Consensus conference on laparoscopic appendectomy: development of guidelines

Vettoretto, Nereo; Gobbi, Sara; Corradi, Alessio; Belli, Fiorenza; Piccolo, Davide; Pernazza, Graziano; Mannino, L.

doi:10.1111/j.1463-1318.2011.02557.x

Cited by 47 publications

(32 citation statements)

References 62 publications

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“…This difference was statistically significant. Based on these findings, CT scans seem to have significant benefit in the evaluation of patients with suspected acute appendicitis, to exclude other pathology, in selected patients such as elderly people [52,70] .…”

Section: Radiological Diagnosismentioning

confidence: 96%

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Treatment options of inflammatory appendiceal masses in adults

Tannoury

Abboud²

2013

WJG

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At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient's own defense mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. Immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small. After successful nonsurgical treatment of an appendiceal mass, the true diagnosis is uncertain in some cases and an underlying diagnosis of cancer or Crohn's disease may be delayed. This report aims at reviewing the treatment options of patients with enclosed appendiceal inflammation, with emphasis on the success rate of nonsurgical treatment, the need for drainage of abscesses, the risk of undetected serious disease, and the need for interval appendectomy to prevent recurrence.

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Section: Radiological Diagnosismentioning

confidence: 96%

“…The examination itself takes longer to perform and may be degraded by motion artifact. There are concerns that, with the exception of trained radiologists, other health care providers are not comfortable interpreting MRI findings [52,[70][71][72][73] .…”

Section: Appendectomy or Without Appendectomymentioning

confidence: 98%

Treatment options of inflammatory appendiceal masses in adults

Tannoury

Abboud²

2013

WJG

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“…The conclusion of the review was that young female, obese, and employed patients seem to benefit from the laparoscopic procedure more than other groups. The European Association of Endoscopic Surgeons (EAES) has recently released guidelines on appendectomy that clearly favor the laparoscopic approach 3 . The justification includes the benefits of decreased wound infection and faster return to activity.…”

Section: Laparoscopic Appendectomymentioning

confidence: 99%

Current Evidence and Recommendations for Laparoscopic Appendectomy

Wu¹,

Wall²,

Lai³

et al. 2012

Appendicitis - A Collection of Essays From Around the World

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“…Laparoscopic appendectomy is not a standard method of fi rst choice for the treatment of acute appendicitis unlike laparoscopic cholecystectomy for cholecystolithiasis. Although many studies have confi rmed equivalent results compared to McBurney´s open appendectomy technique in the right hypogastrium, these studies did not take account of the known advantages of laparoscopy, such as shorter hospital stays, lower consumption of analgesics, shorter sick leave (3)(4)(5)(6). Our study retrospectively evaluates the postoperative complications in patients with acute appendicitis treated with laparoscopic or open appendectomy.…”

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confidence: 99%

Laparoscopic versus open appendectomy in treatment of acute appendicitis

Oravský¹,

Bak²,

Schnorrer³

2014

BLL

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Results: Regarding the intraabdominal complications and hospitalization periods, results confi rm the equivalence of both methods. A signifi cantly lower incidence of wound complications as well as shorter hospital stay were experienced in the laparoscopy-treated group of patients. Conclusion: Based on the results of this study, the laparotomic appendectomy would be reserved for appendicitis with diffuse peritonitis. The laparoscopy is positively preferred in obese patients (Tab. 3, Ref. 16 In the pre-antibiotic era, there was no option of conservative treatment of acute appendicitis. At present time the cases of noncomplicated appendicitis can be treated also by antibiotics, which can eliminate the necessity of surgery (1, 2). From the surgical standpoint, appendectomy remains the gold standard (1), but the method of choice is still unclear. Laparoscopic appendectomy is not a standard method of fi rst choice for the treatment of acute appendicitis unlike laparoscopic cholecystectomy for cholecystolithiasis. Although many studies have confi rmed equivalent results compared to McBurney´s open appendectomy technique in the right hypogastrium, these studies did not take account of the known advantages of laparoscopy, such as shorter hospital stays, lower consumption of analgesics, shorter sick leave (3-6). Our study retrospectively evaluates the postoperative complications in patients with acute appendicitis treated with laparoscopic or open appendectomy. Patients and resultsA retrospective review of 161 patients diagnosed with acute appendicitis treated by appendectomy was performed at 3rd Clinic of Surgery, Bratislava University Hospital in years from 2006 to 2010. Eighty-one patients were females and 80 were males. The mean age of patients treated with laparotomy was 33 years while that of laparoscopy-treated group was 34 years (Tab. 1). The operative approach was based on the surgeon´s decision. The open appendectomy was performed using McBurney´s technique with the incision made in the right hypogastrium area. After excising the appendix, the appendiceal stump was inverted using a Z-suture or purse-string suture. Laparoscopy was performed using three ports including the laparoscope and two working instruments. The appendiceal stump was ligated by a hand-made Roeder´s loop using Vicryl without the following inversion. Antibiotics were not routinely used. Our results were evaluated retrospectively. The number of open appendectomies performed was higher in the fi rst year of our study. Later on, the number of laparotomies was decreasing, and laparoscopic appendectomy has become the treatment of choice in acute appendicitis.In both treated groups of patients the pathological fi ndings showed the predominance of the phlegmonous appendicitis (Tab. 2). Eight times, the laparoscopic operation was converted to laparotomy. In two patients, the cause of conversion was peri-appendiceal infi ltration and in six of them the conversion took place YearOpen appendectomy Laparoscopic appendectomy

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Consensus conference on laparoscopic appendectomy: development of guidelines

Abstract: Consensus development guidelines are herein reported and regard diagnostic pathway, diagnostic laparoscopy, indications, behaviour in case of innocent appendix, technical aspects, learning curve; however, some questions remain unsolved due to the lack of evidence.

Cited by 47 publications

References 62 publications

Treatment options of inflammatory appendiceal masses in adults

Treatment options of inflammatory appendiceal masses in adults

Current Evidence and Recommendations for Laparoscopic Appendectomy

Laparoscopic versus open appendectomy in treatment of acute appendicitis

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