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N Rizk

Publications and source records attributed to N Rizk.

At least 19 recordsLinked to original sources
PubMed2007

Inguinal hernia repair: the choice of prosthesis outweighs that of technique.

BACKGROUND: The use of prostheses in inguinal hernia repair reduces the incidence of recurrence. Quality of life and pain after hernia repair are largely correlated with the technique and type of prosthesis. AIMS OF STUDY: To evaluate the 2-year incidence of recurrence and pain for two types of hernioplasty, Lichtenstein repair and laparoscopy (totally extraperitoneal approach or TEP), and two types of mesh, polypropylene mesh and beta-D: -glucan-coated mesh (Glucamesh). PATIENTS: A total of 410 consecutive patients of mean age 54 years (18-84) underwent repair of inguinal hernias, 96 (23%) of which were bilateral and 56 (13%) recurrent. A total of 273 (66.5%) patients underwent Lichtenstein repair: 215 (78.7%) with polypropylene mesh, 58 (21.3%) with Glucamesh; 137 patients underwent laparoscopy: 80 (58.4%) with polypropylene mesh, 57 (41.6%) with Glucamesh. In each group, the populations were comparable and the techniques utilized were identical. METHODS: The patients were followed-up for at least 2 years, after which the incidence of recurrence was determined, and chronic pain was assessed by means of a visual analog scale and a validated questionnaire. RESULTS: A total of 349 patients (85.1%) were reassessed, 117 of whom had undergone laparoscopy and 232 Lichtenstein repair. There were ten recurrences (2.8%), and incidence which was independent of the technique (laparoscopy 1.7% vs. Lichtenstein 3.4%) (ns) and the type of prosthesis (Glucamesh 1.9% vs. polypropylene 2.4%) (ns). Chronic pain was noted in 69 patients (19.7%) and severe pain in 11 (3.1%). The incidence of chronic pain was the same for the two techniques: laparoscopy 17.9% vs. Lichtenstein 20.7% (ns). The same was true for severe pain: laparoscopy 3.4% vs Lichtenstein 3% (ns). The incidence of chronic pain was closely correlated with the type of prosthesis utilized: Glucamesh 4.8% vs. polypropylene 26.5% (P = 0.02), irrespective of the technique. The same was true for severe pain (0.9 vs. 4%) (P = 0.02). CONCLUSION: The utilization of beta-D: -glucan-coated mesh did not involve more recurrence and was accompanied by a significant decrease in chronic pain at 2 years, independent of the technique. After 2 years, the results of hernia repair show that the choice of prosthesis was more determinant than choice of technique.

Adolescent↗
PubMed2006

Impact of peritoneal tears on the outcome and late results (4 years) of endoscopic totally extra-peritoneal inguinal hernioplasty.

BACKGROUND: The reported rate of intra-operative peritoneal laceration during endoscopic extra-peritoneal hernioplasty (TEP) ranges from 10 to 64%. AIMS: To evaluate in a prospective study the predictive factors of peritoneal tears, their consequences in terms of outcome and late results. PATIENTS AND METHODS: Between July 1994 and December 2000, we performed 467 endoscopic extra-peritoneal hernia repairs (TEP). In 14.8% of the cases, single or multiples recurrences after conventional open herniotomy were treated. One hundred and forty-nine patients (38%) had had previous surgery (appendectomy); 277 procedures (70.8%) were performed by experienced surgeons and 114 (29.2%) by surgical trainees. We used a diathermic hook in 26.3% of the procedures. The mean follow-up period was 68 months (48-100). RESULTS: Peritoneal tears occurred in 43 patients (10.9%). Six of them (13%) required operative closure, and six a conversion (four Lichtenstein, one Shouldice, and one TAPP). In 37 cases (86%), the tears were not closed. Peritoneal tears were significantly correlated with surgical experience, Nyhus classification, scar adhesion from previous surgery and the use of sharp instruments. Peritoneal tears interfere significantly (P=0.001) with the operating time (82 vs. 63 min) and conversion rate (13.9 vs. 1.7%). It does not affect the outcome and late results in terms of recurrences, pain, or small bowel obstruction. CONCLUSION: Our data suggest that peritoneal tears in the vast majority of cases may be safely managed without peritoneal closure. In case of peritoneal laceration, the operative time was significantly longer, and the conversion rate was increased. These situations do not affect the outcome and late complications compared with the procedures without peritoneal tears.

