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Background: Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis. Methods: This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire. Results: The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications. Conclusions: Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles. Trial Registration Number: ClinicalTrials.gov NCT04803422. [ABSTRACT FROM AUTHOR]

Purpose: Choosing the best stump closure method for laparoscopic appendectomy has been a debated issue, especially for patients with acute appendicitis. The lack of consensus in the literature and the diverse techniques available have prompted the need for a comprehensive evaluation to guide surgeons in selecting the most optimal appendiceal stump closure method. Methods: A comprehensive search was conducted on multiple databases from inception until December 2023 to find relevant studies according to eligibility criteria. The primary outcome was the incidence of total complications. Results: 25 studies with a total of 3308 patients were included in this study, overall complications did not reveal a significant advantage for any intervention (RR = 0.72, 95% CI: 0.53; 1.01), Superficial and deep infection risks were similar across all methods, Operative time was significantly longer with endoloop and Intracorporeal sutures (MD = 7.07, 95% CI: 3.28; 10.85) (MD = 26.1, 95% CI: 20.9; 31.29). Conclusions: There are no significant differences in overall complications among closure methods. However, Intracorporeal sutures and endoloop techniques were associated with extended operative durations. [ABSTRACT FROM AUTHOR]

Background: Today, laparoscopy is frequently used in abdominal emergencies such as acute appendicitis. There are several techniques used to close the appendiceal stump during laparoscopic appendectomy. We aimed to compare the use of handmade loop and Hem-o-lok used to close the appendiceal stump in public hospitals where resources are limited, in terms of surgical outcomes and cost. Methods: Between January 2020 and December 2022, patients for whom handmade loops and Hem-o-loks were used to close the appendiceal stump during laparoscopic appendectomy in our clinic were included in the study. There were a total of 638 patients (mean age: 33 ± 13.5 years, 325 females and 313 males) in the patient cohort. Demographic and clinical data, duration of surgery, complications, hospital stay, pathology reports, mortality, and cost of supplies were compared between the two groups. Results: There were 308 patients in the handmade loop group (160 females, 148 males, mean age: 33.7 years, range: 18–85 years) and 330 patients in the Hem-o-lok group (166 females, 164 males, mean age: 32.5 years, range: 18–89 years). There was no significant difference between the two groups for American Society of Anesthesiologists score, duration of symptom, hospital stay, intensive care unit stay, preoperative laboratory values, histopathological results, mortality, and morbidity (P >.05). The mean operation time was 48.76 ± 16.16 minutes in the handmade loop group and 40.53 ± 11.63 minutes in the Hem-o-lok group (p = 0.001). In terms of cost, the cost per case of Hem-o-lok group was about 25.8 times as much as the group that used sutures ($31 versus $1.2). Conclusions: Both methods can be used safely in laparoscopic appendectomy. The use of Hem-o-lok has no advantage other than shortening the operation time. However, it is costlier. Especially in peripheral hospitals where resources are limited, closing the appendiceal stump using a handmade loop is an easy, safe, and cost-effective method. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy is a common procedure and introduced early in general surgical training. How internal (i.e. surgeon's experience) or external (i.e. disease severity) may affect procedure performance is not well-studied. The aim of this study was to evaluate factors that may have an influence on the performance scores for surgical trainees. Methods: A prospective, observational cohort study of laparoscopic appendectomies performed by surgical trainees (experience < 4 years) operating under supervision. Trainers evaluated trainees' overall performance on a 6-point scale for proficiency. Perioperative data were recorded, including appendicitis severity, operating time and the overall difficulty of the procedure as assessed by the trainer. A "Challenging" procedure was defined as a combination of either/or "perforation" and "difficult". Trainees who had performed > 30 appendectomies were defined as "experienced". The trainees were asked if they had used simulation or web-based tools the week prior to surgery. Results: 142 procedure evaluation forms were included of which 19 (13%) were "perforated", 14 (10%) "difficult" and 24 (17%) "Challenging". Perforated appendicitis was strongly associated with procedure difficulty (OR 21.2, 95% CI 6.0–75.6). Experienced trainees performed "proficient" more often than non-experienced (OR 34.5, 95% CI 6.8–176.5). "Difficult" procedures were inversely associated with proficiency (OR 0.1, 95% CI 0.0–0.9). In "Challenging" procedures, identifying the appendix had lowest proficiency (OR 0.4, 95% CI 0.1–0.9). The procedures assessed as "difficult" had significantly longer operating time with a median (IQR) of 90 (75–100) min compared to 59 (25–120) min for the non-difficult (p < 0.001). Conclusion: Both internal and external factors contribute to the performance score. Perforated appendicitis, technical difficult procedures and trainee experience all play a role, but a "difficult" procedure had most overall impact on proficiency evaluation. [ABSTRACT FROM AUTHOR]

Despite all the advances in laparoscopic surgery, it is still controversial whether complicated appendicitis should be treated by laparoscopic or open surgery. In this study, we aimed to compare intraoperative and postoperative outcomes of patients with complicated appendicitis who underwent laparoscopic or open appendectomy. Between March 2018 and March 2022, 151 patients underwent laparoscopic or open appendectomy for complicated appendicitis were analysed retrospectively. Demographic, laboratory data, and postoperative outcomes were examined. The median age of the patients was 46 years (interquartile range: 31-63) and 55% of the patients were male. Laparoscopic appendectomy was performed in 54.3% of the patients. While there was no significant difference observed in hospitalization durations between groups, laparoscopic appendectomy exhibited longer operation times compared to open appendectomy. Furthermore, postoperative follow-ups revealed a higher incidence of severe complications (Clavien-Dindo 3-4) in laparoscopic appendectomy (p=0.037). Subgroup analysis of complications indicated a greater frequency of intra-abdominal abscesses in laparoscopic procedures (p=0.033). Although the benefits of minimally invasive surgeries have been well-established, in cases of complicated appendicitis, we recommend open surgery over laparoscopic surgery to clinicians. [ABSTRACT FROM AUTHOR]

