How to do a laparoscopic retrograde appendicectomy for the difficult appendix

Matthews, Samuel J.; Loper, Nicole; Paterson, Luke; Poole, Garth

doi:10.1111/ans.15658

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…In difficult appendicectomies, LRA (base to tip approach) has been described as a valuable alternative to LAA (tip to base approach) ( 6 , 7 , 9 ). However, there has been limited literature on the safety and efficacy of LRA given there has not been a standardised way of classifying the intraoperative severity of appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…Given the base of the appendix is divided prior to controlling the stump, there is perceived risk of faecal contamination and subsequent development of IAC. More recently, Mathews in 2020 further developed LRA method where a window is dissected in the mesoappendix and the base is initially divided with diathermy instead of cut using a pair of scissors ( 7 , 9 ). As described by Matthews, there are various methods of LRA which may alter the rate of post-operative complications ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Mathews in 2020 further developed LRA method where a window is dissected in the mesoappendix and the base is initially divided with diathermy instead of cut using a pair of scissors ( 7 , 9 ). As described by Matthews, there are various methods of LRA which may alter the rate of post-operative complications ( 9 ). For example, the base of the appendix can be stapled if concerned about the integrity of the appendiceal stump ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

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The safety and efficacy of laparoscopic retrograde appendicectomy, base-to-tip approach

Ko,

Lindsay,

Choi

2023

Front. Surg.

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BackgroundLaparoscopic appendicectomy is one of the most frequently performed surgical procedures worldwide. There is limited evidence evaluating the role and safety of laparoscopic retrograde appendicectomy (LRA), base to tip approach, compared to standard laparoscopic antegrade appendicectomy (LAA), tip to base approach. This study aims to assess the safety of LRA compared to LAA in terms of intra-abdominal collection (IAC) rate and using Sunshine Appendicitis Grading System (SAGS).MethodsRecords of two-hundred and seventy-three patients undergoing laparoscopic appendicectomy by LAA and LRA approaches were analysed. The severity of appendicitis was rated using a standardised Sunshine Appendicitis Grading System (SAGS) score intra-operatively. The primary outcome measure was the occurrence of an intra-abdominal collection, and secondary measures were procedure time, post-operative length of stay and other complications.ResultsOf the two-hundred and seventy-three patients, there were two patients who developed an intra-abdominal collection. Both patients were in the LAA group with SAGS IV scores. Between SAGS IV patients, Chi-squared p value of 0.6691. Therefore, there was no statically significant difference in the intra-abdominal collection (IAC) rate between LAA and LRA groups from this study.ConclusionsThe current study has shown that laparoscopic retrograde appendicectomy (LRA) does not increase risk of intra-abdominal collection compared to laparoscopic antegrade appendicectomy (LAA) within the limit of this study.

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Section: Discussionmentioning

confidence: 99%