Adult↗
PubMed2004

[Are there predictive items of successful surgery in morbid obesity treated by adjustable gastric banding: a prospective study].

BACKGROUND: Surgical treatment of morbid obesity by perigastric adjustable banding give at mid term follow up, contrasted results which associate success, failure and intermediate situations. AIMS: The objective of this work was to prospectively validate predicting items that would predict success in the surgical treatment of morbid obesity by adjustable gastric banding. MATERIAL AND METHODS: Eighty patients with morbid obesity have been treated with adjustable gastric banding. Seventy-one women, and nine men with a mean age of 37.8 years (20-59) with a mean follow up of 17 months (12-52). They have been classified in three groups: success, failure, and intermediate results. Uni- and multivariate analysis was performed on six criteria: age, sex, professional activity, metabolic disorders, length of obesity and body mass index (BMI). RESULTS: Concerning age, sex, professional activity, metabolic disorders, and length of obesity, there was no difference between the three groups. However, a BMI more than 50 kg/m(2) has a strong predictive value. Patients called "super obese", BMI >50, has a high rate of failure (64%) even the weight loss is often important in absolute value, but the BMI at the follow up remain high and more than 40. In this situation: gastric banding does not seem a good treatment because it does not protect these patients against the lethal risk of their comorbidities. CONCLUSION: In this study, there is not a specific candidate "profile" to a successful treatment of morbid obesity by adjustable gastric banding. Meanwhile the initial BMI appear to be a predictive factor of success or failure. In the case of patients with high BMI >50 (super obese) gastric banding did not seen to be a good treatment and another technical approach (gastric bypass) must be discussed.

Adult↗
PubMed2000

Factors related to outcome of salvage therapy for isolated cervical recurrence of squamous cell carcinoma in the previously treated neck: a multi-institutional study.

OBJECTIVE: The goal was to identify factors associated with the outcome of salvage therapy for patients with isolated cervical recurrences of squamous cell carcinoma in the previously treated neck (ICR-PTN). STUDY DESIGN AND SETTINGS: A tumor registry search for ICR-PTN patients was performed at 7 participating institutions, and the charts were reviewed. Kaplan-Meier plots for survival and time until re-recurrence were used to evaluate the significance of associated variables. RESULTS: Median survival and time until re-recurrence were both 11 months. Survival was better in patients with the following characteristics: nonsurgical initial neck treatment, negative initial disease resection margins, no history of prior recurrence, ipsilateral location of the ICR-PTN relative to the primary, and use of surgical salvage. CONCLUSIONS: By pooling the experience of 7 US tertiary care medical centers, we have identified 5 factors that are associated with outcome of salvage therapy for ICR-PTN. SIGNIFICANCE: Consideration of these factors, as well as the reviewed literature, should facilitate patient selection for salvage protocols.

Adult↗
PubMed1999

The use of diagnostic laparoscopy supported by laparoscopic ultrasonography in the assessment of pancreatic cancer.

BACKGROUND: Pancreatic resection with curative intent is possible in a select minority of patients with carcinomas of the pancreatic head. Diagnostic laparoscopy supported by laparoscopic ultrasonography combines the proven benefits of staging laparoscopy with high-resolution intraoperative ultrasound, thus allowing the surgeon to perform a detailed assessment of the pancreatic cancer. METHODS: In a prospective study of 26 patients with obstructive jaundice from a carcinoma of the head of the pancreas, the curative resectability of tumors was assessed by ultrasound (26 cases), computerized tomography (26 cases), endoscopic ultrasound (16 cases), and a combination of diagnostic laparoscopy and laparoscopic ultrasound (26 cases). RESULTS: The findings of ultrasound and computerized tomography were comparable: 50% of patients were excluded from curative resection. Endoscopic ultrasound provided precise information on the primary tumors. The accuracy of the combined diagnostic laparoscopy and laparoscopic ultrasound, when compared with ultrasound, computerized tomography, and endoscopic ultrasound, was better with respect to minute peritoneal or hepatic metastasis: 80.7% (or a further 30.7%) of patients did not qualify for curative resection. CONCLUSIONS: Diagnostic laparoscopy supported by laparoscopic ultrasonography enables detection of previously unsuspected metastases; thus, needless laparotomy can be avoided. It should therefore be considered the first step in any potentially curative surgical procedure.

