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PubMed2004

[Transumbilical laparoscopic-assisted "one-trocar" appendectomy -- TULAA -- as an alternative operation method in the treatment of appendicitis].

INTRODUCTION: Appendectomy is one of the most commonly performed surgical procedures in general surgery and laparoscopic appendectomy represents the beginning of minimal invasive era in visceral surgery. But until yet, laparoscopic appendectomy is not the standard method for removal of the appendix and the discussion about the value and the advantages of laparoscopic appendectomy is still going on between the opponents and advocates of this method. In this article we present the transumbilical laparoscopic assisted "one-trocar" appendectomy (TULAA) as an alternative procedure for appendectomy and our experiences with this technique, which is up to now not very well known in Germany. METHOD: From November 1, 2000 to December 31, 2002, we performed appendectomy in 350 patients. 163 patients (46.6 %) underwent TULAA in the technique of Begin. All of them were examined two weeks and three months after surgery. RESULTS: In 94.5 % the "one-trocar" appendectomy was successful and there were no intraoperative complications. The mortality was 0 %. Conversion to the open procedure was necessary in 3 patients (1.8 %), respectively introduction of accessory trocars was necessary in 6 patients (3.7 %). In 111 from 163 patients (68.1 %) appendectomy was performed because of acute appendicitis. In 14.1 % we detected additional secondary findings during the laparoscopy. The postoperative complication rate was 3.6 %. CONCLUSION: The transumbilical laparoscopic assisted "one-trocar" appendectomy complements the minimal invasive procedures in visceral surgery. The operating technique combines the simplicity and the safety of conventional appendectomy with the survey of laparoscopic appendectomy. It minimizes the trauma of surgery and shows a perfect cosmetic result.

Acute Disease↗

PubMed2002

Appendectomy protects against the development of ulcerative colitis but does not affect its course.

OBJECTIVES: Appendectomy has been shown to protect against the development of ulcerative colitis. The objective of this study was to examine the effect of appendectomy on the clinical features and natural history of colitis. METHODS: A total of 259 consecutive adults patients with ulcerative colitis were studied. Of the patients, 20 had undergone appendectomy (12 before onset of colitis and eight after diagnosis). RESULTS: The frequency of appendectomy was significantly less than in a group of 280 controls, which comprised partners of the patients and a group from the community (OR = 0.25; 95% CI = 0.14-0.44). This was even more significant if only the 12 patients who underwent surgery before the onset of colitis were considered (OR = 0.15; 95% CI = 0.07-0.28). Patients with prior appendectomy developed symptoms of ulcerative colitis for the first time at a significantly later age than those without appendectomy (42.5 +/- 6.5 vs 32.1 +/- 0.8 yr; p < 0.01) or those who had appendectomy after the onset of colitis (24.6 +/- 3.4 yr; p < 0.05). Appendectomy did not influence disease extent, need for immunosuppressive treatment with azathioprine or 6-mercaptopurine (as a marker of resistant disease), or the likelihood of colectomy. Five patients in the appendectomy group had clinical evidence of primary sclerosing cholangitis (25%). This was more common than in those without appendectomy (8%; OR = 4.09; 95% CI = 1.04-13.60). CONCLUSIONS: These results indicate that although appendectomy may delay onset of colitis, it does not influence its course. However, it is associated with the development of primary sclerosing cholangitis. Appendectomy is unlikely to be of benefit in established ulcerative colitis.

Adolescent↗

PubMed1993

Laparoscopic appendectomy. A safety and cost analysis.

To assess the feasibility of laparoscopic appendectomy, we reviewed hospital records and charge data for all patients older than age 15 years who underwent appendectomy between November 1990 and July 1992. Fifty-eight patients underwent laparoscopic appendectomy and 206 patients underwent conventional appendectomy. Intraoperative (1.9%) and postoperative (5.8%) complication rates were low. The rate of conversion to conventional appendectomy was 7.7%. Hospital stay and charge analysis was performed on a cohort of 52 patients undergoing laparoscopic appendectomy and 180 patients undergoing conventional appendectomy. Total costs were similar. The most notable difference between the two groups was the operating room supply charge; this negated any cost savings achieved by the reduced length of stay following laparoscopic appendectomy. Laparoscopic appendectomy is a safe alternative to conventional appendectomy; it shortens hospital stay and allows patients to resume normal activity more quickly than conventional appendectomy.