Background. The number of heart transplant patients makes 1 per 100,000 in the Russian Federation, 1.2 per 100,000 population in the Tambov Region. The medical community is poorly informed about the specific features of managing such patients during non-cardiac surgical interventions. The article presents a case report of the management of a patient with a transplanted heart undergoing surgery for acute appendicitis. Preoperative preparation, anesthesia management, surgery, and postoperative care and rehabilitation were provided taking into account the presence of a transplanted heart in the patient, according to the Guidelines developed by the experts of the V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs where the heart transplant had been performed to the patient, and standard clinical recommendations.Case Report. An 18-year-old patient diagnosed with acute phlegmonous appendicitis with a heart transplanted in 2021 for dilated cardiomyopathy underwent laparoscopic appendectomy 3 years after heart transplantation. Anesthesia was provided taking into account the presence of a denervated donor heart, a high risk of myocardial ischemia and heart ailure (low cardiac output syndrome), and the need for a timely correction of hypovolemia and hypotension. Anesthesia management was a general combined multicomponent anesthesia.Conclusion. This clinical case has shown the possibility of providing medical care to a patient with a transplanted heart at a modern level in an urban multidisciplinary hospital. Non-cardiac surgery was performed in accordance with recommendations of specialists of V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs and clinical recommendations in order to achieve optimal results and the fastest possible rehabilitation in the postoperative period.

Paraduodenal hernias (PDH) pose a diagnostic challenge due to their varied presentations and rarity. We report a rare case report illustrating the clinical course, diagnostic approach, and management of PDH in a 19-year-old female patient with a history of neonatal laparotomy for intestinal atresia. The patient initially presented with chronic, diffuse abdominal pain, which had progressively worsened over 2 years. Physical examination revealed no palpable mass, with normal bowel sounds and vital signs. Imaging studies, including computed tomography of the abdomen, demonstrated protrusion of small bowel loops in the left upper abdominal quadrant consistent with a left paraduodenal hernia. Following laparoscopic exploration, a large defect was identified, and successful repair was performed, resulting in resolution of symptoms and a smooth postoperative recovery. Our case highlights the importance of maintaining a high index of suspicion for PDH in patients with chronic abdominal pain, particularly those with a history of abdominal surgeries. Prompt diagnosis and timely surgical intervention, preferably laparoscopic, can lead to favorable outcomes and improved quality of life for affected individuals.

Purpose: TULAA combines the laparoscopic and open technique and is considered to be a safe, fast and cost-effective procedure. On the other hand, preparation is limited due to the single instrument, especially in complicated appendicitis. In this study we analyze the outcome of our TULAA patients, focusing on conversion and complication rates. Methods: We performed a retrospective study including all patients treated with TULAA in our department between 2006 and 2016. We analyzed patient data, operative data, costs, complications, and conversion rate to standard laparoscopic or open appendectomy. Results: 1275 children and adolescents were enrolled. Mean age was 10.2 years. TULAA was completed in 88% of cases. The overall mean operative time was 33 min. The overall complication rate was 5.7%. The most common complications were wound infection (2.7%), seroma (1.7%) and wound abscess (1.4%). Both the conversion rate and the complication rate were significantly higher in complicated appendicitis. Furthermore, the conversion rate is higher in overweight or obese patients. Conclusion: TULAA is a safe, quick and cost-effective treatment option for acute appendicitis in children and adolescents. The complication rate and conversion rate are significantly correlated with the degree of appendiceal inflammation and comparable other surgical procedures. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the clinic outcomes between new single-port laparoscopic appendectomy (NSLA) and conventional three-port laparoscopic appendectomy (CTLA) for patients with acute appendicitis. Patients who were diagnosed with acute appendicitis and underwent appendectomy were retrospectively collected from a single clinical center from September 2021 to June 2023. Baseline characteristics, surgical information, and postoperative information were compared between the NSLA group and the CTLA group. Univariate and multivariate logistic regression analyses were used to find out the predictors of overall complications. A total of 296 patients were enrolled from a single clinical medical center. There were 146 (49.3%) males and 150 (50.7%) females. There were 54 (18.2%) patients in the NSLA group and 242 (81.8%) patients in the CTLA group. After data analysis, we found the patients in the NSLA group had a shorter postoperative hospital stay (P < 0.01) than the CTLA group. The other outcomes including intraoperative blood loss (P = 0.167), operation time (P = 0.282), nature of the appendix (P = 0.971), and overall complications (P = 0.543) were not statistically different. After univariate and multivariate logistic regression analysis, we found that age (P = 0.018, OR = 1.039, 95% CI = 1.007–1.072), neutrophil percentage (P = 0.018, OR = 1.070, 95% CI = 1.011–1.132), and fever (P = 0.019, OR = 6.112, 95% CI = 1.340–27.886) were the predictors of overall complications. However, the surgical procedure (NSLA versus CTLA) was not a predictor of overall complications (P = 0.376, OR = 1.964, 95% CI = 0.440–8.768). Compared with CTLA, there was no significant increase in postoperative overall complications with NSLA, making it a safe and feasible new surgical procedure. More studies are needed to evaluate the long-term results. [ABSTRACT FROM AUTHOR]

Background: Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis. Methods: This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage. Results: A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table 1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835). Conclusions: Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To compare the use of Titanium clips and Monopolar diathermy for laparoscopic appendectomy mesoappendix closure in terms of operative time and cost. Study Design: Quasi-experiment study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Nowshera Pakistan, from Jul 2021 to Jun 2022. Methodology: A total of 70 patients who were diagnosed with acute appendicitis and were admited for laparoscopic appendectomy were randomly divided into two groups via the lotery method. In Group-A, the closure of the mesoappendix was done using Titanium clips, and in Group-B, the ligation of the mesoappendix was done using Monopolar diathermy. Patient outcomes in terms of operative time and procedure cost were assessed. Results: Out of 70 patients, 49(70.0%) were males and 21(30.0%) were females, aged 18 to 60 years, with a mean age of 37.57±7.71 years. The overal mean weight of the patients was 65.29±12.14 kg; height was 1.71±0.12 metres; and BMI was 24.96±5.23 kg/m2, respectively. Prolonged operative time was observed in 16(45.71%) patients in Group-A, compared to 7(20.0%) in Group-B (p-value 0.022). In Group-A, the total cost of the operation was Rs. 32,000, whereas in Group-B, it was Rs. 30,000 (p-value=0.001). Conclusion: This study concluded that Monopolar diathermy for the closure of the mesoappendix is beter in terms of operating time and cost as compared to the use of Titanium clips. [ABSTRACT FROM AUTHOR]

Background Pediatric obesity is a common comorbid condition that may complicate pediatric surgeries, such as appendectomy. Prior research on the consequences of obesity on pediatric appendectomy outcomes have been limited by small-sample sizes and pooled analyses that do not distinguish the effects of surgical approach. Associations between surgical approach, pediatric obesity, and postoperative appendectomy outcomes thus remain unclear.