Endosonography↗
PubMed1999

[Impact of learning and experience on the laparoscopic treatment of gastroesophageal reflux].

STUDY AIM: Laparoscopic treatment of gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the most appropriate surgical treatment after failure of medical treatment. The aim of this study was to compare the results of the same series in three consecutive periods in order to determine the effects of the learning curve and experience on the technique and outcome. PATIENTS AND METHODS: From January 1993 to January 1998, 150 patients (84 men and 66 women) with a mean age of 52.2 years (18 to 78) were included. Three groups of 49, 50 and 51 patients were chronologically defined. The comparison was established on the following criteria: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results with short and medium follow-up. RESULTS: The three groups were comparable with respect to patients and GERD characteristics. One hundred and thirty two patients had a TF and 18 had a PF. Rossetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 min). The rate of conversion decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. Seven cases of recurrence occurred (4.6%), 5 in group I (10.2%), 2 in group II (4%), and 0 in group III, (with a shorter follow-up). CONCLUSION: The effect of the learning curve has to be taken into account in the training of surgeons (within experienced departments, with "guidance" during initial interventions) and also in the evaluation of results, in order to allow a more accurate comparison between the different treatments for GERD.

Adolescent↗
PubMed1999

A comparison of laparoscopic ultrasound versus cholangiography in the evaluation of the biliary tree during laparoscopic cholecystectomy.

OBJECTIVE: This study assessed the effectiveness of laparoscopic ultrasound in detecting main biliary duct stones. METHODS: From November 1994 to August 1998, 600 patients treated by laparoscopic cholecystectomy were included in a prospective study, to compare intraoperative cholangiography and laparoscopic ultrasound. The biliary tree was successively explored by these two methods in the routine detection of common bile duct stones. RESULTS: The feasibility of laparoscopic ultrasound was 100%. Cholangiography was performed only in 498 cases (83%). The time taken for laparoscopic ultrasound examination was significantly shorter (10.2 vs 17.9 min, P=0.0001). In this study, common bile duct stones were found in 54 cases (9%). For their detection, results were comparable to laparoscopic ultrasound and intraoperative cholangiography. For laparoscopic ultrasound, sensitivity was 80% and specificity 99%; and for cholangiography 75 and 98% respectively. Both examinations combined had a 100% sensitivity and specificity. Laparoscopic ultrasound failed to recognize the intrapancreatic part of the common bile duct in 78 cases (13%) and did not show anatomical anomalies detected by cholangiography. It did however detect other unsuspected intra-abdominal pathologies. CONCLUSIONS: Laparoscopic ultrasound is safe, repeatable, and non-invasive, but a considerable learning curve is necessary to optimize its efficacy. Comparison of relative cost must be undertaken.

Adult↗
PubMed1999

The effect of the learning curve on the outcome of laparoscopic treatment for gastroesophageal reflux.

The laparoscopic treatment for gastroesophageal reflux (GR) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period, during which the rate of complications, conversions, and duration of surgery and hospitalization are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in three groups of consecutive patients to determine the effect of the learning period on outcome. One hundred and fifty-six patients (88 men and 68 women) with an average age of 52.3 years (range, 18-78) were included. Surgery was indicated for failure or early relapse after the end of medical treatment or a symptomatic sliding hernia. The preoperative workup (endoscopy, barium meal, or esophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of patients were chronologically defined. The parameters that were examined were the type of preoperative exploration, the type of fundoplication, the operative technique, the conversion rate, the mortality and morbidity rates, the duration of surgery and hospitalization, and the results at short- and medium-term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GR. All patients had an endoscopy, 91% had a barium meal, 77.5% underwent esophageal manometry, and 67% had pH monitoring. One hundred and thirty-six patients had a TF and 20 had a PF. Rossetti type TF became the reference procedure (67% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between groups I and groups II and III (140, 100, 80 minutes, respectively). The rate of conversion, due to a variety of causes, decreased from 9.8% to 3.8%, and then to 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 15% to 3.8%, and then to 0%. There were seven cases of relapse (4.6%), five in group I (10%) and two in group II (4%), with no cases in group III, although the follow-up in group III was shorter. There is an effect of the learning curve on the outcome of treatment for GR, and this must be taken into account in the training of surgeons (training within experienced departments and guidance during their initial interventions) and also in publications to allow a more accurate comparison of this technique with other treatments for GR.

