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Introduction: Acute appendicitis is one of the most common causes of emergency abdominal surgery. Laparoscopic and open (mini-incision) appendectomy are the two primary surgical techniques used for treatment, each offering unique advantages. This study aims to compare postoperative outcomes, including wound infection rates and pain levels, between laparoscopic and mini-incision open appendectomy. Materials and Methods: A prospective study was conducted from July 2021 to July 2022 in Van, Türkiye, with 239 patients. After excluding 13 patients, 226 were analyzed. Surgeries were performed by a single surgeon. Data on age, gender, wound infection rates, postoperative pain (measured by the Visual Analog Scale), and length of hospital stay were collected. Statistical analysis was conducted using Mann-Whitney U and Chisquare tests. Results: No significant differences were found between the laparoscopic and mini-incision open groups in terms of age, gender, wound infection rates, or postoperative pain at 12 and 24 hours (p>0.05). The wound infection rate was slightly lower in the laparoscopic group, but the difference was not statistically significant. Conclusion: Both laparoscopic and mini-incision open appendectomy are safe and effective methods for treating acute appendicitis. No significant differences were observed in terms of wound infection rates, postoperative pain, or patient demographics. Larger studies with longer follow-up periods are recommended to further evaluate long-term outcomes. [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 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.

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.

Chunsheng Duan, Yuan Li, Jiansu Ma, Yanglin Song, Lixia Zhou Department of Pediatric Surgery, Xingtai People’s Hospital, Xingtai, Hebei, 054000, People’s Republic of ChinaCorrespondence: Lixia Zhou, Department of Pediatric Surgery, Xingtai People’s Hospital, 16 Hongxing Street, Xingtai, Hebei, 054000, People’s Republic of China, Tel/Fax +86-0319-3286096, Email zhoulx_xt@163.comPurpose: Surgery impairs immune function and increases postoperative complications. B7H3, a co-stimulatory molecule, plays a crucial role in immune regulation. The present study examined the impact of B7H3 on the postoperative immune response in children with acute suppurative appendicitis (ASA) by comparing preoperative and postoperative B7H3 levels in laparoscopic surgery (LA) and open appendectomy (OA).Patients and Methods: 198 pediatric ASA patients were enrolled. The researcher group performed LA, while the control group performed OA. Perioperative time, recovery time of gastrointestinal function, time to pass gas, length of incision, and length of hospitalization were compared in the perioperative period. Additionally, an ELISA assay was conducted to examine the levels of inflammatory factors and B7H3 and CD28. Short-term postoperative complications were also evaluated.Results: Compared with the control group, the research group had a short operative time, gastrointestinal function recovery time, gas time, and hospitalization time. The short-term complication rate was significantly lower in the research group. More importantly, B7H3 and CD28 were insignificantly different preoperatively, but they were all reduced postoperatively. Moreover, the reduction was more pronounced in the research group. The same results were noted in inflammatory factors and immune markers, which were non-significant different preoperatively and were typically reduced postoperatively, particularly in the research group. Finally, postoperative B7H3 was positively correlated with both inflammatory factors and immune cell levels.Conclusion: B7H3 was reduced in both postoperative periods, and the reduction was more pronounced in the LA group. B7H3 may be involved in postoperative recovery by modulating postoperative inflammation and immune responses.Keywords: ASA, laparoscopic surgery, open appendectomy, B7H3, CD298

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.

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]

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: 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: 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]

Objective: To evaluate the frequency of surgical site infection after pressure saline irrigation in open appendectomy for uncomplicated and complicated cases. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Sep 2017 to Mar 2018. Methodology: A total of 300 patients of both gender with inflamed appendix perioperative who underwent open appendectomy were included. The per-operative procedure and post-operative findings were recorded. The patients were grouped into experimental and control Groups on basis of whether saline irrigation was done or not. Then the patients were monitored again on 5th and 10th post-operative day for any surgical site infection. The maximum follow-up time was for a month. Results: Age range in this study was from 10-50 years with mean age of 29.280±6.40 years in Group-A while 29.446±8.28 years in Group-B. Male gender was dominant in both Groups. Surgical site infection was seen in 10(6.7%) patients in Group-A (saline irrigation Group) as compare to 35(23.3%) cases in Group-B (p<0.001). Pressure Saline irrigation did not significantly prevent surgical site infection in uncomplicated cases (p-value=0.331), however, it was effective in preventing infection in complicated cases (p-value<0.001 OR 0.074 95% CI 0.024-0.230). Conclusion: Saline syringe irrigation of wound is a nontoxic, economical, and easily available procedure in any operation theatre to decrease the rate of surgical site infection especially in complicated appendectomy. [ABSTRACT FROM AUTHOR]

Background: Appendectomy is the most common emergency operation and is often performed during on-call hours, when surgeons with different sub-specialties and levels of experience in emergency surgery operate on patients. However, little is known about the safety of the procedure when operations are performed by surgeons not regularly using standard laparoscopic techniques. Here we aim to assess variation in outcomes in patients operated on by surgeons with different levels of experience in laparoscopic surgery. Materials and methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between September 1, 2014 and April 30, 2017 for acute appendicitis were included. The data were analyzed by level of experience among surgeons regularly performing laparoscopic surgery and by volume among surgeons performing over 30 appendectomies per year or fewer. Results: A total of 1560 patients underwent appendectomy, with 61% operated on by laparoscopic surgeons, and the rest by surgeons not habitually using laparoscopic techniques. Demographic characteristics, as well as share of patients with perforated appendicitis were similar in both groups. Morbidity was higher among those operated on by non-laparoscopic surgeons (6.1% and 3.0% p = 0.004), especially if appendicitis was complicated (18% and 5.6%, p < 0.001). Infectious complications were the most common. The risk of postoperative organ/space surgical site infections was higher among patients operated on by non-laparoscopic surgeons (3.5% vs. 1.4%, p = 0.006; Clavien–Dindo III–IV 2.0% vs. 0.7%, p = 0.030). Morbidity was 2.7% among those operated on by surgeons performing ≥ 30 appendectomies per year compared to 5.2% among those performing < 30 appendectomies per year. In multivariate analysis surgeon's experience (p = 0.002; HR 2.32, 95% CI 1.38–3.90) and complicated disease (p < 0.001; HR 4.71; 95% CI 2.79–7.93) predicted higher morbidity. Discussion: According to our study, routine use of laparoscopic techniques in daily practice improves outcomes after appendectomy. In addition, a higher surgical volume correlates with improved outcomes. [ABSTRACT FROM AUTHOR]