Adolescent↗

PubMed2006

Diagnosis underlying appendectomy and coeliac disease risk.

BACKGROUND: Earlier studies suggest that appendectomy is associated with a substantially reduced risk of certain types of bowel inflammation such as ulcerative colitis, particularly where the underlying diagnosis is acute appendicitis. Previous research on appendectomy and coeliac disease is inconsistent, based on small numbers with retrospective data collection, and has not differentiated between different diagnoses underlying appendectomy. OBJECTIVE: To investigate the association of diagnosis underlying appendectomy with coeliac disease. METHODS: We used Cox regression to study the risk of later appendectomy in more than 14,000 individuals with coeliac disease and 68,000 referents without coeliac disease, identified through the Swedish National Registers 1964-2003, and conditional logistic regression to study the risk of coeliac disease associated with a history of prior appendectomy. Appendectomy was categorised according to the underlying diagnosis: perforated appendicitis, non-perforated appendicitis, and appendectomy without appendicitis. RESULTS: Overall, coeliac disease was negatively associated with perforated appendicitis (hazard ratio=0.78, 95% confidence interval=0.60-1.01), not associated with non-perforated appendicitis (hazard ratio=1.11, 95% confidence interval=0.99-1.25), but positively associated with appendectomy without appendicitis (hazard ratio=1.58, 95% confidence interval=1.32-1.89). The magnitudes of the relative risks were similar irrespective of whether coeliac disease occurred prior to or after appendectomy. CONCLUSION: Coeliac disease and perforated appendicitis are negatively associated irrespective of the timing of the conditions. Not surprisingly, CD increases the risk for appendectomy without appendicitis.

Adolescent↗

PubMed1996

A clinical outcome and cost analysis of laparoscopic versus open appendectomy.

BACKGROUND: Benefits of laparoscopic appendectomy are controversial, and the results of recent clinical studies have contradictory conclusions. We performed a cost analysis comparing laparoscopic and open appendectomies to assess potential efficacy of the laparoscopic approach. METHODS: All patients operated on for suspected acute appendicitis at the University of Washington Medical Center (UWMC) from January 1, 1991 through January 1, 1995 were analyzed. Potential benefits of the laparoscopic approach were examined in five major categories: hospital length of stay, total hospital charges, operative time, operating room charges, and postoperative complications. Patients were stratified according to the presence or absence of perforation for outcome analysis. RESULTS: There were 163 appendectomies performed in 82 men and 81 women. Twenty-seven (17%) patients had laparoscopic evaluation, of which 21 underwent attempted laparoscopic appendectomy. Among nonperforated patients, laparoscopic appendectomy did not reduce hospital stay compared with open appendectomy, but did lead to greater hospital charges ($7760 vs $5064; P < 0.001). Operating times were longer in the laparoscopic group (104 vs 74 minutes; P < 0.001) compared with open appendectomies. Operating room charges for laparoscopic appendectomies exceeded charges for the open approach ($4740 vs $1870; P < 0.001). Complication rates were similar (laparoscopic, 19% vs open, 16%; NS). The false diagnostic rate for women was four times greater than for men among patients undergoing open appendectomy (31% vs 8%; P < 0.01). Patients with perforation undergoing a midline incision had a longer hospital stay (9.5 vs 5.9; P < 0.02) than patients operated on through a right lower quadrant incision. CONCLUSIONS: In our analysis, laparoscopic appendectomy, while safe, was more expensive and was not associated with better clinical outcome compared with open appendectomy patients.

Acute Disease↗

PubMed2003

Histopathology of interval (delayed) appendectomy specimens: strong association with granulomatous and xanthogranulomatous appendicitis.