Adolescent↗
PubMed1999

Thromboembolism in laparoscopic surgery: risk factors and preventive measures.

The aim of this study was to assess the risk of clinical thromboembolism in laparoscopic digestive surgery. From June 1992 to June 1997, 2,384 consecutive patients were studied. All received perioperative prophylaxis with low-molecular-weight heparin (LMWH), which was continued until full mobility was regained. Eight cases (0.33%) of deep venous thrombosis were noted, but there were no cases of pulmonary embolus. In six cases (five cholecystectomies with reverse Trendelenburg position and one inguinal hernia repair), release of the pneumoperitoneum took longer than 2 hours, and in two cases (one rectopexy and one sigmoid colectomy for diverticulitis), longer than 3 hours. In six of the eight cases, the diagnosis of DVT was made after LMWH had been ceased and the patient had been discharged. All cases were diagnosed before the 10th postoperative day. Pneumoperitoneum is felt to predispose to deep venous thrombosis. Long operations and reverse Trendelenburg position are further potentiating factors. Thromboprophylaxis for laparoscopy should be the same as for conventional surgery, i.e., tailored to individual risk and continued for a minimum of 7 to 10 days. We also recommend using graduated compression stockings, maintaining a relatively low insufflation pressure, keeping use of the reverse Trendelenberg position to a minimum, and intermittently releasing the pneumoperitoneum in longer procedures.

Adolescent↗
PubMed1999

Does laparoscopy reduce the incidence of unnecessary appendicectomies?

The aim of this study was to evaluate the impact of laparoscopic appendicectomy on the incidence of histologically normal appendices. Between 1987 and 1997, 1,220 patients (average age 23.5 years [17-73]; 841 women [69%]) had appendicectomy due to the presence of at least one of the following three criteria: right iliac fossa guarding, fever >38 degrees C, and leukocytosis >10,000. Patients were divided into two groups: one group of 930 patients were operated on using the classic Mac Burney approach and the other group of 355 patients underwent laparoscopic exploration, with an appendicectomy performed if macroscopic abnormalities were observed (290 cases). In all cases, the appendices were examined blind and classified as normal or pathologic, with the latter divided with respect to the nature and severity of the lesions. In the Mac Burney group, the incidence of histologically normal appendices was 25.1%. In the laparoscopic group, the incidence was only 8.2% (p=0.015). The types of pathologic appendices were identical between the two groups. In 65 cases (18.3%), a macroscopically normal appendix was left in place. In 56 cases the symptoms were due to another identified cause, however, in 10 cases no cause was found. All patients were followed-up for an average of 3 years. One patient (1.8%) had a second operation (an appendicectomy), which revealed minor histologic lesions. The problem is the inability of the operator to differentiate between a healthy and a pathologic appendix on laparoscopy. The risk of false-positives and false-negatives is approximately 10%. Diagnostic difficulties usually occur in the initial phase of the disease with acute mucosal involvement in a morphologically normal appendix. At this stage the outcome cannot be predicted, although appropriate antibiotic treatment can be effective. This study shows that laparoscopy significantly reduces the number of histologically normal appendices as compared to a conventional Mac Burney operation. This can only be achieved by not removing macroscopically normal appendices, a small proportion of which (5-10%) could be cases of early appendicitis with only mucosal involvement. In the absence of other causes of the symptoms, a 3-day course of antibiotics can be tried to treat possible mucosal lesions. This approach reduces costs without having adverse consequences on the outcome.

Adult↗
PubMed1998

[Laparoscopic treatment of generalized peritonitis with diverticular perforation of the sigmoid colon. Report of 10 cases].