Aim: This analysis compared the impact of laparoscopic appendicectomy (LA) and open appendicectomy (OA) on treating adult perforated appendicitis (PA). Methods: Articles relating to LA and OA in treating PA were retrieved from databases including PubMed, Cochrane Library and Embase since their founding to January 2022. These articles were independently filtered based on the inclusion and exclusion criteria by two investigators. The quality of these articles was assessed and article data were extracted. Dichotomous data were presented in the form of odd's ratio (OR), whereas continuous data were in the form of weighted mean difference (WMD). The included articles reported at least one of the following outcomes: intra-abdominal abscess (IAA), wound infection, operative time, hospital stay and complications. Results: Three randomised control trials (198 LA cases vs. 205 OA cases) and 12 case - control trials (914 LA cases vs. 2192 OA cases) were included. This analysis revealed that although the IAA formation rate was similar in the LA and OA groups (OR: 1.28, 95% confidence interval [CI]: 0.87-1.88), the wound infection rate was lower in the LA group (OR: 0.38, 95% CI: 0.28-0.51). Furthermore, LA was associated with shorter hospital stay (WMD: -1.43 days, 95% CI: -2.33--0.52) and fewer complications than OA (OR: 0.40, 95% CI: 0.28-0.57). Conclusion: LA has significant benefits in treating PA and is associated with better post-operative outcomes such as shorter hospital stay, lower incidence of wound infection and other complications. However, more studies with randomised and large-sample populations are still required to determine the clinical benefit of LA in treating PA. [ABSTRACT FROM AUTHOR]

Background The role of laparoscopic appendectomy remains controversial in the context of complicated appendicitis. This study aimed to compare the clinical outcome of laparoscopic versus open appendectomy (OA) in patients with complicated appendicitis regarding operative time, morbidity, hospital stay, postoperative pain, ileus, 1-month follow-up, and need for readmission. Methods A randomized controlled study was performed on 40 patients presenting with complicated appendicitis. 20 patients were subjected to laparoscopic appendectomy (LA) and 20 patients underwent traditional OA. Results 25 (62.5%) patients were female, and 15 (37.5%) patients were male. A significant difference was noted in the domains of postoperative pain, return of peristalsis, time to start oral, hospital stay, and return to daily activities. The mean operative time was shorter in OA 91.4±11.99 min than in LA 109.1±16.71 min No statistically significant difference between both groups was calculated as regards the occurrence of intraabdominal collection. Conclusion Based on its clinical outcomes, laparoscopy should be considered in the setting of complicated appendicitis. The possibility of intraabdominal collection should not be a barrier against the widespread practice of this surgical procedure among laparoscopic surgeons if adequate precautions were employed. [ABSTRACT FROM AUTHOR]

Background: Although laparoscopic appendectomy is the criterion-standard treatment method for acute appendicitis, the decision on laparoscopic or conventional technique is usually made according to individual perspectives. The reasons affecting this individual point of view include whether the disease is complicated, the infrastructure of the hospital, the patient's comorbid factors, and previous intra-abdominal operations. This cross-sectional retrospective study aimed to evaluate the safety of laparoscopic appendectomy in patients with a possible diagnosis of "appendicitis" in patients who had undergone previous abdominal surgery. Methods: Patients who were operated on with the diagnosis of acute appendicitis in our clinic between March 2021 and March 2022 were retrospectively analyzed. Patients were grouped as those with a history of abdominal surgery (group 1) and without (group 2). In addition, demographic data of the patients (age, sex), body mass index, presence of comorbid disease, history of abdominal surgery, operation time, rate of conversion to open surgery, postoperative hospital stay, complications, and radiological and pathological appendix size were recorded. Results: A total of 181 patients were included in the study. The mean age was 32.51 ± 15.89 years. Seventy (38.7%) of the patients were female, and 111 (61.3%) were male. Thirty-four patients (18.8%) were in group 1, and 111 patients (81.2%) were in group 2. The mean age, body mass index, and operation time in group 1 were statistically higher than in group 2 (P < 0.001). However, there was no difference between the groups regarding postoperative hospital stay, radiological and pathological appendix size, conversion to open surgery, and presence and severity of complications (P > 0.05). Conclusion: In line with the data the authors have shown in their study, a laparoscopic appendectomy can be performed safely in patients who have undergone abdominal surgery. Therefore, surgeons should not stray from a laparoscopic appendectomy when they see an abdominal incision. [ABSTRACT FROM AUTHOR]