Patients who present with a ruptured acute appendicitis are often treated with antibiotic therapy and drainage followed by a delayed or interval appendectomy. We noticed interval appendectomy specimens with granulomatous inflammation and postulated that interval appendectomy may lead to granulomatous appendicitis. To test this hypothesis, we reviewed the histopathology of all interval appendectomy specimens within a 4-year period and compared them with a control group of patients who had acute appendicitis and underwent routine acute appendectomy. All slides were randomized and reviewed blindly to assess the inflammatory patterns, with special attention given to the presence of granulomas and other Crohn-like features. Twenty-two cases of interval appendectomy were found. The interval between symptom onset and appendectomy ranged from 30 to 95 days with a mean of 58 days, whereas all 44 control patients had surgery within 72 hours of symptoms onset. Thirteen (59.1%) of the 22 interval appendectomy cases contained granulomas compared with only 3 of 44 controls (P < 0.0001). Eight (36.4%) of the interval appendectomy cases had xanthogranulomatous inflammation compared with none in the acute appendicitis group (P < 0.0001). A Crohn-like appearance was seen in 11 (50.0%) of the interval appendectomy cases and 1 of the controls (P < 0.0001). Follow-up data were available in 8 of 11 cases with Crohn-like features; none developed Crohn disease during an average follow-up period of 23 months. Delayed or interval appendectomy specimens often have a characteristic inflammatory pattern that includes granulomas, xanthogranulomatous inflammation, mural fibrosis/thickening, and transmural chronic inflammation. Without the appropriate clinical history, these changes may be misinterpreted as Crohn disease.

Adolescent↗

PubMedDate not supplied

Laparoscopic appendectomy in children.

BACKGROUND AND OBJECTIVES: The advantages of laparoscopic appendectomy over open appendectomy have not yet been clearly demonstrated. The present study evaluated our early experience with laparoscopic appendectomy in children, in terms of its safety, effectiveness, technical difficulties, and economics. METHODS: We reviewed the records of 50 cases involving laparoscopic appendectomy performed at our affiliated institutions between September, 1994, and September, 1996. Patient age ranged from 6 to 18 years (mean, 14 years). Thirty-two patients had acute nonperforated appendicitis, six had perforated appendicitis, two had fibrosis of the appendix, and ten had a histologically normal appendix. RESULTS: In five patients the laparoscopic procedures were converted to open appendectomies because of technical difficulties. There were postoperative complications in four patients: one incomplete appendectomy which subsequently required an open appendectomy for completion, one pelvic abscess, one bowel obstruction, and one minor wound infection. CONCLUSIONS: Laparoscopic appendectomy is a safe and effective procedure. It takes longer operative time than open appendectomy. Length of hospitalization and incidence of postoperative complications are equivalent to those of open appendectomy. Economic benefits are difficult to assess at present. In sum, we believe that with better training, surgical techniques and equipment, laparoscopic appendectomy will eventually become the surgical procedure of choice in appendicitis.

Adolescent↗

PubMed1995

Is laparoscopic appendectomy the new 'gold standard'?

OBJECTIVES: To determine the efficacy of laparoscopic appendectomy compared with open appendectomy in patients with acute appendicitis and to compare the morbidity between the two groups. DESIGN: Prospective sampling of 102 patients who underwent diagnostic laparoscopy and laparoscopic appendectomy for acute appendicitis and retrospective hospital chart review of 204 patients who underwent open appendectomy for acute appendicitis. RESULTS: The mean +/- SD duration of surgery was 83 +/- 29 minutes in the laparoscopic group and 64 +/- 30 minutes in the open appendectomy group (P < .001). Hospital stay was shorter in the laparoscopic group (P < .04). There was no difference in the complication rate between the patients who underwent laparoscopic appendectomy (13%) and the patients who underwent open appendectomy (11%). The occurrence of postoperative ileus was correlated with the duration of operation (P < .01) but not with laparoscopic appendectomy. CONCLUSIONS: The results confirm that laparoscopic appendectomy had a longer time of surgery, a shorter hospital stay, and no difference in complications. Further investigation will likely establish that laparoscopic appendectomy can be considered the "gold standard."

