BACKGROUND:There is still no consensus about whether laparoscopic appendectomy should be performed in selected cases or routinely in all cases for treatment of acute appendicitis. Especially for rural hospitals with laparoscopic equipment shortages, it is critical to develop surgical methods alternative to LA. This prospective study aimed to compare mini-incision open appendectomy (MOA) and laparoscopic appendectomy (LA) procedures. METHODS:A total of 102 patients who had been operated on by a single surgeon for acute appendicitis between July 2018 and February 2020 and whose body mass index (BMI) was <30 were included in this study. Fifty-one patients were operated on with MOA and 51 with LA technique. The patients were evaluated concerning operation time, postoperative pain, hospital stay, postoperative infectious complications and cost-effectiveness. RESULTS:Operation time was shorter in the MOA group than LA group (p<0.001). VAS scores at postoperative 12 th and 24 th hours were significantly lower in the MOA group than those in the LA group (p<0.001). Total hospitalization costs were lower in the MOA group than those in the LA group (p<0.001). No significant difference was found between the two groups concerning length of hospital stay and postoperative infectious complications (p=0.061 and p>0.999, respectively). CONCLUSION:Mini-incision open appendectomy is a reliable method in patients with acute appendicitis who have a BMI of <30 and it is superior to laparoscopic appendectomy concerning the operation time, postoperative pain and cost.

Missed gland is an extremely rare condition. It is a mediastinal thyroid mass found after total thyroidectomy. We report a case of missed gland. The patient underwent total thyroidectomy due to multinodular goiter and thyroid stimulating hormone levels did not increase after surgery. Pathological tests revealed a micropapillary carcinoma. Thyroid ultrasonography and scintigraphy scan revealed mediastinal thyroid mass. The patient underwent redo surgery without sternotomy and there was no morbidity after the second surgical procedure. Most missed thyroid gland cases are due to incomplete removal of plunging thyroid goiter during total thyroidectomy. They also can be attributed to a concomitant, unrecognized mediastinal goiter, which is not connected to the thyroid gland with vessels or a thin fibrous band. It should be noted that absence of signs like mediastinal mass or tracheal deviation in preoperative chest X-ray does not exclude substernal goiter. The presence of a missed thyroid gland should be kept in mind when postoperative thyroid stimulating hormone levels remain unchanged.

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Abdominal pain is the most common reason of emergency admission in hospitals and acute abdomen is a surgical emergency condition that needs complex diagnosis and treatment. A physician must be careful at differantial diagnosis of appendicitis; sometimes there is no one reason to explain the patient disturbances. Intussusception is the invagination of a proximal segment and mesentery of intestine into distal part of bowel. Intussusception can result in acute abdomen due to obstruction and is mostly seen in children aged. Adult intussusception accounts only %5-10 of all cases and is frequently caused by benign or malign tumors. Gastrointestinal lipomas are reported as benign lesions in 1757 by Bauer. Lipomas mostly originate from adipocyte cells of the submucosa and subserosa of the intestinal wall. Lipomas smaller than 2 cm are frequently have no symptoms but larger than 2 cm diameter mostly have pain, bleeding and obstruction symptoms. Abdominal CT is the most sensitive technique for detecting of presence and level of intussusception. Treatment of adult intussusception is always surgery. Laparoscopic surgery is an useful and succesful procedure for small intestine intussusception except cases that have contraindications for laparoscopy. In the case we determined the togetherness of intussusception due to ileal lipoma with acute appendicitis.

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