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Purpose To evaluate the laparoscopic approach advantages for the management of acute appendicitis in morbidly obese patients. Methods A prospective study included all morbidly obese patients who had presented to the emergency department at Sohag University Hospitals and were diagnosed with acute appendicitis between the 1st of June 2022 and the 31st of January 2023. All those patients were invited to participate in the research by randomization. The authors informed patients and their first-degree relatives about both techniques, signed a consent form for participation in the study. The authors categorized them into two groups; laparoscopic approach (group I) and open approach (group II). Comparisons were based on operative time, intraoperative complications, length of hospital stay, postoperative complications, and time until return to normal daily activities. Results The study enrolled 64 patients: 33 had a laparoscopic appendectomy, and 31 had an open appendectomy. The groups were similar in terms of clinicopathologic characteristics. The operating time was significantly shorter for Group I patients than Group II (Group I, 49.09±16.21 min vs. Group II, 68.03±15.78 min; P value less than 0.05). Regarding the length of hospital stay, twenty-six patients (78.8%) were discharged within the 1st 24 h in the laparoscopic group versus 17 patients (54.8%) in the open group (P value 0.041). The time until return to the routine daily work was significantly shorter in the laparoscopic group (11.27±2.6 days) than in the open group (17.23±4.8 days) (P value less 0.05). Four postoperative complications were reported in the study population: wound complications (infection, seroma formation), residual abdominal abscess, paralytic ileus, and thromboembolic complications (Deep venous thrombosis and pulmonary embolism). Group II had a statistically significant higher complication rate (32.3%) than Group I (9.09%) (P value 0.007). Conclusion Laparoscopic appendectomy had superior clinical outcomes than an open appendectomy in morbidly obese patients. In addition to minimal invasiveness and better cosmetic results, it has a great advantage as a diagnostic and therapeutic tool in morbidly obese patients with suspected appendicitis. It is also a safe and feasible approach with a low rate of complications with a well-trained expert surgeon. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common cause of acute abdomen. Currently, larger numbers of appendectomies are being performed laparoscopically. The aim of this study was to compare laparoscopic appendectomies to open surgery in terms of intra- and post-operative complications, including the risk of intra-abdominal abscess formation, operative time, time of initiating oral diet, and the length of hospital stay in our institution. Methods: The study group of 283 patients having undergone appendectomies between January 2013 and Jan 2016 was divided into two subgroups as ‘open’ and ‘laparoscopic’. The data regarding the surgical outcomes of these groups were evaluated retrospectively and statistically analyzed. Results: In terms of postoperative complications, intra-abdominal abscesses were found to be higher in the laparoscopic group (p=.045). On the other hand, surgical site infection (SSI) rates were found to be higher in the open group (but did not reach statistical significance). Operative time was affected by the surgeon’s expertise and was found to be shorter in the laparoscopic group (p<0.05). The time of initiating oral diet was sooner in the laparoscopic group compared to the open group (p=0.043), and the overall length of hospital stay was shorter in the laparoscopic group (p=0.0001). Conclusions: Laparoscopic appendectomy is associated with early return to a normal diet, fewer wound complications, and a shorter hospital stay, but also with a slightly higher rate of intra-abdominal abscesses. Notably, it is now the standard method of acute appendicitis management in some centers. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is most found in the second decade of life. It can be categorized into two major categories: uncomplicated and complicated appendicitis. Laparoscopic appendectomy (LA) and Open appendectomy (OA) are two common techniques for the surgical removal of appendices in acute appendicitis. The goal of this research was to examine and explain the effectiveness of laparoscopic appendectomy in patients with complicated appendicitis. Methods: A retrospective study was carried out in General Surgery Department, Faculty of Medicine, Zagazig University from March 2020 to September 2020. It involved 36 patients with reported complicated appendicitis randomly assigned (through alternation) to two groups of 18 patients, Group A; patients underwent open appendectomy by gridiron incision at McBurney stage. Group B; patients undergoing laparoscopic appendectomy. All patients were subjected to demographic data taking, complete clinical examination, Laboratory investigations and Radiological investigation. Results: Postoperative wound infection was higher in the open group (A) than in the laparoscopic group (B) but did not display a substantial difference (33.3 per cent infected in open cases and just 11.1 per cent infected in laparoscopic cases) with PV=0.23. Postoperative hospital stays and the time required to return to usual every day practices were lower in laparoscopic group (B) than in open group (A with P Value = 0.09 and 0.0002 respectively. Conclusions: LA constitutes a safe and feasible procedure for the treatment of complicated appendicitis and can be the first choice with no increase in postoperative complications. [ABSTRACT FROM AUTHOR]

Background and Objective: Surgical site infection (SSI) after open appendectomy (OA) is a common healthcare-associated infection. The most common form of SSI is superficial (SSSI) which is associated with substantial morbidity and mortality. The aim of the study is to assess factors contributing to SSSI in emergency OA. Methods: This is a retrospective cohort study on patients who had emergency OA at Shar teaching hospital in Sulaimani City, Iraq for 6 months; from March to September 2022. Wound assessment was done by Centers for Disease Control and Prevention SSI Criteria (only skin of surgery site be affected, symptoms of pain or tenderness and erythema, purulent drainage, or organisms be found in wound culture). Demographic information, medical history, and preoperative and postoperative variables were compared and collected. Findings: Of 320 participants, 51.6% were men and their mean age was 21±12.2. Total number of SSIs were 35 (10.9%). There were no differences between groups based on gender. Age, obesity, smoking, chronic illness, multiple intraoperative and preoperative factors were associated with SSI in the bivariable analysis. However, after adjusting for predictors, only use of subcuticular suturing techniques was associated with a significantly higher risk of SSI compared to simple interrupted suturing (p=0.004, OR=20.184, 95%CI [2.673-152.437]); and proper bathing within first 5 days after surgery had a significantly lower risk of SSI compared to others (p=0.025, OR=0.042, 95% CI [0.004-0.417]). No significant association was found between presence or timing of drain removal, postoperative length of stay, changing of dressing, antiseptics, or suture removal day. Conclusion: The results of the study showed a wide range of effective factors in superficial surgical site infection in patients undergoing open appendectomy. [ABSTRACT FROM AUTHOR]