Acute Disease↗

PubMedDate not supplied

Prospective nonrandomized study of conventional versus laparoscopic appendectomy.

With the introduction of laparoscopic appendectomy a prospective study was started. Patients with suspected appendicitis were selected for conventional appendectomy or laparoscopy according to the preference of the surgeon on call. During a 1-year period 233 patients were included, of whom 97 underwent conventional appendectomy and 136 laparoscopy. Among the patients selected to laparoscopy, laparoscopic appendectomy was carried out in 72 cases, conventional appendectomy in 32, and only diagnostic laparoscopy in the remaining 32. Removal of a normal appendix was significantly more common in the group of patients directly selected for conventional appendectomy compared to laparoscopy (p < 0.01). The duration of the operation was shorter (p < 0.05) and the postoperative hospital stay and the convalescence longer (p < 0.05) with conventional than with laparoscopic appendectomy. Peroperative problems and minor postoperative complications were more common (p < 0.01) with laparoscopic than conventional appendectomy. However, the clinical impact of these problems were limited. The difference between the procedures regarding major complications was not significant. Laparoscopic appendectomy seems to be at least as good as conventional appendectomy. However, randomized controlled trials are needed to decide which of the procedures to recommend.

Adolescent↗

PubMed1997

Should laparoscopic appendectomy be avoided for complicated appendicitis in children?

BACKGROUND/PURPOSE: Laparoscopic appendectomy is becoming the preferred technique for treating acute appendicitis. However, recent literature on adults suggests that laparoscopic appendectomy may increase the risk for postoperative infectious complications in complicated (gangrenous or perforated) cases. This study was undertaken to compare the results of open versus laparoscopic appendectomy for complicated appendicitis in children. METHODS: A retrospective review from two institutions was performed for all children treated operatively for complicated appendicitis from January 1994 through November 1996. RESULTS: Fifty-six cases were identified. Twenty-seven children underwent laparoscopic appendectomy, whereas 22 underwent open appendectomy. Seven children underwent conversion from laparoscopic to open surgery. Operating times and length of hospital stay did not differ significantly between the laparoscopic and open groups. Postoperative complications developed in 24 children (42.8%). Complications were more frequent after laparoscopic appendectomy compared with open appendectomy (56% v 18%, P = .002). A postoperative intraabdominal abscess (IAA) developed in 14 children (25%). An IAA occurred in two children after open appendectomy compared with 11 children after laparoscopic appendectomy (9% v 41%, P = .01). CONCLUSION: The findings suggest that laparoscopic appendectomy should be avoided in children who have complicated appendicitis because of the increased risk for postoperative intraabdominal abscesses. The authors propose a prospective, randomized trial to verify this finding.

Abdominal Abscess↗

PubMed2001

Incidental appendectomy in the era of managed care and laparoscopy.

BACKGROUND: In a study carried out before laparoscopy or managed care, there was no cost or patient benefit for routine incidental appendectomy. With the onset oflaparoscopy, a change in indications for surgery, and increased prevalence of capitated contracts, a reanalysis of the cost-effectiveness of incidental appendectomy is warranted. STUDY DESIGN: Financial data from 251 patients undergoing appendectomy for acute appendicitis without complication at a single institution were identified. Age-specific epidemiology data from the Centers for Disease Control, Atlanta, were applied to assess risk and cost of future appendectomy. The net cost or savings for incidental appendectomies necessary to prevent one case of acute appendectomy was determined and stratified by gender and age to the population as a whole. Further adjustment was made for the variable level of surgeon reimbursement for incidental appendectomy. RESULTS: At 10% surgeon reimbursement, open incidental appendectomy was cost-effective in those less than 25 years of age (< 35 years of age in a capitated system). Applied to the general population, open incidental appendectomy in those less than 25 years represented savings of up to $1,100 per 10,000 population per year. A surgeon fee of greater than 50%, or the laparoscopic approach using staplers, accrued no savings in any age groups. CONCLUSIONS: Open incidental appendectomy at low physician reimbursement is a cost-effective procedure for patients of less than 35 years of age. A decrease in equipment cost for laparoscopic approach will extend these indications.

