to drain usage, hospital stay time, or complications (p>0.05). In contrast, a statistically significant difference was found between the groups in terms of operation time, pain scores, gas-stool outputs, and return to normal activity in the laparoscopic appendectomy group (p=0.001). Conclusion Laparoscopic appendectomy can be performed in a facile, safe, and cost-effective manner with laparoscopic intracorporeal knotting and glove endobag. By using these techniques, the use of expensive instruments can be avoided when performing laparoscopic appendectomy.

Background: although diagnostic criteria for appendicitis are well- defined, the indications for performing appendectomy are still vague. This implies that the decision-making process differs between surgeons, hospitals and countries. Healthcare in China has developed over the last two decades, and is in many respects comparable to western countries, though there still exists room for improvement. To explore how medical decision-making works in China, and whether or not their medical results are applicable to the Western setting, we compared the indications for appendectomy in China with those in Sweden.Objective: to investigate decision-making on appendectomy in Sweden and China.Methods: a retrospective evaluation of all appendectomy procedures at the Karolinska Hospital in 2009 formed the basis of a questionnaire. Using this questionnaire, a prospective study was coinducted at Sodersjukhuset and Karolinska University Hospital Stockholm in 2010 and at Taizhou hospital in 2013. The decision-making surgeon reported which factors were present at the time of treatment decision, and which factors had the greatest impact on their decision.107 questionnaires were collected in China and compared to 117 collected in Sweden.Results: the most frequently reported factors in Sweden and China were similar, but there were some differences. Tenderness in the right fossa had a great impact on the decision to operate in both countries, but an interesting difference was that there was a greater tendency to rely on image diagnostics in Sweden.Limitations: further investigation is needed to evaluate how decision-making is related to evidence and how this affects outcome.Conclusions: as regards appendicitis, the decision-making process in China is similar enough to allow results from China to be used in the Western setting.

PURPOSE: The latest development in the field of minimal invasive surgery is NOTES (Natural Orifice Transluminal Endoscopic Surgery), in which an endoscopic access through the gastrointestinal tract or the vagina is used. In contrast to classical laparoscopic surgery, this technique allows surgery to be performed without visible scars. Cholecystectomy and appendectomy procedures have already been successfully performed with this technique, but it has not yet been employed in the field of surgical gynaecology. This study examines whether this new technique can also be used in gynaecological surgery. MATERIAL AND METHODS: A flexible endoscope (Storz) was inserted intraperitoneally using a transvaginal approach. Via the integrated working canals, it was possible to perform both an adnexectomy and a hysterectomy. To date, NOTES has been used in two female patients at the I. Gynaecological Hospital of the LMU Munich. RESULTS: The surgical technique and the postoperative outcomes of the patients are presented. CONCLUSION: The NOTES technique is a new and promising development in minimally invasive surgery, which can reduce invasiveness even further compared to classical laparoscopic surgery. Its use in a bigger collective of patients will demonstrate the value of this method in the field of gynaecological surgery.

Aim To evaluate antibiotic use in paediatric appendectomy procedures. Method Demographic, clinical and antibiotic prescribing data for patients who had appendectomies were reviewed in two paediatric hospitals retrospectively (pre-intervention). The data was analysed against standard guidelines for abdominal surgery. A multifaceted education strategy was designed and administered only in the case hospital. A post-intervention evaluation was conducted in both hospitals (case and control). Results 207 cases and 224 controls were evaluated. There was no significant difference (p > 0.05) between gender, age and length of stay between the groups. Post-intervention, appropriateness of theatre antibiotics changed from 0 to 65% (cases) and from 52.9% to 53.3% (controls). The appropriateness of ward antibiotics changed from 48 to 84.7% (cases) and 76.4 to 71.4% (controls). The total antibiotic dosage appropriateness changed from 0 to 58.2% (cases) and 12 to 3.8% (controls). Conclusion Antibiotic use significantly improved following the multifaceted educational intervention.

Previously, the authors demonstrated the feasibility of a pure transvesical natural orifice translumenal endoscopic surgery (NOTES) for uterine horn resection (UHR) using a rigid ureteroscope in swine as an appendectomy model. However, visualization was poor, and there was room for improvement. The authors have assessed the feasibility and safety of a revised technique that uses a 5-mm rigid laparoscope. Eight operations on four female pigs (35–40 kg) were performed as a proof of concept study. Four right-side operations were performed in a survival model. The surgical procedure was similar to the original technique. However, the rigid ureteroscope was replaced by a 5-mm laparoscope after modification of the access system. In addition, the clipped metal threads used for bladder closure were easily placed with a long 13-gauge needle. In the survival model, a Foley catheter was placed for 1 day. The new technique provided considerably better visualization and operability than the original technique. The mean total operative time was 96.6 ± 18.2 min, and the mean estimated blood loss was 15.0 ± 13.5 ml. On postoperative day 3, pig 2 in the survival study died of peritonitis resulting from a small bowel injury. The lab results for the other pigs demonstrated no adverse events and tolerable immune responses. Necropsy showed complete healing of the vesicotomy. The revised transvesical NOTES UHR technique improved the outcomes and feasibility of the original technique. This approach may be translatable to human appendectomy procedures in the future.

The authors performed graded compression abdominal ultrasound (US) examinations in children with suspected acute appendicitis, whose clinical presentation was atypical. Abdominal US examination results were 95% accurate, far exceeding that reported for other imaging modalities. The sensitivity was 86%, the specificity was 98%, and the positive and negative predictive values were 96% and 94%, respectively. A positive sonogram made the likelihood of acute appendicitis 50 times greater compared with the pretest clinical impression. In addition, the use of US permitted identification of other pathological conditions that manifest similar symptoms and signs. The authors conclude that, with proper experience, US can be extremely useful in assisting the surgeon to markedly decrease the number of unnecessary appendectomy procedures, without increasing the risk of perforation.

The recent experience with open appendectomy was compared to our initial experience with laparoscopic appendectomy. Thirty-eight patients had open appendectomy for acute appendicitis. Two major and four minor complications occurred. Concurrently, 39 patients had laparoscopic appendectomy. There was one major and one minor complication. Of the laparoscopic patients, 69% received less than 24 hours of parenteral postoperative analgesia, compared to 44% of the patients in the open group. Fifteen of 39 laparoscopic patients (38%) were discharged within 24 hours of operation versus 3 of 38 (8%) in the open group. Total mean hospital cost for the laparoscopic group, $7,500, was significantly greater than for the open group, $5,700, because of increased laparoscopic equipment charges. Both open and laparoscopic appendectomy procedures were performed with minimal morbidity. The benefits of laparoscopy were earlier hospital discharge and less parenteral analgesic use, but it was significantly more expensive.