Relevance Treatment of complicated forms of acute destructive appendicitis continues to be an urgent problem in emergency abdominal surgery. Aim of study Improving the results of surgical treatment of patients with appendiceal peritonitis with laparoscopic appendectomy.Material and methods A retrospective analysis of the treatment of 150 patients with acute appendicitis complicated by local and diffuse peritonitis aged from 17 to 69 years was carried out. There were 77 (51.3%) women and 73 (48.7%) men. Depending on the treatment tactics used, two groups of patients were divided. In the main group (64 patients), the leading treatment method was laparoscopic appendectomy. In the comparison group (86 patients), traditional approaches were used, including open appendectomy with the McBurney approach in 72 patients (83.7%) and laparotomy for diffuse peritonitis in 14 (16.4%).Results The analysis of the surgical techniques used showed that in the main group, wound postoperative complications developed in 9 patients (14.1%). In the comparison group, postoperative complications developed in 32 patients (37.2%). For local non­limited peritonitis, the total duration of hospitalization after laparoscopic appendectomy performed in 49 patients was 6.7±1.4 days, and 8.6±2.1 days (p

Despite all the advances in laparoscopic surgery, it is still controversial whether complicated appendicitis should be treated by laparoscopic or open surgery. In this study, we aimed to compare intraoperative and postoperative outcomes of patients with complicated appendicitis who underwent laparoscopic or open appendectomy. Between March 2018 and March 2022, 151 patients underwent laparoscopic or open appendectomy for complicated appendicitis were analysed retrospectively. Demographic, laboratory data, and postoperative outcomes were examined. The median age of the patients was 46 years (interquartile range: 31-63) and 55% of the patients were male. Laparoscopic appendectomy was performed in 54.3% of the patients. While there was no significant difference observed in hospitalization durations between groups, laparoscopic appendectomy exhibited longer operation times compared to open appendectomy. Furthermore, postoperative follow-ups revealed a higher incidence of severe complications (Clavien-Dindo 3-4) in laparoscopic appendectomy (p=0.037). Subgroup analysis of complications indicated a greater frequency of intra-abdominal abscesses in laparoscopic procedures (p=0.033). Although the benefits of minimally invasive surgeries have been well-established, in cases of complicated appendicitis, we recommend open surgery over laparoscopic surgery to clinicians. [Med-Science 2024; 13(3.000): 633-6]

Appendectomy is the most common emergency abdominal surgery in the United States. Open appendectomy has been the standard procedure for decades, whereas laparoscopic appendectomy is a newer, less-invasive method of removing the appendix. This review intends to elucidate the similarities and differences between these two procedures as well as explore the advantages and disadvantages of each approach. Socioeconomic factors, associated costs, preoperative imaging, operative time and methods, length of hospital stay, recovery time, and complications associated with open and laparoscopic appendectomy are discussed. Overall, laparoscopic appendectomy has shorter hospital stays and recovery times, requires less analgesics, and results in better postoperative outcomes. Although such an analysis/comparison involves several perspectives, a review of the available literature suggests that laparoscopic appendectomy is the operation of choice in most cases.

Objective To investigate the advantages and disadvantages of purse-string suture, Hem-o-lok clip and double thread ligation in the treatment of appendiceal stump. Methods A retrospective study was conducted on 237 acute appendicitis patients who underwent laparoscopic appendectomy at Nanjing Jiangbei Hospital from July 2021 to April 2023. According to the treatment, the patients were divided into purse-string suture group (n=48), Hem-o-lok clip group (n=152) and double thread ligation group (n=37). The baseline data, surgical time, intraoperative bleeding, length of hospital stay, total hospitalization costs, and incidence of postoperative complications among three different treatment methods were compared. Results There was no significant in operation time, blood loss, and hospital stay among three groups (P＞0.05). there was significant difference in total hospitalization cost among three groups (F=5.823, P=0.003), and that in double thread ligation group was (9 809.1±1 199.7) yuan, which was significantly lower than that in the purse-string suture group ［(10 355.0±1 133.7) yuan］ and Hem-o-lok clip group ［(10 541.6±1 179.3) yuan］ (P＜0.05). The incidence of complications in the purse string suture group was 2.1% (1/48), the Hem-o-lok clip group was 2.0% (3/152), and the double thread ligation group was 2.7% (1/37). There was no statistically significant difference in the incidence of complications among the three groups (P＞0.05). Conclusion The three methods to secure the appendiceal stump are safe and effective, but double thread ligation is cost-saving than purse-string suture and Hem-o-lok clip.