Acute Disease↗

PubMed2005

Watchful waiting versus interval appendectomy for patients who recovered from acute appendicitis with tumor formation: a cost-effectiveness analysis.

BACKGROUND: Interval appendectomy after conservative treatment of appendicitis with tumor formation remains controversial. The purpose of this study was to evaluate the efficacy of interval appendectomy based on a cost-effectiveness analysis. METHODS: This was a retrospective study including appendicitis patients with tumor formation who received conservative treatment at first admission to Taipei Veterans General Hospital between January 1998 and December 2003. Demographic data, rate of recurrent appendicitis, and medical costs were analyzed. RESULTS: Of the 165 patients, 1 died after an acute myocardial infarction. The rate of recurrence of appendicitis after conservative treatment was 25.5%. The median cost of follow-up after conservative treatment was NT24,344 dollars. The median cost of interval appendectomy was NT47,746 dollars. The median cost of appendectomy after recurrent appendicitis was NT62,135 dollars. Routine interval appendectomy in all 164 patients would have cost NT7,830,344 dollars. The follow-up protocol with appendectomy after recurrence cost NT5,655,220 dollars. An additional NT2,175,124 dollars (38%) would have been needed for routine interval appendectomy compared with the follow-up policy, an extra NT13,263 dollars per person. CONCLUSION: Routine interval appendectomy would increase the cost per patient by 38% compared with follow-up and appendectomy after recurrence. Routine interval appendectomy is not a cost-effective intervention.

Acute Disease↗

PubMed2004

Impact of previous appendectomy on the outcomes of endoscopic totally extraperitoneal inguinal hernioplasty.

Previous lower abdominal surgery presents a technical challenge during endoscopic totally extraperitoneal inguinal hernioplasty. Whether the presence of appendectomy scarring and adhesions will adversely influence the outcomes of totally extraperitoneal inguinal hernioplasty remains largely unknown. The objectives of the present study were to evaluate the safety of totally extraperitoneal inguinal hernioplasty in patients with a history of appendectomy and examine its impact on the perioperative outcomes. Between November 1999 and September 2003, patients who underwent totally extraperitoneal inguinal hernioplasty and had previous appendectomy were recruited as the appendectomy group. For each case patient, 3 age-matched cohorts were randomly selected during the same period. Perioperative data and postoperative outcomes were compared between the 2 groups of patients. A total of 92 patients, 23 cases and 69 controls, were recruited. There was no predominance of either direct or indirect inguinal hernia in the appendectomy group. One patient in the appendectomy group required conversion to transabdominal preperitoneal inguinal hernioplasty because of adhesions. The incidence of peritoneal tear and operative time was higher and longer in the appendectomy group respectively but the differences were not significant. Comparisons of the mean duration of hospitalization, postoperative morbidity rates, pain scores, and time taken to resume normal activities showed no significant difference between the 2 groups. Totally extraperitoneal inguinal hernioplasty in patients who had previous appendectomy was technically safe. A higher incidence of peritoneal tear was anticipated in the presence of appendectomy scarring and adhesions. Postoperative recovery and outcomes were equivalent to those who had no history of appendectomy.

Aged↗

PubMed2004

Does appendectomy reduce the risk of ulcerative colitis?