Background: Nowadays laparoscopic appendectomy (LA) is the management of choice for acute appendicitis (AA) in simple, uncomplicated cases. For complicated acute appendicitis (CAA), laparoscopic or conventional open appendectomy (OA) is still in debate. Objective: This study aimed to compare minimally invasive LA and traditional OA in CAA cases. Methods: In this study, 44 patients with CAA (22 for LA and 22 for OA) with 18 years of age or older were enrolled. It was conducted in General Surgery Department, Helwan University Hospital. Results: The operative time difference between the LA and OA groups was statistically significant (18.5 minutes shorter in the OA group, (p<0.001). The median length of hospital stay, return to normal activity, and patient satisfaction were significantly better in the LA group (p-values of 0.001, 0.00, and 0.14 respectively). The need for analgesics in the LA group was significantly lower than in the OA group. There were no detectable statistically significant findings concerning the occurrence of surgical findings, postoperative vomiting, postoperative ileus, wound infection, wound dehiscence, or postoperative intra-abdominal collection. Conclusions: Laparoscopic appendectomy management of CAA is feasible, safe, and has numerous advantages over the traditional open procedure in terms of reducing postoperative pain, requiring fewer analgesics, shortening the postoperative hospital stay, having a low incidence of postoperative infectious complications, and allowing a rapid return to daily activities with improved comfort and satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Background This paper compares the postoperative recovery of patients with acute appendicitis (AA) after laparoscopic appendectomy (LA) and open appendectomy (OA), aiming to determine the optimal diagnosis and treatment plan for appendectomy. Methods Related literature was retrieved from PubMed, Web of Science, Embase, CNKI and Wanfang databases. Articles on LA and OA for AA published between 2010 and 2021 were selected to extract data. Besides, Stata16.0 was used for meta-analysis. Results A total of 777 articles were retrieved, and 16 of them were finally selected. Totally, 1251 patients underwent LA, while 898 patients received OA. According to the results of meta-analysis, LA was associated with lower incidence of adverse reactions [OR = 0.257, 95% CI (0.162, 0.408), P

Background: The most frequent reason of pain abdomen and a common cause of emergency surgery is appendicitis. Males have an 8.6% lifetime risk of suffering appendicitis, while females have a 6.7 percent lifetime risk. Materials and Methods: Between July 2018 and June 2019, we did a retrospective review of patients who had appendectomies at The Oxford Medical College Hospital in Bangalore, Karnataka. We looked at the clinical data of 140 patients who matched the inclusion criteria. The patients were split into two groups: those who had a laparoscopic appendectomy [LA = 70] and those who had an open appendectomy [OA = 70]. A total of 140 patients with acute appendicitis, 70 patients each underwent open and laparoscopic appendectomy.Results: The time taken to return to ordinary daily activities were significantly different between the two groups, with the laparoscopic group taking 11.5±3.1 days on average against 16.1±3.3 days in the open appendectomy group. In the laparoscopic group, seven patients had complications, while in the open appendectomy group fifteen had complications. Laparoscopic appendectomy has fewer complications than open appendectomy.Conclusion: Regardless of age, sex, or return to regular activity, laparoscopic appendectomy is the operation of choice for the majority of patients. It has fewer complications and requires a fewer hospital stays, as well as the ability to treat concurrent disorders.

Appendiceal diverticulitis is a very infrequent cause of pain in the right lower quadrant of the abdominal area. To have good management, it is essential to understand its clinical evolution, whether it is symptomatic or discovered incidentally during an appendectomy or barium enema. So far, few cases of appendiceal diverticulitis in different people have been reported. It is important in this case to avoid misdiagnosis in the form of another disease, especially acute appendicitis and/or possible complications. In this report we present the case of a 45-year-old man who came to the emergency room with symptoms of acute appendicitis. CT scan showed suspicious mass-like tissue in the appendiceal region, while pathological examination showed inflammation with no malignancy. An open appendicectomy was performed in this patient and appendicular diverticulitis was established as the final diagnosis.

Objective: To compare Open Appendectomy and Laparoscopic Appendectomy in the treatment of perforated Appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Abbottabad Pakistan, from Dec 2016 to Jan 2022. Methodology: A total of 240 patients underwent either open (Group-A) or laparoscopic (Group-B) appendectomy. Patients of Perforated Appendicitis fulfilling inclusion criteria were included in the study after getting informed consent. Variables of operative time, hospital stays, surgical site infection and Intra-abdominal infection were recorded. Results: Mean operating time for the Open Appendectomy-Group (49.7±6.10 minutes) was significantly shorter than the time of Laparoscopic Surgery-Group (58.93±5.41 minutes; p<0.001). The mean hospitalization time was shorter (2.57±0.77 days) in Laparoscopic Appendectomy than Open Surgery-Group (3.23±0.62 days, p=0.001). Two port sites (6.7%) in the Laparoscopic Group and nine surgical sites (30.0%) in the Open Surgery-Group got infected (p=0.021). Two patients (6.7%) in Open Appendectomy-Group and three patients (10.0%) in Laparoscopic Appendectomy-Group had postoperative complication of intra-abdominal abscess (p=1.00). Conclusion: As compared to open approach, laparoscopic appendectomy had significantly lesser surgical site infections, shorter hospital stays and longer operating time. There was no statistically significant difference in the intra-abdominal infection in both techniques. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency of Surgical Site Infection after open appendectomy using antimicrobial sutures. METHODOLOGY: Present study design was prospective case series conducted after the approval from the Research, Training and Monitoring Cell of CPSP in Department of Surgery, Dr.Ruth K.M Pfau, Civil Hospital Karachi/ Dow University of Health Sciences Karachi from December 2017 to May 2018 with nonprobability sampling technique. All patients between the age of 15-40 years of either sex who visited the Emergency Department and were diagnosed clinically with acute appendicitis were included in the study. Patients with generalized peritonitis or per-operative findings of malignancy, perforation, or gangrenous appendix were not enrolled. Open appendectomy was carried out in all patients, antimicrobial coated sutures were used throughout the surgery, and the patient was kept under followup for 3 months in surgical OPD to detect any clinical feature of SSI. The data was analyzed using SPSS version 17. RESULTS: Among 139 studies cases, 76 (54.68%) were male, and 63 (45.32%) were females with a male to female ratio of 1.2:1. The age range was from 15 to 40 years with a mean age of 27.23±5.97 years. The majority of the patients, 88 (63.31%), were between 15 to 30 years of age. In this study, frequency of SSI after appendectomy using antimicrobial coated suture was found in 14 (10.07%) patients. CONCLUSION: The results demonstrate that the frequency of surgical site infection after incorporating antimicrobial sutures (Triclosan) is not significantly different statistically as expected in cleancontaminated abdominal surgery.