Appendiceal diverticulitis is an uncommon condition that clinically resembles acute appendicitis. However, it is an incidental finding in histopathological studies and is rarely diagnosed preoperatively by imaging studies. In this article, we present the clinical and imaging findings of a male patient presenting with right upper quadrant pain with a preoperative imaging diagnosis of appendiceal diverticulitis. He underwent laparoscopic appendectomy and confirmed the diagnosis of appendiceal diverticulitis. This is a rare preoperative diagnosis. The management is often like typical appendicitis which is appendectomy. It is important to differentiate it from diverticulitis of the small intestine or colon because these diseases usually require only conservative treatment. [ABSTRACT FROM AUTHOR]

The present report elucidated a rare complication post-laparoscopic appendectomy, the suprapubic laparoscopic port-related urinary bladder rupture. By highlighting the present case, the author emphasized the importance of surgical awareness, the feasibility of conservative management in specific scenarios, and the vital role of patient involvement in decision-making. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration. Study Design and Methods: We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery. Discussion: No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic. [ABSTRACT FROM AUTHOR]

Background: Glucocorticoids are conventionally associated with increased postoperative infection risk. It is necessary to clarify if preoperative glucocorticoid exposure is associated with postoperative infection in appendectomy patients and if the association is different for open and laparoscopic appendectomies. Methods: A Danish nationwide study of appendectomy patients between 1996 and 2018. Exposures were defined as high (≥ 5 mg) versus no/low (< 5 mg) glucocorticoid exposure in milligram prednisone-equivalents/day preoperatively. The main outcome was any postoperative infection. Then, 90-day cumulative incidences (absolute risk) and adjusted hazard ratios (relative risk) of the outcome were calculated for high versus no/low glucocorticoid exposure within all appendectomies and within open and laparoscopic subgroups. Propensity-score matching was used for sensitivity analysis. Results: Of 143,782 patients, median age was 29 years, 74,543 were female, and 7654 experienced at least one infection during the 90-day follow-up. The 90-day cumulative incidence for postoperative infection was 5.3% within the no/low glucocorticoid exposure group and 10.0% within the high glucocorticoid exposure group. Compared to no/low glucocorticoid exposure, adjusted hazard ratios for 90-day postoperative infection with high glucocorticoid exposure were 1.25 [95% CI 1.02–1.52; p = 0.03] for all appendectomies, 1.59 [1.16–2.18; p = 0.004] for laparoscopic appendectomies, and 1.09 [0.85–1.40; p = 0.52] for open appendectomies (pinteraction < 0.001). The results were robust to sensitivity analyses. Conclusion: Preoperative high (≥ 5 mg/day) glucocorticoid exposure was associated with increased absolute risk of postoperative infections in open and laparoscopic appendectomies. The relative risk increase was significant for laparoscopic but not open appendectomies, possibly due to lower absolute risk with no/low glucocorticoid exposure in the laparoscopic subgroup. [ABSTRACT FROM AUTHOR]

Purpose: Polymeric clips (Hem-o-lok ligation system) are now widely used to securing the base of the appendix during laparoscopic appendectomy. Studies comparing the use of single or double hem-o-lok clips are limited. The aim of this study was to compare the reliability of a single hem-o-lok clips with a double hem-o-lok clips for closure of an appendiceal stump. Methods: This prospective randomized study includes patients from two centers who underwent laparoscopic appendectomy with the diagnosis of appendicitis between September 2020 and March 2023. Demographic, operative and clinical outcomes of the use of single or double hem-o-lok clips for closure of the appendiceal stump were compared. Factors affecting long postoperative hospital stay were investigated using univariate and multivariate analyzes. Results: One hundred forty two (48.3%) patients in the single hem-o-lok arm and 152 (51.7%) patients in the double hem-o-lok arm were included in the analysis.The shortest operative time was noted in the single hem-o-lok group (52.1 ± 19.9 versus 61.6 ± 24.9 min, p < 0.001). The median hospital stay was 1 day (range 1–10) in the single hem-o-lok group and 1 day (range 1–12) in the double hem-o-lok group, and was shorter in the single hem-o-lok arm (1.61 ± 1.56 vs 1.84 ± 1.69, p = 0.019). Based on multivariate analysis, drain placement was identified as an independent predictive factor for long hospital stay. Conclusions: The use of single hem-o-lok clips for appendiceal stump closure during laparoscopic appendectomy is safe and effective. Trial registration NCT04387370 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Background: Osteogenesis imperfecta (OI) is a genetic connective tissue disease defined by the loss of bone mass and density, which makes the bones more brittle and more likely to fracture over time. Bone deformity and articular instability are the subsequent symptoms. Case report: This 25-year-old man had malformed lower limbs and trouble walking due to OI and dwarfism. He arrived complaining of fever, nausea, vomiting and diffuse peri-umbilical pain. During ultrasonography a blinded, oedematous lobe formation containing an appendicolith was discovered. Acute suppurative appendicitis was diagnosed, necessitating a laparoscopic appendectomy. Because the patient had previously undergone general anaesthesia, anaesthesia was thought to be attainable. Pneumoperitoneum and a 10 mm optical port inserted into the umbilicus were used in the surgical procedure. A diagnostic laparoscopy revealed faecolith obstruction and an acute suppurative appendicitis. After an hour, a laparoscopic appendectomy was performed effectively with little blood loss. Without experiencing any difficulties because of the surgery position, the patient was discharged. Conclusion: We present a case of an OI dwarf patient with acute suppurative appendicitis. It highlights the possibility of performing laparoscopic surgery in general and a laparoscopic appendectomy in particular on OI patients.

Background. Nowadays, simultaneous techniques have been widely adopted in abdominal pediatric surgery as they allow to perform surgical interventions for several diseases at the same time. However, the safety of such interventions requires further studies. Objective. The aim of the study is to analyze the short-term outcomes of simultaneous hernia repair in laparoscopic appendectomy in children. Methods. The study included data from patients hospitalized with suspected acute appendicitis in 2022–2023. The study group included children operated for acute appendicitis and who had signs of patent processus vaginalis. Percutaneous internal ring suturing (PIRS) was performed in all cases. The control group (no indirect inguinal hernia was revealed) was formed by pairwise matching of patients by gender, age (± 1 year), and appendicitis type. The surgery time, the blood loss volume, the beginning of enteral feeding, and the presence of postoperative complications were analyzed. Results. The compared groups (13 individuals each) were comparable in gender (38% boys), age (median age about 10 years), and appendicitis type (catarrhal — 31%, phlegmonous — 38%, gangrenous — 31%), and white cell count at admission, presence of serous exudate and omentum changes revealed during surgery. The beginning of enteral feeding, the stool, as well as total duration of hospital stay after surgery did not differ in two groups. Moreover, both groups were comparable in terms of surgery duration, intraoperative blood loss volume, pain syndrome severity. No pyo-inflammatory complications of abdominal cavity or postoperative wounds were revealed during the hospital stay. Conclusion. Simultaneous hernia repair via PIRS method is effective and safe method of surgical management of pediatric patients with combination of acute appendicitis and inguinal hernia.