BACKGROUND: The classical treatment of perforated sigmoid diverticulitis with generalised peritonitis is based on the principle of two-stage surgical procedures with a temporary initial defunctioning colostomy. This approach is associated with significant morbidity, concerning mainly the abdominal wall. PATIENTS AND METHODS: Ten consecutive patients, eight female and two male, with a mean age of 54.6 years, underwent an emergency laparoscopy for generalised peritonitis secondary to perforated diverticula. Six had had previous infectious episodes; six were obese; four were diabetic and two had chronic lung disease. After exploration of the abdominal cavity and discovery of a purulent peritonitis (n = 8) or faecal peritonitis (n = 2), an extensive peritoneal lavage was performed (average 15 litres), the contaminating sigmoid lesion was covered with biological glue and a drain inserted at the site of the lesion. In some cases, drainage of dependent zones was also performed. No colostomies were performed. Antibiotic therapy instituted as soon as the diagnosis had been made was continued, on average, for 7 days. RESULTS: There was no mortality. There was a low morbidity: one case of lymphangitis on catheter and one of broncho-pulmonary infection. No cases of abdominal wall sepsis or residual deep collections were observed. The mean duration of hospitalisation was 8 days. Nine patients underwent a sigmoid resection (laparoscopic in eight cases) 3 to 4 months later, with a mean duration of hospitalisation of 6 days. One conversion to laparotomy was necessary. CONCLUSIONS: Laparoscopic treatment of generalised peritonitis secondary to perforated sigmoid diverticulitis constitutes an alternative to classical surgery. It is associated with a decreased morbidity and a marked reduction in duration of the hospitalisation. Colostomy can be avoided and the patient's quality of life is improved during the period previous to secondary colectomy, performed by laparoscopy eight times out of nine. In addition, the cost of this approach is significantly lower.

Adult↗
PubMed1998

[Videolaparoscopic treatment of splenic injuries. A study of 5 cases].

BACKGROUND: When splenic trauma does not require an emergency splenectomy in order to achieve hemostasis, the current policy is either observation under close surveillance, with transfusions if necessary, or conservative surgical procedure through laparotomy. Videolaparoscopic approach has the advantage of achieving in the same procedure, complete evacuation of the hemoperitoneum, full investigation of the abdominal cavity and repair of the damaged spleen. PATIENTS AND METHODS: Over a 4-year period, five patients aged 27.3 years on average, with severe splenic trauma but no major hemodynamic disturbance, were operated on by emergency laparoscopy. The diagnosis of splenic lesion had been confirmed preoperatively by ultrasonography. The procedure performed by open laparoscopy included evacuation of the hemoperitoneum and blood clots and splenic hemostasis which was achieved by the use of electrocoagulation and biological glue, associated in three cases with omentoplasty. Drains were inserted systematically. RESULTS: The average length of operation was 75 min. There were no cases of conversion, nor mortality, no morbidity. The average duration of hospitalization was 10 days. No blood transfusions were required. A CT-scan was performed immediately in the postoperative course and served as the baseline for comparison during the follow-up. There were no reinterventions. The longest follow-up was 4 years and the mean follow-up 2.5 years. Laboratory tests or isotopic imaging did not detect any change in splenic function. CONCLUSION: In specific defined circumstances, videolaparoscopic repair of splenic trauma is justified provided that careful attention is paid to the patient's condition.

Adult↗
PubMed1998

Evaluation of the biliary tree during laparoscopic cholecystectomy: laparoscopic ultrasound versus intraoperative cholangiography: a prospective study of 150 cases.

From November 1994 to March 1996, 150 patients treated by laparoscopic cholecystectomy were included in a prospective study, to compare intraoperative cholangiography (IOC) and laparoscopic ultrasonography (LU). The biliary tree was successively explored by these two methods in the routine detection of common bile duct stones. The feasibility of LU was 100%. Cholangiography was performed only in 125 cases (83%). The time taken for LU was significantly shorter (11.6 vs. 17.6 minutes, p = 0.0001). In this study, common bile duct stones were found in 14 cases (9%). For their detection, results were comparable to LU and IOC. For LU, sensitivity was 80% and specificity 99%; and for IOC, 78 and 97%, respectively. Both examinations combined had a 100% sensitivity and specificity. Laparoscopic ultrasonography failed to recognize the intrapancreatic part of the common bile duct in 25 cases (17%) and did not show anatomic abnormalities detected by IOC. It did, however, detect other unsuspected intraabdominal abnormalities. Although LU is safe, repeatable, and noninvasive, a considerable learning curve is necessary to optimize its efficacy. Comparison of relative cost must be undertaken.

Adult↗
PubMed1998

[Laparoscopic treatment of pancreatic pseudocyst. 3 cases].