Appendiceal mucoceles represent abnormal accumulation of mucin in the appendix. They are rare and can be due to neoplastic and nonneoplastic causes, the most common cause being low-grade appendiceal mucinous neoplasm (LAMN), also known as mucinous cystadenoma of the appendix. We present the case of a 48-year-old woman who had complaints of abdominal pain for 2 months. Imaging showed mucocele of the appendix. She was taken for open appendectomy which revealed a huge (16.5 × 7 × 6 cm) mucocele, and histology proved it to be a LAMN with negative margins.

Acute appendicitis is one of the most common urgent abdominal interventions. Open appendectomy has been a standard procedure for acute appendicitis for more than 100 years. However, in the last 20 years, after many studies, laparoscopic appendectomy has become a gold standard in solving acute appendicitis. The main goal of our study was to compare results of open and laparoscopic appendectomies with regard to in-hospital stay, time of operation, postoperative complications and postoperative pain. All patients underwent open or laparoscopic appendectomy in the Center of Minimally Invasive Surgery and Emergency Center of the University Clinical Center Niš, Serbia in the period of one year. A total of 126 patients were enrolled and submitted to retrospective analysis. One hundred and twenty-six patients who underwent laparoscopic or open appendectomy surgery were retrospectively analysed. A laparoscopic appendectomy was performed in 58 patients, while 68 patients underwent an open appendectomy. Groups were demographically similar and there was no significant difference between the age structure and gender distribution (t = 0.927; p = 0.057). Average height (p = 0.123), weight (p = 0.200) and BMI (p = 0.425) were mostly similar. Previous surgical operations were more common in patients with open appendectomy, but with no statistical significance (p = 0.141). Percentage of patients with WBC > 10 were the same in both groups (p = 0.927). Diabetes mellitus was more common in patients with open appendectomy, but with no statistical significance (p = 0.563). Acute and perforated appendicitis were similar in both groups (p = 0.490). Average time of operation was the same in both groups (p = 0.751). Number of days of in-hospital stay was shorter in patients who underwent laparoscopic appendectomy (p < 0.001). The analysis of administration of parenteral and oral analgesics showed that postoperative pain was less in the group of patients who underwent laparoscopic appendectomy than in the group of patients with open appendectomy. There was no statistically significant difference with respect to postoperative complications between two groups (p < 0.001). The treatment of appendicitis by using laparoscopic surgery in comparison to open approach provides a better result in terms of duration of hospital stay, recovering time, postoperative complications and postoperative pain. [ABSTRACT FROM AUTHOR]

Background: Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive Objective: To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods: This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results: In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p < 0.01) In the study, The mean hospital stay score was 1.77 ±0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p < 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p < 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion: We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy. [ABSTRACT FROM AUTHOR]