Introduction: Pain is almost the main problem after surgery, effective pain management is crucial for recovery, since poorly managed pain can have detrimental effects on a patient's physical functioning, mental health, interpersonal connections, and productivity. Objective: Our study compares LA and OA to evaluate post-operative pain in 42 ​h using the Visual Analouge Scale (VAS) with the goal decreasing the requirement for opioids to address postoperative pain. Methods: A retrospective analysis of patients with an appendicitis diagnosis who were admitted to the Department of General Surgery at General Hospital University of Muhammadiyah Malang between January 2018 and June 2019. 258 individuals with acute appendicitis, with 137 undergoing open appendectomy (OA) and 121 undergoing laparoscopic appendectomy (LA). Result: We reported patients who obtained OA surgery experienced significant pain on first day, compared with patients who underwent LA operation, who reported light pain (P ​= ​0.000). On second day Thirteen patients who underwent OA surgery reported a reduction in pain levels from moderate to mild (P ​= ​0.000). Patients who underwent LA procedure, 59 participants had a significant reduction of pain level, 54 patients reduced from mild to no pain. and moderate pain to light pain reported in 5 patients, whereas the remaining 62 had no change level of pain (P ​= ​0.000). Conclusion: In terms of post-operative pain, the LA operation is a reliable surgical technique and is preferable to an OA appendectomy.

Objectives Method Result Conclusion Modified endoscopic retrograde appendicitis therapy (mERAT) has been proposed as an alternative to laparoscopic appendectomy for the treatment of appendicitis. However, data from children in large samples are lacking. The aim of this article is to evaluate the efficacy between mERAT and laparoscopic appendectomy (LA) in children with uncomplicated appendicitis.We retrospectively analyzed 594 patients with suspected uncomplicated appendicitis from October 2018 to May 2021. A pool of 294 consecutive patients who met the inclusion criteria were ultimately enrolled in this study (228 and 66 patients in mERAT and LA, respectively). Given the differences in baseline clinical data (gender, age), the regression equation including differences in clinical baseline, grouping factor, and white blood cell count was established to address the influence of potential confounding factors.The initial success rate of mERAT management was 96.9%, and the recurrence rate was 6.9% in the mERAT group and 1.7% in the LA group within 1 year, which was no significant difference. But the mERAT group had a lower rate of adverse events. Finally, those results indicated that the treatment modalities, LA or mERAT, had no significant effect on initial success rate (P = 0.99) or recurrence rate (P = 0.17) within 1 year, but a significant effect on the adverse events rate during hospitalization (P = 0.01) in the multivariate regression analysis.Among children with uncomplicated appendicitis, an initial mERAT management strategy had a success rate of 96.9%, which was similar to the LA group at 1 year. This follow‐up supports the feasibility of mERAT alone as an alternative to surgery for uncomplicated appendicitis. [ABSTRACT FROM AUTHOR]

Laparoscopic appendectomy is a procedure with the lowest morbidity and combines diagnostic and therapeutic advantages. The trend towards minimally invasive surgery has led general surgeons to evaluate the potential conversion of nearly all surgeries to laparoscopic procedures. Therefore, the purpose of the present study was to evaluate the efficacy of Laparoscopic appendectomy in patients with Appendicular Perforation in our setup. A prospective study conducted on 50 cases of appendicitis with perforation were diagnosed, admitted, investigated, treated and followed up in the Department of General Surgery, Government General Hospital, Ananthapuram during the period of November 2020 to November 2022. Clinical and demographic details were obtained and subjected to appropriate statistical analysis. Majority (72%) of patient's age group lied in 2nd and 3rd decade of life with predominance for male gender was observed. The clinical findings of perforation was based on tachycardia (> 90/mt.), tachypnoea(16-20/min.). Nausea/vomiting was in (36) 72% of patients. 39(78%) patients had RIF tenderness. 11000/cmm to 15000/cmm was occupied by 31(62%) patients. Detection of appendicular perforation by ultrasonography was 70% (in 35 cases) and 93.33% (14) patients were detected by CECT abdomen in suitable patients. Appendicular mass was seen in 7 (14%) and abscess in 13(26%) patients. Various positions of appendix like retro cecal 35(70%), pelvic 11(22%), subcecal 2(4%), preileal 0(0%) post ileal 2(4%) were documented. Site of appendicular perforation at tip was in 40(80%) of cases. Conversion of laparoscopic procedure to open procedure was seen only in 2(4%) cases. Placement of drain was in 11 (22%). Postoperative Ileus was seen in 24(48%) patients. 21(42%) of patients have been discharged by POD-3. Our study certainly proved that laparoscopic appendicectomy in patients with perforated appendix is advantageous in reducing post-operative morbidity and early recovery of the patient. Study proved laparoscopic appendectomy is the BEST approach in perforated appendicitis. [ABSTRACT FROM AUTHOR]

Appendectomy is the most common emergency abdominal surgery in the United States. Open appendectomy has been the standard procedure for decades, whereas laparoscopic appendectomy is a newer, less-invasive method of removing the appendix. This review intends to elucidate the similarities and differences between these two procedures as well as explore the advantages and disadvantages of each approach. Socioeconomic factors, associated costs, preoperative imaging, operative time and methods, length of hospital stay, recovery time, and complications associated with open and laparoscopic appendectomy are discussed. Overall, laparoscopic appendectomy has shorter hospital stays and recovery times, requires less analgesics, and results in better postoperative outcomes. Although such an analysis/comparison involves several perspectives, a review of the available literature suggests that laparoscopic appendectomy is the operation of choice in most cases. [ABSTRACT FROM AUTHOR]

