<50 3269 (70.79%) First operator, n (%) Specialist 2589 (56.06%) Resident 2029 (43.94%) Median operative time, min (IQR) 55 (40-70) Technique, n (%) Clipping 2841 (61.64%) Suturing/ligature 453 (9.79%) Stapler 313 (6.75%) Endoloop 606 (13.11%) Röder loop 403 (8.71%) Complicated appendicitis, n (%) 1269 (27.48%) Uncomplicated appendicitis, n (%) 3349 (72.52%) Intraoperative adverse events, n (%) 104 (2.25%) Drainage, n (%) 3493 (75.64%) Postoperative morbidity, n (%) 310 (6.71%) Clavien-Dindo classification of surgical complications, n (%) I 146 (3.16%) II 80 (1.73%) III 77 (1.67%) IV 4 (0.09%) V 3 (0.06%) Conversions, n (%) 294 (6.37%) Reinterventions after primary procedure, n (%) 98 (2.12%) LOS 3 (2-4) Readmissions, n (%) 118 (2.56%)

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1—<40 years old; Group 2—between 40 and 64 years old; Group 3—between 65 and 74 years old; and Group 4—75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2–4] vs 3 [IQR 3–5], vs 4 [IQR 3–5], vs 5 [IQR 3–6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.

Two cases of chylous ascites following retroperitoneal lymphadenectomy are presented. The first case, a 3-year-old girl, underwent a right radical nephrectomy and retroperitoneal lymph node dissection for Wilms' tumor. Chylous ascites developed postoperatively and resolved after 3 months of supportive therapy. The second case, a 45-year-old woman, underwent a right radical nephrectomy and retroperitoneal lymph node dissection for renal carcinoma. Chylous ascites occurred postoperatively and resolved after a single paracentesis. Diagnosis, evaluation, and therapeutic modalities are outlined and the literature is reviewed.Cancer 42:349-352, 1978.

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