Background: The presence of clinical frailty can pose an escalated risk toward surgical outcomes including in cases that involve minimally invasive procedures. Given this premise, we evaluate the effects of frailty on post-appendectomy outcomes using a national in-hospital registry. Methods: 2011–2017 National Inpatient Sample was used to isolate inpatient appendectomy cases; the population as stratified using Johns Hopkins ACG clinical frailty, expressed as either binary or ternary (prefrailty, frailty, and without frailty) indicators. The controls were matched to frailty-present groups using propensity score matching and compared to various endpoints, including mortality, length of stay (LOS), hospitalization costs, and postoperative complications. Results: Post-match, there were 11,758 with and without frailty per binary; and 1236 frail, 10,522 pre-frail with respective equal number controls per ternary indicator. Using binary term, frail patients had higher mortality (4.22 vs 1.49% OR 2.92 95%CI 2.45–3.47), LOS (14.3 vs 5.35d p < 0.001), and costs ($160,700 vs $64,141 p < 0.001). In multivariate, frail patients had higher mortality (aOR 2.77 95%CI 2.32–3.31), as well as higher rates of postoperative complications. Using ternary term, frail patients had higher mortality (5.02 vs 2.27% OR 2.28 95%CI 1.45–3.59), LOS (18.9 vs 5.66 day p < 0.001) and costs ($200,517 vs $66,193 p < 0.001). In multivariate, frail patients had higher mortality (aOR 2.16 95%CI 1.35–3.43) and complications. Those with pre-frailty had higher mortality (4.12 vs 1.47% OR 2.88 95%CI 2.39–3.46), LOS (13.8 vs 5.34 day p < 0.001) and costs ($156,022 vs $63,772 p < 0.001). In multivariate, pre-frailty patients had higher mortality (aOR 2.79 95%CI 2.31–3.37) and complications. Conclusions: Frailty and prefrailty (using the ternary indicator) are associated with increased postoperative mortality and complication in patients who undergo appendectomy; given this finding, it is imperative that these vulnerable patients are identified early in the preoperative phase and are provided risk-modifying measures to ameliorate risks and optimize outcomes. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis (AA) is one of the most common causes of abdominal pain requiring surgical intervention. Approximately 20% of AA cases are characterized by complications such as gangrene, abscesses, perforation, or diffuse peritonitis, which increase patients’ morbidity and mortality. Diagnosis of AA can be difficult, and evaluation of clinical signs, laboratory index and imaging should be part of the management of patients with suspicion of AA. Methods This consensus statement was written in relation to the most recent evidence for diagnosis and treatment of AA, performing a literature review on the most largely adopted scientific sources. The members of the SPIGC (Italian Polispecialistic Society of Young Surgeons) worked jointly to draft it. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by the American College of Chest Physicians (CHEST) for the strength of the recommendations. Results Fever and migratory pain tend to be present in patients with suspicion of AA. Laboratory and radiological examinations are commonly employed in the clinical practice, but today also scoring systems based on clinical signs and laboratory data have slowly been adopted for diagnostic purpose. The clinical presentation of AA in children, pregnant and elderly patients can be unusual, leading to more difficult and delayed diagnosis. Surgery is the best option in case of complicated AA, whereas it is not mandatory in case of uncomplicated AA. Laparoscopic surgical treatment is feasible and recommended. Postoperative antibiotic treatment is recommended only in patients with complicated AA.

Abstract Background Traditionally, uncomplicated acute appendicitis (AA) has been treated with appendectomy. However, the surgical alternatives might carry out significant complications, impaired quality of life, and higher costs than nonoperative treatment. Consequently, it is necessary to evaluate the different therapeutic alternatives' cost-effectiveness in patients diagnosed with uncomplicated appendicitis. Methods We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18–60 years with a diagnosis of uncomplicated AA from the payer´s perspective at the secondary and tertiary health care level. The time horizon was 5 years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed. Methods We performed a model-based cost-effectiveness analysis comparing nonoperative management (NOM) with open appendectomy (OA) and laparoscopic appendectomy (LA) in patients otherwise healthy adults aged 18–60 years with a diagnosis of uncomplicated AA from the payer’s perspective at the secondary and tertiary health care level. The time horizon was five years. A discount rate of 5% was applied to both costs and outcomes. The health outcomes were quality-adjusted life years (QALYs). Costs were identified, quantified, and valorized from a payer perspective; therefore, only direct health costs were included. An incremental analysis was estimated to determine the incremental cost-effectiveness ratio (ICER). In addition, the net monetary benefit (NMB) was calculated for each alternative using a willingness to pay lower than one gross domestic product. A deterministic and probabilistic sensitivity analysis was performed. Results LA presents a lower cost ($363 ± 35) than OA ($384 ± 41) and NOM ($392 ± 44). NOM exhibited higher QALYs (3.3332 ± 0.0276) in contrast with LA (3.3310 ± 0.057) and OA (3.3261 ± 0.0707). LA dominated the OA. The ICER between LA and NOM was $24,000/QALY. LA has a 52% probability of generating the highest NMB versus its counterparts, followed by NOM (30%) and OA (18%). There is a probability of 0.69 that laparoscopy generates more significant benefit than medical management. The mean value of that incremental NMB would be $93.7 per patient. Conclusions LA is a cost-effectiveness alternative in the management of patients with uncomplicated AA. Besides, LA has a high probability of producing more significant monetary benefits than NOM and OA from the payer’s perspective in the Colombian health system.

Background: Appendicitis is a common surgical emergency with a lifetime risk of appendectomy being 9.6 to 9.8 %. Open and laparoscopic approaches are being advocated with similar benefits. Aim and Objective: Our study aims to compare the outcomes in open and laparoscopic appendectomies in a teaching hospital in rural Maharashtra. Material and Methods: This is an observational study of 114 consecutive patients who underwent appendectomy from August 2017 to July 2020 in the department of surgery at a rural medical college and teaching institute. Sixty-eight patients of open appendectomy (43 acute cases and 25 chronic cases) and 46 of laparoscopic appendectomy (20 acute cases and 26 chronic cases) were included in the study. We investigated operative time, length of hospital stays, postoperative pain, intravenous analgesia complication rate and cost between the two groups. Results: We observed longer operative time (51.26 ± 11.67 vs 33.69 ± 10.27 minutes for open, P < 0.0001) and shorter postoperative stay (LA vs OA: 3.67 ± 0.92 vs 5.71 ± 1.49 days respectively P < 0.0001) for the laparoscopic surgery(LA) group as compared to open appendectomy(OA). Postoperative intravenous analgesic use was less in the laparoscopy group (2.38 days vs 4.10 days, P < 0.0001). The cost difference was not statistically significant. There was no significant perioperative morbidity in either group. Conclusion: Laparoscopic appendicectomy is associated with lesser use of postoperative analgesics, fewer complications, shorter hospital stay, early return to routine work. Laparoscopic appendicectomy was found to have longer duration of surgery.