Background: The most common surgical disease is acute appendicitis. Appendicular stump closure is the most crucial part in appendectomy. The aim of the present study was to compare outcomes of Hem-o-lok clip and extracorporeal sliding knot in appendicular stump closure during L-APPE. Methods: This study was designed as prospective randomized clinical trial for evaluation of the outcomes of appendix stump closure with Hem-o-lok clip or extracorporeal sliding knot during L-APPE. This study was carried out in Zagazig University Hospitals, Egypt. All patients diagnosed as acute appendicitis patients and operated by L-APPE at Zagazig University Hospital during the period from 1st of September 2020 till 31st of March 2022 were assessed for study eligibility. Results: In total, 160 patients (80 patients in each arm) were enrolled into the study. No difference in hospital stay in both groups but operative time was noted in the hem-o-lok group (group I) of patients 35.45 ± 9.24 minutes in Hemo-lok group, but in the extracorporeal knot group (group II) it was 44.15 ± 7.51 minutes. Regarding postoperative complications, 2 patients (2.5%) within group I had superficial infection versus three patients (3.8%) within group II. While two patients (2.5%) within group I had one patient (1.2%) deep infection versus within group II overall 3 cases (1.8%) of deep infection in both groups. Conclusions: Hem-o-lok clip is safe and effective method in appendicular stump closure during L-APPE with less operative time. [ABSTRACT FROM AUTHOR]

The management of complicated appendicitis has undergone a transformative shift in recent years, moving away from the traditional conservative approach followed by interval appendectomy towards early appendectomy. This review article explores the current landscape of complicated appendicitis management, investigating the roles of conservative treatment, interval appendectomy, and early appendectomy. With no definitive consensus in place, the choice of treatment largely depends on the individual surgeon. The emergence of laparoscopic appendectomy has played a pivotal role in this paradigm shift, further highlighting the need to reevaluate and understand the various management options available. A total of 43 articles, 24 from Asia, 12 from Europe, 5 from the USA and 1 from Africa were retrieved from PubMed, Google scholar and the Cochrane database of clinical reviews. This review synthesizes existing literature, shedding light on the advantages and considerations associated with each approach. [ABSTRACT FROM AUTHOR]

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Laparoscopic appendectomy has become one of the most common laparoscopic surgery performed in day to day of a surgeon. Advantages outrage far more when compared to open appendectomy and thus the shift from open to minimal access surgery has gained importance considering mainly perioperative period. Small studies done during the past decade have demonstrated same-day discharge after appendectomy as an option for non-perforated appendicitis. Here we have examined a study group to confirm that same-day discharge in acute non-perforated appendicitis is a safe option. All patients older than 18 years of age with acute, non-perforated appendicitis who underwent a laparoscopic appendectomy were included. Compared patients discharged on the day of surgery with patients hospitalized for 1 night and followed up sequentially. The study was composed of 100 patients; 70 patients were in the same-day discharge group and 30 patients were in the hospitalized group. Patients in the same-day discharge group had a lower rate of readmission within 30 days when compared with the hospitalized group (2.2% vs 3.1%; p < 0.005). Postoperative general surgery department visits were slightly higher in the hospitalized group (85% vs 81%; p < 0.001). [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy and safety of enhanced recovery protocol (ERP) combined with laparoscopic appendectomy (LA) in the treatment of acute uncomplicated appendicitis (AUA) without antibiotics. Methods: In this study, a total of 160 patients with AUA who underwent LA between January 2018 and December 2021 were included and divided into the antibiotic group (n = 80) or the no-antibiotic group (n = 80). The patients in the antibiotic group received the ERP combined with antimicrobials during the perioperative period, while those in the no-antibiotic group only received the ERP during the perioperative period. The clinical data of these patients were collected to compare the inflammation level and stress state before and after surgery. In addition, the incidence of postoperative complications and the recovery speed of the patients were compared between groups. Results: There were no significant differences in the inflammation level and stress state before or after surgery, the incidence of postoperative complications or the recovery speed between the antibiotic group and the no-antibiotic group (P > .05). Conclusion: The use of ERP combined with LA as an antimicrobial-free treatment scheme in the perioperative period was found to be safe and effective for patients with AUA. Therefore, this approach is clinically valuable. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic appendectomy is the most preferred surgical method in the treatment of acute appendicitis. In our study, we aim to determine the clinical and radiological factors affecting conversion from laparoscopic appendectomy to open surgery. Materials and Methods: All patients older than 18 years, who were operated on with the diagnosis of acute appendicitis in the General Surgery clinic of Prof. Dr. İlhan Varank Training and Research hospital between January 2020 and January 2022, were included in the study. The data consisting of clinical, laboratory, and radiological (computed tomography) findings of the patients were evaluated retrospectively. The patients were divided into two groups as those whose surgery was completed laparoscopically (Group 1) and those converted from laparoscopic appendectomy to open surgery (Group 2). The risk of conversion to open surgery was analyzed by binary logistic regression analysis as univariate and multivariate models. Results: Appendectomy was performed in 831 patients within the specified period. The surgery of 31 (3.73%) patients started laparoscopically; however, they were completed by converting to open surgery. Multivariable analysis showed that the risk of conversion to open surgery increased with leukocyte count, Alvarado score and with the presence of periappendiceal fluid and lymphadenopathy on CT. Conclusion: Our study shows that patients with high risk of returning to open surgery can be identified preoperatively with the risk analysis method in which clinical, laboratory, and radiological findings are evaluated together. We conclude that, starting the operation of these patients with the open technique from the beginning will prevent unnecessary expenditures and reduce morbidities. [ABSTRACT FROM AUTHOR]

Common complications following laparoscopic appendectomy include wound infection, bleeding, intra-abdominal abscess, small bowel obstruction, stump leakage, and stump appendicitis. Here, we presented a case reporting detailing a rare complication following laparoscopic appendectomy: the development of a metastatic neck abscess induced by Klebsiella pneumoniae(K. pneumoniae). A 49-year-old male underwent emergency laparoscopic surgery with prophylactic antibiotic administration for acute appendicitis. Subsequently, he experienced persistent neck pain and fever postoperatively, prompting further investigation. Pus and blood cultures revealed K. pneumoniae, with magnetic resonance imaging confirming the presence of a neck abscess. Antibiotic therapy was adjusted, and surgical drainage of the abscess was performed after multidisciplinary consultation. The patient was discharged without complications. While rare, metastatic abscesses following appendectomy warrant consideration, particularly in K. pneumoniae infections. Comprehensive clinical assessment, imaging, and laboratory evaluation are crucial for timely diagnosis and management of such complications.

Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after laparoscopic appendectomy. A 57-year-old male, with a history of minimally invasive esophagectomy and intrathoracic gastric tube reconstruction 5 years before, underwent a laparoscopic appendectomy. A chest X-ray taken on postoperative Day 1 revealed the development of the right pneumothorax, which took more than 3 days to resolve spontaneously. Although the mechanism of postoperative pneumothorax was unclear, it seemed likely that the air that had replaced carbon dioxide in the peritoneal cavity migrated into the thoracic cavity through the esophageal hiatus, which was not covered by the peritoneum or pleura after surgical resection. The present case, together with our previous similar case, suggests that a history of esophageal cancer surgery per se increases the risk of pneumothorax after laparoscopic surgery, probably regardless of when this was performed. [ABSTRACT FROM AUTHOR]

Acute appendicitis supposedly results from appendix obstruction caused by various conditions, including caecal cancer. Here, we report an adenocarcinoma found in the specimen of a 65-year-old man diagnosed with acute appendicitis. The adenocarcinoma was detected in the appendix stump after emergency laparoscopic appendectomy. The patient was diagnosed with caecal cancer based on post-operative lower endoscopy findings, and an additional laparoscopic right hemicolectomy was performed. Acute appendicitis can occur at any age and may require emergency surgery. It is a benign disease that can be cured entirely by appendectomy in most cases but may result from an underlying malignant disease in some cases, especially in patients >40 years of age. Thus, clinicians should consider the possibility of a malignancy while diagnosing and treating acute appendicitis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to identify the predominant bacteria cultured from the surface of removed appendices in pediatric patients with acute appendicitis and determine the appropriate choice of antibiotics for preoperative and postoperative management. Methods: A 2-year retrospective cohort study was conducted at Mediclinic Parkview Hospital, Dubai, UAE. Patients under 14 years of age with diagnosed acute appendicitis who underwent laparoscopic appendectomy were included. Swab cultures, along with demographic, laboratory, and pathology data, were analyzed. Results: Out of the 56 enrolled patients, 27 (48 %) exhibited bacterial growth on swab cultures, while 29 (52 %) showed no bacterial growth. Escherichia coli (E. coli) was the predominant isolated bacteria, present in 23/27 patients (85 %). Seven patients had co-infections involving E. coli and other bacteria, with Pseudomonas being the second most common bacteria identified in 7/27 patients (25 %). Antibiotic sensitivity testing indicated that 85 % of the isolated bacteria were sensitive to Gentamicin, 63 % to Amoxicillin/Clavulanic acid, 59 % to Trimethoprim + Sulfamethoxazole, and 27 % to Cefazolin. Conclusion: E. coli was the most prevalent bacteria identified on swabs taken from inflamed appendices in pediatric patients. Amoxicillin/Clavulanic acid was determined to be an appropriate choice for preoperative prophylaxis. This study provides valuable insights for guiding the management of pediatric appendicitis and facilitating the appropriate and judicious use of antibiotics.

Introduction: Laparoscopic appendectomy is standard of care for acute appendicitis and commonly involves use of linear staplers for dividing the appendiceal base and mesoappendix. We present a series of a rare complication, postoperative intestinal volvulus from retained staples. Cases: Patients are a 1) 10-year-old male, 2) 13-year-old, and 3) 12-year-old female all diagnosed with acute appendicitis and treated with laparoscopic appendectomy using linear endostapler.Case 1 had abdominal pain 10 days post-operation with peritonitis on exam, leukocytosis, high lactate. CT imaging was concerning for volvulus. Emergent laparotomy reduced the volvulus caused by adhesion to the mesentery from free staples. He was discharged ten days later.Case 2 had emesis and abdominal pain 22 days postoperatively, with CT findings concerning for volvulus. Emergent laparoscopy found an adhesive band from mesentery to terminal ileum involving staples and was reduced. He was discharged the following day.Case 3 had abdominal pain and emesis two days postoperatively. Ultrasound showed hemorrhagic ovarian cyst, and later showed ascites. Pain persisted; STAT CT showed closed loop bowel obstruction requiring emergent laparotomy. A staple was embedded into mesentery with an adhesive band causing a volvulus. Post-operative course was complicated by re-operations and re-admission for additional obstruction. She discharged 14 days after the initial exploratory laparotomy. Conclusion: Post-operative volvulus, a serious complication, can occur following surgical procedures that involve the use of staplers. Free staples left behind in the peritoneal cavity carry a risk of causing such complication. Removal of free staples is recommended at the conclusion of any operation where staples are used.

OBJECTIVE: Acute appendicitis (AA) is the most common cause of acute abdomen and appendectomy is one of the most common surgical procedures. In this study, we aimed to compare open appendectomy (OA) and laparoscopic (LA) surgical techniques in the treatment of AA. METHODS: The data of 236 patients treated with the diagnosis of AA in 2019-2020 were analyzed. Of these patients, 85 patients who received OA and 84 patients who received LA were included in the study. Then, the two groups were compared in terms of demographic, laboratory, clinical, and surgical treatments. RESULTS: A total of 169 patients were included in the study. The mean age was 34.9 years (range 16-78), and the male-tofemale ratio was 0.69. Statistical analysis revealed that the OA group had more leukocytosis, more female gender, and longer operation time than the LA group, but the LA group's complication rate was lower (p<0.05). CONCLUSION: LA offers less morbidity, a shorter duration of hospital stay, and a fast return to normal activities compared to OA. In the surgical treatment of AA, LA can be applied as a routine and first-line treatment. [ABSTRACT FROM AUTHOR]