BACKGROUND: Persons who have had an appendectomy are less prone to develop ulcerative colitis than those who have not. The underlying mechanism and the clinical use of this finding are unknown. METHODS: Two competing hypotheses were examined: (1) the inverse association between appendectomy and ulcerative colitis is conferred by a mutual determinant such as genes, and (2) the appendix itself has biologic effects that promote the development of ulcerative colitis. We performed a population-based cohort study of all 234,559 persons who had an appendectomy performed in Denmark 1977 through 1999. We used a bidirectional cohort design, calculating the standardized incidence rate of ulcerative colitis both before and after the appendectomy. If the hypothesis of a constant, confounding factor were true, incidence rates of ulcerative colitis would be equal before and after appendectomy. If the incidence of ulcerative colitis were lower after appendectomy than before, it would support the second hypothesis and a true protective effect of the appendectomy. We controlled confounding by age and sex using direct standardization. RESULTS: Of 234,559 persons who had an appendectomy, 559 developed ulcerative colitis during a mean follow up of 17.5 years. The standardized incidence rate of ulcerative colitis was lower in the postappendectomy period than in the preappendectomy period (incidence rate ratio = 0.74; 95% confidence interval = 0.62-0.88). CONCLUSIONS: The inverse association between appendectomy and ulcerative colitis is not explained by time-stable factors such as genes. Appendectomy might have a genuine protective effect toward development of ulcerative colitis.

Adolescent↗

PubMed1999

Day-care laparoscopic appendectomies.

OBJECTIVE: To demonstrate the safety of laparoscopic appendectomy in a day-care setting and to compare patients selected for laparoscopic versus open appendectomy. DESIGN: A retrospective, nonrandomized study. SETTING: A community hospital in a small town in British Columbia. PATIENTS: Ninety-four consecutive patients with a clinical diagnosis of acute appendicitis. INTERVENTIONS: Each patient underwent laparoscopic or open appendectomy as selected by the operating surgeon. OUTCOME MEASURES: Duration of operation and of hospital stay, morbidity and mortality. RESULTS: The average operating time was 32 minutes for open appendectomy and 36 minutes for laparoscopic appendectomy. Two (4%) of the 52 patients who had a laparoscopic appendectomy had significant complications; 1 of them required reoperation for intra-abdominal abscess. Thirty-nine (75%) of the laparoscopic appendectomies were done as day-care procedures. The average length of stay for the remaining patients was 2.1 days. The overall complication rate for patients who underwent open appendectomy was 20%. The average length of stay for these patients was 3.2 days; no patient was discharged within 24 hours. CONCLUSIONS: Laparoscopic appendectomy can be safely performed as a day-care procedure, even for selected patients with gangrenous or perforated appendices. Patients typically selected for open appendectomy include children and those with more advanced infection.

Adolescent↗

PubMed2001

Laparoscopic appendectomy in children: evaluation of different techniques.

Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis. Clinical studies have shown this approach to be a reasonable alternative to open appendectomy. The objective of the current study was to assess the outcome of laparoscopic appendectomy using three different techniques. The study sample consisted of 150 children with acute appendicitis who underwent surgery at Al-Azhar University Hospitals, Cairo, Egypt, and at Al Mishary Hospital in Riyadh, Saudi Arabia, between October 1997 and October 1999. The patients were allocated to undergo extracorporeal laparoscopic appendectomy, Endoloop laparoscopic appendectomy, or EndoGIA (Ethicon Endo-surgery, Inc., Cincinnati, OH, USA) laparoscopic appendectomy. All patients were assessed for the severity of the disease at baseline using clinical and hematologic indicators. The ages of the children ranged from 7 to 14 years, with a mean of 10 years (SD, 2.14 years). Of the children, 55.3% were female. The results showed that children who underwent laparoscopic appendectomy using the EndoGIA had statistically significant shorter operating times, did not have complications, and had the shortest duration of hospital stay (although duration of hospital stay did not reach the statistically significant level of P > 0.05). Therefore, the study showed that laparoscopic appendectomy using the EndoGIA is the procedure that is most recommended, except for the relatively high cost of the disposable materials. Endoloop laparoscopic technique was the second most preferable procedure, and the least preferred procedure was extracorporeal laparoscopically assisted appendectomy. The major drawback of the last technique is the high frequency of complications. Endoloop laparoscopic appendectomy with a purse-string suture can be performed safely if the EndoGIA is not available.

Acute Disease↗

PubMed2001

Association of MALTectomy (appendectomy and tonsillectomy) and inflammatory bowel disease: a familial case-control study.