Background: This paper compares the postoperative recovery of patients with acute appendicitis (AA) after laparoscopic appendectomy (LA) and open appendectomy (OA), aiming to determine the optimal diagnosis and treatment plan for appendectomy. Methods: Related literature was retrieved from PubMed, Web of Science, Embase, CNKI and Wanfang databases. Articles on LA and OA for AA published between 2010 and 2021 were selected to extract data. Besides, Stata16.0 was used for meta-analysis. Results: A total of 777 articles were retrieved, and 16 of them were finally selected. Totally, 1251 patients underwent LA, while 898 patients received OA. According to the results of meta-analysis, LA was associated with lower incidence of adverse reactions [OR = 0.257, 95% CI (0.162, 0.408), P < 0.001], shorter operation time (SMD = − 1.802, 95% CI − 2.435, − 1.169; P < 0.001) and hospitalization (SMD = − 1.184, 95% CI − 1.512, − 0.856; P < 0.001). In addition, compared with the OA group, LA was found with less intraoperative blood loss (SMD = − 3.650, 95% CI − 5.088, − 2.212; P < 0.001) and shorter recovery time of gastrointestinal function (SMD = − 3.010, 95% CI − 3.816, − 2.203; P < 0.001). Aside from all these, the counts of leukocyte (SMD = − 0.432, 95% CI: − 0.775, − 0.089; P = 0.013), neutrophil (SMD = − 1.346, 95% CI − 2.560, − 0.133; P = 0.030), and C-reactive protein (SMD = − 2.391, 95% CI − 3.901, − 0.882; P = 0.002) all decreased in a significant manner after LA. Conclusion: Compared with OA, LA boasts the advantages of less adverse reactions, shorter operation time and hospitalization, fewer complications, and lower inflammatory response, evidencing its safety and feasibility of applying in the treatment of AA. [ABSTRACT FROM AUTHOR]

Objective: To compare the post-operative outcomes in pregnant patients with appendicitis undergoing laparoscopic versus open appendicectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgery Department, Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan, from Jan 2018 to Dec 2019. Methodology: This study consisted of patients with acute appendicitis during pregnancy who were presented to Surgery Department or referred to it from Obstetrics and Gynecology Department. Patients were divided into 2 groups: Group A had patients who underwent Laparoscopic appendicectomyand Group B had patients who underwent Open appendicectomy. Postoperative outcomes in both groups including fetal loss, preterm delivery, operative time and surgical complications were observed. The p-value of <0.05 was considered significant. Results: Total of 90 pregnant women were included. Group A consisted of 44 cases and 46 patients were in Group B. The mean maternal age was 24.5 ± 5.2 year (Group A) and 23.5 ± 4.2 years (Group B). About 30 patients (33.33%) were in the first trimester, 38 (42.22%) in second while 22 (24.44%) patients were in the third trimester. Wound infection occurred in two patients in Group B (p=0.08). Fetal loss occurred in one patient in Group A and in 3 patients in Group B (p=0.09). Hospital stay was significantly shorter in Group A (1.4 ± 1.9 days). Conclusions: Laparoscopic appendectomy is safe with low incidence of post operative maternal as well as fetal complications. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent.

Introduction: Acute appendicitis is the most common surgical emergency with a lifetime incidence of 7%–8%. There are two operative modalities that are currently used for the management of this condition in the paediatric population. The objective of this cohort study was to review the outcome of the management of paediatric surgical patients presenting with acute appendicitis after either an open appendectomy (OA) or laparoscopic appendectomy (LA) was performed. Methods: This was a 2-year retrospective study conducted from 01 January 2016 until 31 December 2017 on paediatric surgical patients < 13 years of age undergoing appendectomies. Eighty-one (n = 81) files of patients were reviewed, and data analysis was performed on two comparative groups namely the OA group and LA group, with the aid of the SAS system with statistical significance based on P < 0.05. Results: During the study period, 81 children (male: female ratio of 2:1) underwent appendectomies. Nearly 38% (n = 31) of the cases had an OA, with 62% (n = 50) of the cases having an LA. Seven (14%) LA cases were converted to OA. Simple appendicitis accounted for 16% (n = 13) of the patients, with complicated appendicitis accounting for 79% (n = 64) and other pathologies accounting for 5% (n = 4). There were no post-operative complications in the cases of simple appendicitis. Six cases (15.38%) in the LA group versus two cases (5.26%) in the OA group developed intra-abdominal collections, which was statistically significant (P = 0.018). One (2.56%) patient in the LA group versus two patients (7.89%) in the OA group developed intestinal ileus (P = 0.09). Two patients (5.13%) in the LA group versus six patients (15.79%) in the OA group developed surgical-site infection, which was statistically significant (P = 0.013). The mean days of hospital stay was 4.51 days in the LA group versus 5.34 days in the OA group, which was statistically significant (P = 0.016). There were no re-admissions or re-operations in the simple appendicitis group. In the complicated appendicitis cases, five cases (12.82%) were re-admitted in the LA group compared to five cases (13.16%) in the OA group (P = 0.943). Two (5.13%) cases had a re-operation in the LA group compared to one case (2.63%) in the OA group (P = 0.360). Conclusion: Considering that there was an increased incidence of complicated cases and operations being performed by trainees, LA appears feasible at a tertiary-level hospital in a developing country, as shown in this study. Therefore, cases of simple appendicitis can be performed laparoscopically; however with regard to complicated appendicitis, there is no superiority between the two operative modalities in this study, which is consistent with international literature. However, in this study, it can be postulated that the learning curve was a major contributory factor to the increased levels of complications, as all operations were performed by trainees. Therefore, we recommend implementation of adequate simulation practices in laparoscopy in the setting of a developing country to attain the laparoscopic expertise of our international counterparts in order to improve the standard of care.

