Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

Background Appendectomy is the most common emergency operation and is often performed during on-call hours, when surgeons with different sub-specialties and levels of experience in emergency surgery operate on patients. However, little is known about the safety of the procedure when operations are performed by surgeons not regularly using standard laparoscopic techniques. Here we aim to assess variation in outcomes in patients operated on by surgeons with different levels of experience in laparoscopic surgery. Materials and methods Consecutive patients undergoing appendectomy at Tampere University Hospital between September 1, 2014 and April 30, 2017 for acute appendicitis were included. The data were analyzed by level of experience among surgeons regularly performing laparoscopic surgery and by volume among surgeons performing over 30 appendectomies per year or fewer. Results A total of 1560 patients underwent appendectomy, with 61% operated on by laparoscopic surgeons, and the rest by surgeons not habitually using laparoscopic techniques. Demographic characteristics, as well as share of patients with perforated appendicitis were similar in both groups. Morbidity was higher among those operated on by non-laparoscopic surgeons (6.1% and 3.0% p = 0.004), especially if appendicitis was complicated (18% and 5.6%, p < 0.001). Infectious complications were the most common. The risk of postoperative organ/space surgical site infections was higher among patients operated on by non-laparoscopic surgeons (3.5% vs. 1.4%, p = 0.006; Clavien–Dindo III–IV 2.0% vs. 0.7%, p = 0.030). Morbidity was 2.7% among those operated on by surgeons performing ≥ 30 appendectomies per year compared to 5.2% among those performing < 30 appendectomies per year. In multivariate analysis surgeon’s experience (p = 0.002; HR 2.32, 95% CI 1.38–3.90) and complicated disease (p < 0.001; HR 4.71; 95% CI 2.79–7.93) predicted higher morbidity. Discussion According to our study, routine use of laparoscopic techniques in daily practice improves outcomes after appendectomy. In addition, a higher surgical volume correlates with improved outcomes.

Background Retrovesical cysts present with varying etiologies. We initiated this study to provide insights into retrovesical cysts in boys through a case series and systematic literature review and to aid in treatment alternatives. Materials and methods Case series of seven patients from the in-hospital register with a systematic literature review on retrovesical cysts in children. Results We identified seven patients from the in-hospital register during 2005–2020 and eighty-two patients from the literature review. The literature review showed that children’s retrovesical cysts are mainly asymptomatic before puberty. Those detected earlier in childhood present mostly with renal abnormalities. In our series, retrovesical cysts derived from three distinct etiologies with different treatment modalities. Asymptomatic cysts do not need excision and are to be followed up through puberty, but in the case of an ectopic ureter, nephroureterectomy is optional. Symptomatic retrovesical cysts may demand surgical excision. Ultrasonography is usually sufficient for diagnosis, but MRI provides better anatomical delineation and aids in surgical planning. Conclusions Retrovesical cysts in boys are benign conditions associated with abnormal development of the ureter and kidney. Ultrasonography is sufficient for diagnosis, with MRI giving further detail for surgical planning. Treatment consists of cyst excision, heminephrectomy/nephrectomy, transurethral canalization, or excision of prostatic utricle, depending on etiology. Asymptomatic cases are to be followed up through puberty, but in cases of an ectopic ureter, nephroureterectomy is preferred.