UNLABELLED: There is some controversy regarding the prevalence of tonsillectomy and appendectomy among patients with Crohn's disease (CD) and a lower rate of appendectomy among patients with ulcerative colitis (UC). However, some environmental and familial factors that could alter those figures have not been studied. OBJECTIVE: To explore the prevalence of MALTectomy (appendectomy and tonsillectomy) among patients with IBD, stressing those factors that may be significantly associated to it. METHOD: Age-and-sex matched case-control study in patients with IBD, their relatives and the general population. Two hundred and eighty seven cases were IBD patients (153 UC, and 134 CD), the "family control" group included 203 siblings and the population-based control group included 570 individuals. Potential confounding factors, such as smoking, educational level, oral contraceptive use, place of birth and residence up to the age of 15 years, were ruled out. RESULTS: Appendectomy and UC: 7% of UC patients had undergone appendectomy versus 20% (OR: 0.23; 95% CI: 0.11-0.5; p < 0.0001) of controls. Appendectomy rates in families with at least one case of UC were 17/153 (6.3%) and 61/306 (20%) in the control group (p < 0.001). Appendectomy and CD: Twelve per cent of CD patients had undergone appendectomy six months before the onset of the disease versus 17% among the control population (OR: 0.43; 95% CI: 0.29-0.95; p < 0.01). The frequency of appendectomy in families with at least one case of CD was 22/221 (10%), which was significantly lower (p < 0.05) than among the control group 45/264 (17%). No differences were found between IBD patients and familial controls. Tonsillectomy and CD: Forty six per cent of CD patients had undergone tonsillectomy versus 39% of control patients (OR: 1.77; 95% CI: 0.92-2.05; p = ns). Tonsillectomy and UC: Twenty eight per cent of UC patients had undergone tonsillectomy versus 39% of the population control group (OR: 1.07; 95 CI: 0.57-1.25: p = ns). In fact, no differences were found regarding the prevalence of tonsillectomies within families with IBD cases as compared to population controls. CONCLUSIONS: Appendectomy is not only less frequent among CD and UC patients, but also among their relatives, thus suggesting the existence of environmental and genetic factors with opposed etiological roles in IBD and appendicitis.

Adolescent↗

PubMedDate not supplied

Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery.

BACKGROUND: Laparoscopic surgery has reduced the length of hospital stay for common operations like cholecystectomy, gastric fundoplication, and appendectomy. We have noticed a reduction in length of hospital stay for children undergoing laparoscopic appendectomy. We, therefore, looked at our data to assess whether laparoscopic appendectomy in children could be performed as fast-track or same-day surgery (< or = 24-hour postoperative stay). METHODS: We performed a retrospective review of the records of all children who underwent laparoscopic appendectomy for suspected appendicitis during a 3-year period (7/97 to 7/00). RESULTS: Laparoscopic appendectomy was performed in 79 children (44 boys and 35 girls), between 2 to 17 years of age (mean, 11 years). In 4 (5%) children with perforated appendicitis, the laparoscopic appendectomy was converted to an open appendectomy. At operation, 51 (64.5%) had acute appendicitis, 22 (27.8%) had perforated appendicitis, 4 (5%) had ruptured ovarian cysts, and 2 (2.5%) had no pathology. The median operative time was 54 minutes. Total length of stay for all 79 patients was a median of 58 hours, and median postoperative LOS was 35 hours. Complications included wound infection (2), abdominal abscess (4), drug rash (2), and epididymo-orchitis (1). In 57 (72%) children without perforated appendicitis, the total length of hospital stay was a median of 42 hours, while median postoperative length of stay was only 28 hours. Thirty-two (56%) children went home in < or = 24 hours following laparoscopic appendectomy. No significant morbidity was noted in the nonperforated group (drug rash, 1 fever > 24 hrs, 3); and no readmissions or reoperations were necessary on follow-up. CONCLUSION: Laparoscopic appendectomy is safe and effective for treating children with appendicitis. Laparoscopic appendectomy may be safely performed as fast-track or same-day surgery, in select children without perforated appendicitis, with a postoperative stay of < or = 24 hours.

Adolescent↗