Objectives: To determine the frequency of obstructive appendicitis in patients undergoing open appendectomies for acute appendicitis. Negative appendectomy rate will also be calculated. Study Design: Cross-Sectional study. Setting: Department of General Surgery of Ayub Teaching Hospital Abbottabad. Period: September 2019 to February 2020. Material & Methods: The study population included patients of any gender, age from 10 years to 45 years found to have acute appendicitis diagnosed by clinical and ultrasound findings and confirmed by open appendectomy. Sample size of 174 was calculated, using WHO software for sample size calculation. After detailed examination and investigations, patients who underwent open appendectomy as per advice of visiting consultants were included; by filling predesigned research per forma. Results: Mean age of the patients was 26.33±11.177 and more than half were male i-e 106 (60.9%). Where majority i-e 93(53.4%) of appendices were of obstructed type, this wasn't statistically higher than the non-obstructed type (p=0.363). In frequency of operative findings, acutely inflamed appendix was most common with 71(40.8%) patients. While suppurative, gangrenous and perforated samples were noted in 55(31.6%), 13(7.5%) and 8(4.6%) cases respectively. Negative appendectomy was done in 27(15.5%) patients. Conclusion: This study concluded that obstruction was noted in more than half of the cases i-e 93(53.4%), but it was not statistically higher from the other subtype. Negative appendectomy rate was 15.5%; higher than globally set target, but was similar to the one noted in Pakistan by previous researchers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency of Surgical Site Infection after open appendectomy using antimicrobial sutures. METHODOLOGY: Present study design was prospective case series conducted after the approval from the Research, Training and Monitoring Cell of CPSP in Department of Surgery, Dr. Ruth K.M Pfau, Civil Hospital Karachi/Dow University of Health Sciences Karachi from December 2017 to May 2018 with nonprobability sampling technique. All patients between the age of 15-40 years of either sex who visited the Emergency Department and were diagnosed clinically with acute appendicitis were included in the study. Patients with generalized peritonitis or per-operative findings of malignancy, perforation, or gangrenous appendix were not enrolled. Open appendectomy was carried out in all patients, antimicrobial coated sutures were used throughout the surgery, and the patient was kept under followup for 3 months in surgical OPD to detect any clinical feature of SSI. The data was analyzed using SPSS version 17. RESULTS: Among 139 studies cases, 76 (54.68%) were male, and 63 (45.32%) were females with a male to female ratio of 1.2:1. The age range was from 15 to 40 years with a mean age of 27.23±5.97 years. The majority of the patients, 88 (63.31%), were between 15 to 30 years of age. In this study, frequency of SSI after appendectomy using antimicrobial coated suture was found in 14 (10.07%) patients. CONCLUSION: The results demonstrate that the frequency of surgical site infection after incorporating antimicrobial sutures (Triclosan) is not significantly different statistically as expected in cleancontaminated abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis and cholecystitis during pregnancy are the most common non-obstetrical surgical emergencies and can create severe clinical issues. Surgical treatment tends to be the method physicians recommend due to its tolerability and safety. During pregnancy, surgical intervention should minimize fetal risk without compromising the mother's health, although a favorable outcome for pregnant women is heavily dependent on accurate, early diagnosis and prompt intervention. Furthermore, the physicians should remain informed on the differences in current techniques to optimize the outcome of the operation. Methods: This article performs a systematic review of the literature to examine whether laparoscopic treatment of acute appendicitis in pregnancy is a better option when compared to open surgery. We searched all major medical databases, identified the most relevant published studies on the subject, and performed a statistical analysis to answer that question. Results: We identified 15 studies for inclusion, and their data were extracted. The resulting pool referred to 2,837 pregnant patients. Of those included patients, 1,103 underwent laparoscopic surgery and 1,656 had open surgery. All surgeries occurred in the second trimester. For laparoscopic surgery, the fetal demises rate was 2.44 % (27 deaths), and the preterm deliveries rate was 9.79 % (108 deliveries) as opposed to open surgery with a fetal demise rate of 2.64 % (48 deaths), and preterm deliveries rate at 10.7 % (178 deliveries). Conclusions: Our meta-analysis and data suggest that laparoscopic appendectomy is a safer option for treatment. There is a reduced risk of fetal demise and preterm delivery for pregnant women. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcomes of laparoscopic and open appendectomy in obese patients in Surgical departments of a tertiary care hospital. Study Design: Prospective observational study. Place and Duration of Study: Bahawal Victoria Hospital. Bahawalpur, from Jan 2013 to Dec 2016. Methodology: A sample of 173 patients (aged ≥16 years, BMI >30) admitted to a surgical teaching service with a clinical diagnosis of acute appendicitis. This study was conducted on appendicitis patients, who underwent standard laparoscopic appendectomy (LA) and open Appendectomy (OA). Complicated appendicitis cases were disqualified. Variables analyzed includes age of patients, gender, operative time (OT), postoperative pain, return of bowel function, intra-abdominal abscesses, wound sepsis and length of Hospital stay. Results: Laparoscopic appendectomy was performed on 83 patients & open appendectomy on 90. Statistical disparity in mean operative time between the laparoscopic (52 ± 8min) and open appendectomy (67 ± 13 min) groups was determined. Rate of intra-abdominal abscess was higher after open appendectomy (11%) than laparoscopic (3%) as well as the wound sepsis which was 9% in Open Appendectomy and 2% in Laparoscopic Appendectomy. Likewise, post-operative ileus was 12% in Laparoscopic Appendectomy and 20% in Open appendectomy. The span of stay in hospital was shorter in laparoscopic group (3 ± 1 day) as compared with open group (5 ± 1 days). Two cases needed re-exploration (0.5%) for appendicular stump leakage and pelvic collection respectively. Conclusion: Laparoscopic approach is advantageous in comparison with open appendectomy in terms of less postoperative pain, shorter Hospital stay, reduced wound sepsis and operative time in obese patients.