Aim Single‐site laparoscopic interval appendectomy (SLIA) for severe complicated appendicitis after conservative treatment (CT) to ameliorate inflammation and eradicate the abscess should be safer and less invasive than emergency appendectomy (EA). However, only a few reports have been published regarding SLIA. Methods We retrospectively collected data on 264 consecutive patients admitted to Kinan Hospital for treatment of appendicitis between 2012 and 2018. The safety and feasibility of SLIA and its perioperative outcomes for severe complicated appendicitis were investigated. Results A total of 61 patients were included in this study, 25 of whom underwent CT and 36 EA. Among the 25 patients who underwent CT, 23 (92.0%) succeeded; a total of 16 patients (69.5%) underwent SLIA. Compared to the EA group, the SLIA group had less bleeding (median volume 8.5 vs 50 mL, P = .005) and lower rate of expansion surgery (0% vs 27.8%, P = .022). Although the postoperative hospital stay was shorter in the SLIA group than in the EA group (9 vs 12 days, P = .008), the total hospital stay, including the CT period, was longer in the SLIA group than in the EA group (24 vs 12 days, P < .001). Conclusion SLIA is safe, feasible, and less invasive than EA and may provide the advantages of minimally invasive surgery even if appendicitis is severe. SLIA may be a promising option for complicated appendicitis in select cases despite its disadvantage of prolonging the hospital stay.

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Current guidelines indicate that laparoscopic appendectomies are safe for pregnant patients with acute appendicitis. Recently, single- and reduced-port laparoscopic surgeries have gained popularity for nonpregnant patients, because they minimize abdominal wall trauma. Here, we describe a reduced-port laparoscopic appendectomy (RPLA) in a 31-year-old pregnant female performed at 27 weeks gestational age. Preoperative abdominal ultrasonography and computed tomography imaging showed an inflamed, swollen appendix and blood test results showed elevations in the white blood cell count and the C-reactive protein level. Accordingly, acute appendicitis was diagnosed. A surgical incision was performed at the umbilicus with an EZ-access device; an additional 5-mm trocar was placed at the right lower quadrant. Recovery was uneventful. The patient was discharged 8 days postoperatively. A vaginal delivery was achieved at term. The RPLA was a good surgical option for minimizing surgical invasiveness, without increasing the technical difficulty, in conditions where the uterus and fetus are growing.

Background The perforation of upper gastrointestinal tract, primarily caused by peptic ulcer or cancer, is afflicted by a notoriously high mortality rate. The selection of appropriate risk assessments and therapeutic alternatives becomes important when addressing the risk for morbidity and mortality. We aimed to evaluate the optimal treatment and the post-treatment complications for this condition.Methods We retrospectively analyzed 50 patients with intraperitoneal free air due to perforated stomach or duodenum who were consecutively treated at a single institution between 2010 and 2019.Results All patients received initial inpatient treatment that was categorized as either surgery (n = 43, 86%) or non-surgery (n = 7, 14%). The non-surgically cured patients were significantly younger and had no or localized peritonitis, no ascites, lower C-reactive protein (CRP) levels, and shorter hospital stay than the surgery patients. Of seven non-surgery patients, two patients were converted to surgery for worsening symptoms. One of them, who was elderly and had a longer perforation-to-treatment time, stayed at the hospital more than 2 months after surgery with CD Grade Ⅱ. Evaluation of postoperative complications using the Clavien-Dindo classification showed that the patients with Grade Ⅱ–Ⅴ (n=21) were significantly older and had higher heart rates, poorer physical status, and longer perforation-to-surgery than those with Grade 0–Ⅰ (n=24). Preoperative CRP, prothrombin time, and lactate were significantly higher, and hemoglobin was significantly lower in the patients with Grade Ⅱ–Ⅴ. They had significantly longer operation times and found acute renal failure more frequently. Postoperative findings showed a significantly more prolonged period of antibiotic administration, fasting, and hospital stay. The postoperative blood examinations of them showed that minor changes were observed in WBC and neutrophil, and neutrophil and CRP were significantly higher after surgery. The multivariable analyses identified elevated lactate as an independent risk factor for postoperative complications. The postoperative outcomes in patients with perforated gastric cancer depended on the stage and whether a curative resection could be performed.Conclusions Consideration should be given to the indications of non-surgery in elderly patients as well as the delay of treatment and postoperative outcomes of patients with elevated lactate preoperatively.