Introduction Acute appendicitis is a major cause of acute abdomen. Although its diagnosis is clinical, it is often supported by complementary diagnostic tests. Sometimes, delay in diagnosis can lead to worsening of the clinical picture, resulting in a complicated acute appendicitis. Some series have studied some clinical and analytical parameters as possible predictors of complicated acute appendicitis. Study design A retrospective analysis of patients admitted for acute appendicitis and undergoing appendectomy between January 2014 and December 2017 was performed in order to assess the possible existence of preoperative analytical predictive factors for complicated acute appendicitis (such as leukocytosis, C-reactive protein and ratio between neutrophils and lymphocytes). Results 841 patients underwent emergency appendectomy during the analysed period. This initial sample was divided into two groups: Group 1 with patients with uncomplicated acute appendicitis and Group 2 with patients with complicated acute appendicitis. Group 2's presentation age, duration of symptoms and hospital stay was significantly higher than Group 1. Regarding analytical parameters, the measurement of leukocytes, C-reactive protein and ratio between neutrophils and lymphocytes was significantly higher in patients with complicated acute appendicitis. After a multivariate analysis, it was found that only C-reactive protein was a good predictor of complicated acute appendicitis. Conclusion Several publications have studied and demonstrated the possible use of certain analytical parameters as predictors of complicated acute appendicitis. In our study, C-reactive protein proved to be a good independent predictor of complicated acute appendicitis and, therefore, when an assay of this protein exceeds 63.3 mg/L, faster surgical approach should be considered due to the high probability of the presence of a complicated picture of this clinical entity.

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Background: Recent advances in robotic technology suggest that da Vinci Single-Site cholecystectomy (dVSSC) is safe, feasible and reduces the stress load of the surgeon compared to single-incision laparoscopic cholecystectomy (SILC). However, evidence needed to objectively assess differences based on high-quality comparative data is lacking to date. Methods: This single centre, single-blinded controlled trial included 60 patients with benign gallbladder disease randomly assigned to dVSSC (n=30) or SILC (n=30). The primary endpoint surgeon's physical and mental stress load was assessed using the validated Local Experienced Discomfort (LED) and Subjective Mental Effort Questionnaires (SMEQ). Secondary endpoints included operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, procedure costs, health-related quality of life, cosmesis and complications. Patients and ward staff were blinded until 12 months postoperatively. Results: The dVSSC-group showed a significant reduction of mental stress load of the surgeon compared to SILC (SMEQ: median 25.0 vs. 42.5 points; p=0.002) and a trend toward reduced physical stress load (LED: median 8 vs. 12 points; p=0.088). The rate of postoperative complications that required a re-intervention (Dindo-Clavien grade!IIIa) was similar in both groups (SILC n=2 vs dVSSC n=0, p=0.492). The length of stay was longer in the SILC group (3.06 vs 1.9 days, p=0.034) but overall hospital costs were higher for dVSSC (9831 vs. 6900 CHF; p=0.001). Conclusions: dVSSC provides significant benefits over SILC in terms of surgeon's stress load, matches the standards of the laparoscopic single-incision approach with regard to patients' outcomes but increases overall expenses. Clinicaltrials.gov trial-no: NCT02485392.

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