Three patients with pancreatic pseudocysts were treated laparoscopically by cysto-enteric by pass. Two developed a large cyst in the course of acute biliary pancreatitis. The third patient had chronic pancreatitis of unknown etiology. The mean size of the collection was 12 cm (8-20). Treatment was performed with a delay of 80 days (30-300) after the onset of the disease. Two patients underwent laparoscopic cysto-gastrostomy using laparoscopic ultrasound. Stapling anastomosis appears easy and safe. The third patient underwent operating laparoscopically assisted cysto-jejunostomy with an-Y loop. Mean time was 120 minutes (90-200) and hospital stay was 7 days (5-8) without morbidity. The follow-up was 18 months without radiological recurrence and with excellent clinical results.

Adult↗
PubMed1998

[Inguinal hernia. 4-year follow-up of 2 comparative prospective randomized studies of Shouldice and Stoppa operations with pre-peritoneal totally laparoscopic approach (461 patients)].

The aim of this study was to evaluate the late (4 years) recurrence rate after laparoscopic totally preperitoneal (TPP) approach, to Shouldice and Stoppa procedures. All patients were reviewed at one, six months, one year and yearly there after. The mean follow-up was 4 years: the follow-up was 100 per cent at one month, 98 per cent at 6 months, 95 per cent at one year, 91 per cent at 2 years, 84 per cent at 3 years, 79 per cent at 4 years and 61 per cent at 5 years. At one year, the recurrence rate was 2.2 per cent in the laparoscopic group, 1.2 per cent for Shouldice and 0 per cent for Stoppa procedure (ns). At 3 years, the recurrence rate was comparable and 3.6 per cent for laparoscopy, 5.1 per cent for Shouldice and 5.2 per cent for Stoppa respectively (ns). At 4 years, the recurrence rate was lower (but ns) for the laparoscopic group 7.4 per cent versus 12.5 and 10.5 per cent. Two predictive factors for recurrence in laparoscopic treatment were the size of the mesh and the surgeon's experience.

Adult↗
PubMed1998

[Risk factors and prevention of thromboembolic risk in laparoscopy].

The aim of this prospective study was to assess the clinical thrombo-embolic risk in laparoscopic digestive surgery. The study prospectively included 2384 patients, who underwent surgery between April 1991 and June 1997. All patients received peri-operative Low Molecular Weight Heparin (LMWH) thromboprophylaxis. This regimen was administered until the patients resumed normal ambulatory activity. Eight cases of phlebitis were observed (3.36/1000), but no pulmonary embolism was noted. In six out of eight cases, the diagnosis of deep vein thrombosis was established after cessation of LMWH delivery, after the patients were discharged home, and before day postoperative 10. Pneumoperitoneum predisposes to deep vein thrombosis formation. Long operations, and reverse Trendelenburg are aggravating factors. In laparoscopy, heparin thromboprophylaxis has to be identical to that of open conventional surgery; i.e. appropriate for the potential risks and must be delivered for a duration of 7 to 10 days. We recommend the use of graduated compression stockings, to reduce intra-abdominal pressure and the duration of reverse Trendelenburg, and to perform intermittent exsufflation.

Adolescent↗
PubMed1998

[Does laparoscopy reduce the incidence of useless appendectomies?].

The aim of this retrospective study is to evaluate the impact of laparoscopic appendicectomy on the incidence of histologically normal appendices. Between 1987 and 1997, 1220 consecutives patients--with an average age of 23.5 years (17-73) and including 841 women (69%)--underwent appendicectomy due to the presence of at least one of the following 3 criteria: right iliac fossa guarding, fever greater than 38 degrees C and hyperleucocytosis greater than 10,000. Patients were divided into two group.: First group with 930 patients were operated by laparotomy and the other group of 355 patients underwent laparoscopic exploration with appendicectomy when macroscopic abnormalities were observed (290 cases). In all cases, the appendices were examined under blind conditions and classified as normal or pathological, and were subsequently classified according to the nature and the severity of the lesions. In group I (laparotomy), the incidence of histologically normal appendices was 25.1%. In group II (laparoscopic), this incidence was only 8.2%. The difference was significant (p = 0.015). In 65 cases (18.3%), a macroscopically normal appendix was left in place: in 55 cases the symptoms were due to another identified cause, however, in 10 cases no cause was found. This study suggests that laparoscopy significantly reduces the number of histologically normal appendices because an other cause is identified more easily provided macroscopically normal appendices are not removed with a small proportion (5-10%) cases of early appendicitis with only mucosal involvement. In the absence of other causes for the symptoms, a three-day course of antibiotics can be tried in order to treat possible mucosal lesions. This approach reduces costs without having any adverse consequences on outcome.

Adolescent↗