Background/Objective Postappendectomy abscess (PAA) is the most controversial complication after appendectomy. We aimed to identify the actual incidence of PAA and to compare the success rate of different lines of treatment both in adult and pediatric age groups in our institute. Methods A prospective study was conducted on patients who had a radiologically confirmed PAA. They were subdivided into adults (group A) and children (group B). A stepwise approach was used for the management of the PAA. The success rate of each line of treatment was recorded and compared between both groups. Results Five hundred twenty appendectomy patients were included in this study (321 adult and 199 pediatric patients). In group A, 14 (4.36%) patients had a PAA in comparison to 9 (4.52%) children in group B. In group A, the success rate of both the medical and surgical treatment was 66.7%, whereas the radiological drainage was successful in the three cases. In group B, medical treatment was successful in 83.3% and the patient who failed medical treatment was drained laparoscopically. The remaining three cases were radiologically drained. Conclusion This is the first trial to compare the success rate of different lines of treatment of PAA between adult and pediatric patients. Our results conclude that there is no statistically significant difference between the success rate of each line of treatment. [ABSTRACT FROM AUTHOR]

Background: We sought to understand which factors are associated with open appendectomy as final operative approach. We hypothesize that higher American Association for the Surgery of Trauma (AAST) Emergency General Surgery (EGS) grade is associated with open appendectomy. Patients and Methods: Post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated and Gangrenous (MUSTANG) prospective appendicitis database was performed. All adults (age >18) undergoing appendectomy were stratified by final operative approach: laparoscopic or open appendectomy (including conversion from laparoscopic). Univariable analysis was performed to compare group characteristics and outcomes, and multivariable logistic regression was performed to identify demographic, clinical, or radiologic factors associated with open appendectomy. Results: A total of 3,019 cases were analyzed. One hundred seventy-five (5.8%) patients underwent open appendectomy, including 127 converted from laparoscopic to open. The median age was 37 (25) years and 53% were male. Compared with the laparoscopic group, open appendectomy patients had more comorbidities, higher proportion of symptoms greater than 96 hours, and higher AAST EGS grade. Moreover, on intraoperative findings, the open appendectomy group had a higher incidence of perforated and gangrenous appendicitis with purulent contamination, abscess/phlegmon, and purulent abdominal/pelvic fluid. On multivariable analysis controlling for comorbidities, clinical and imaging AAST grade, duration of symptoms, and intra-operative findings, only AAST Clinical Grade 5 appendicitis was independently associated with open appendectomy (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.24–25.55; p = 0.025). Conclusions: In the setting of appendicitis, generalized peritonitis (AAST Clinical Grade 5) is independently associated with greater odds of open appendectomy. [ABSTRACT FROM AUTHOR]

Introduction: Many factors contribute to pain after laparoscopic appendectomy. We devised a method to reduce pain after laparoscopic appendectomy by wrapping the cecum with the greater omentum. This study aimed to investigate the effectiveness of this method. Materials and methods: This study was conducted to compare the operative and postoperative outcomes in patients with omental wrapping and traditional laparoscopic appendectomy patients. The primary endpoints were the degree of postoperative intra-abdominal pain intensity evaluated by visual analogue scale (VAS), and analgesic use. The secondary endpoints were the operation time, time to pass gas, white blood cell count, C-reactive protein (CRP) on the second postoperative day, numerical rating scale for postoperative nausea, frequency of antiemetic medications frequency, and length of hospital stay. The study was registered in the International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN 89363255). Results: This study evaluated 106 patients. Fifty patients were assigned to the traditional group and 56 to the wrapping group. Pain scores in the first postoperative 24 hours were significantly higher in traditional group patients (p = 0.007). Between 24 and 48 hours, pain score was also higher in traditional group patients (p = 0.01). Time to pass gas was achieved earlier in the wrapping group (p < 0.001). Conclusion: Omental wrapping of the cecum and appendix stump in laparoscopic appendectomy can provide postoperative pain relief by reducing the intensity of visceral pain. [ABSTRACT FROM AUTHOR]

Background: Routine placement of a drain for complicated appendicitis is one of the approaches to reduce postoperative complication. In a resource-limited hospital where radiologist-directed monitoring is not feasible, drainage is beneficial for complication follow-up. Nevertheless, emerging studies indicated drainage did not significantly impact on amelioration of patients’ outcomes. This study aimed to compare the postoperative results of pediatric patients with or without drainage after laparoscopic appendectomy for complicated appendicitis at a rural children's hospital. Methods: We performed a quasi-randomized recruitment of pediatric patients who underwent laparoscopic treatment for complicated appendicitis with or without drainage. Several parameters, including operative time, lengths of stay, complication rate, duration of antibiotic administration, and hospital charges were monitored for assessment. Results: From 05/2020 to 05/2022, there were 184 cases of recruited pediatric patients who underwent laparoscopic appendectomy for complicated appendicitis, with 91 patients in drain-placing group (49.5%). Demographic baseline and pre-surgery symptoms did not indicate any differences between two groups. Data of postoperative complications including intra-abdominal abscesses and wound infections showed no significance in discrepancy. Notably, patients of drainage group experienced longer length of stay than non-drainage group, with average of 8.5 days and 7.5 days, respectively (p

Background: We aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries. Methods: We conducted a single institution, clinical trial (NCT04145895) from January 2020 to February 2022. Patients who presented for a routine inguinal hernia repair (ages 2-13) or laparoscopic appendectomy for uncomplicated appendicitis (aged ≤ 18) were eligible for participation. Participants chose to enroll in either the control (PDAR) or experimental (SDAR) groups. Control patients were instructed to restrict full activities for two weeks. For SDAR, patients were instructed to return to full activity when the patient and family felt comfortable doing so. Postoperatively, participants were asked to complete a survey to assess time to resume full activity, surgical complications, and patient and caregiver satisfaction. Results: 20 (24.4%) enrolled in PDAR and 62 patients (75.6%) enrolled in SDAR. The majority of patients underwent laparoscopic appendectomy (78%). Of patients who completed the postoperative survey, the average time to resume full activity was 11.91 days for PDAR and 9.51 days for SDAR (p = 0.328). There was no difference in parent satisfaction or postoperative complications (p >0.999). Conclusions: The time to resume full activity was two days sooner for SDAR without compromising post-operative outcomes. There are psychosocial benefits to children resuming normal activities, and SDAR may lessen a family's societal burden. Therefore, we propose that SDAR appears safe and should be utilized for routine surgery.