Interventions to optimize recovery after laparoscopic appendectomy: a scoping review

Hamill, James; Rahiri, Jamie‐Lee; Gunaratna, Gamage; Hill, Andrew

doi:10.1007/s00464-016-5274-2

Cited by 18 publications

(9 citation statements)

References 64 publications

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“…17 Lately, there have been calls for the pediatric application of such enhanced recovery protocols, where the shorter LOS relies on the use of minimally traumatic operative techniques. 19,52 Mortality among esophageal atresia cases is infrequent and based on our results did not differ between the 2 techniques. 1 Instead, death typically depends on the severity of associated congenital malformations such as CHARGE or VACTERL.…”

Section: Safe or Safer Outcomessupporting

confidence: 48%

Thoracoscopy or Thoracotomy for Esophageal Atresia

2020

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Objective: This systematic review with meta-analysis compares health-and provider-based outcomes of thoracoscopic to thoracotomy repair of esophageal atresia. Summary of Background Data: Thoracoscopic surgery has become a routine operation for esophageal atresia repair. However, large studies comparing the safety and efficacy of thoracoscopy to thoracotomy are scarce. Current reviews are obscured with institutional experiences or pool small samples. Methods: PRISMA-compliant search in Medline/PubMed, EMBASE, Web of Science, and Cochrane Library (PROSPERO #CRD42019121862) for original studies comparing thoracoscopy to thoracotomy for esophageal atresia. Quality assessments were performed using the Joanna Briggs Institute Critical Appraisal Tool. Meta-analyses were presented as odds ratios and standardized mean differences. Results: This is the largest published meta-analysis, including 17 studies and 1043 patients. Thoracoscopy produce shorter hospital stay [standardized mean differences (SMD) À11.91; 95% confidence interval (CI) 23.49-6.10; P ¼ 0.0440], time until extubation (SMD À3.22; 95% CI 5.93-0.51; P ¼ 0.0198), time until first oral feeding (SMD À2.84; 95% CI 4.62-1.07; P ¼ 0.0017), and fewer musculoskeletal complications [odds ratio (OR) 0.08; 95% CI 0.01-0.58; P ¼ 0.0133). Thoracoscopy is as safe as thoracotomy regarding leakage (OR À1.92; 95% CI 0.97-3.80; P ¼ 0.0622), stricture formation (OR 2.66; 95% CI 0.86-3.23; P ¼ 0.1339), stricture dilatation (OR 1.90; 95% CI 0.16-3.88; P ¼ 0.0767), and mortality (OR 1.18; 95% CI 0.34-4.16; P ¼ 0.7934). However, thoracoscopy take longer (SMD þ27.69; 95% CI 12.06-43.32; P ¼ 0.0005) and necessitate more antireflux surgery (OR 2.12; 95% CI 1.06-4.24; P ¼ 0.0343). Conclusion: Thoracoscopy is effective and safe, with similar or better outcomes than thoracotomy for patients and providers. The only significant drawback is the need for antireflux surgery in the first years of life. Comparative randomized long-term studies are needed.

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Section: Safe or Safer Outcomessupporting

confidence: 48%

Thoracoscopy or Thoracotomy for Esophageal Atresia

2020

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“…The critical factor, that directly influences the well-being of the patient and economical concern, reduced is LOS, which resulted from earlier resumption of oral intake, postoperative complications, and so quicker return to activity. [ 13 ] Distinguishing features of the laparoscopically treated group of children over the conventional open approach include the aforementioned advantages, which have been indicated by recent meta-analysis, which indicated that patients undergoing LA return earlier to work or normal daily activities. [ 14 , 15 ] Our analysis involved closely monitored measures, with continuous intestinal function monitoring and frequent nursing assessments, which could be taken in our hospital setting.…”

Section: Discussionmentioning

confidence: 99%

Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients

Han²,

Yang³

et al. 2017

Medicine

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Laparoscopic appendectomy (LA) has become well accepted, but the role of LA for appendicitis upon presentation with an abscess remains undefined. This study was to assess the postoperative recovery and complications following LA in pediatric patients with appendiceal abscess in comparison with open appendectomy (OA).We conducted a retrospective review of patients presented with appendiceal abscess between 2005 and 2016. Propensity score matching (PSM) was conducted to adjust for any potential selection bias for the surgical approaches. In 108 matched patients, operative outcomes and surgical complications were evaluated based on LA or OA.The patients with LA experienced prompt postoperative gastrointestinal function recovery, like first bowel movement (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.44–0.69; P < .001), so spend the lower mean length of hospitalization (RR, 0.53; 95% CI, 0.41–0.76; P < .001) in comparison with patients with OA. Furthermore, the immunologic and inflammatory variable white blood cell (WBC) (RR, 0.56; 95% CI, 0.46–0.73; P < .001) and C-reactive protein (CRP) (RR, 0.58; 95% CI, 0.43–0.86; P = .011) on postoperative days (POD) 5 was reduced in patients undergone LA compared with that of OA. A lower overall postoperative complication rate, including surgical wound infection (odds ratio [OR], 0.38; 95% CI, 0.18–0.81; P = .008) and incision dehiscence (OR, 0.06; 95% CI, 0.01–0.45; P < .001) was noted in patients with LA compared with OA.LA was feasible and effective for appendicitis upon presentation with an abscess and associated with beneficial clinical effects, such as postoperative gastrointestinal function recovery and reduced postoperative complications. LA should be seriously considered as the first line procedure of choice.

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“…Appendicitis is common, with a lifetime risk of 6.7% to 8.6% in the United States [ 1 ], and affects people of all ages, but especially children [ 2 ]. In 2011, approximately 327,000 appendectomies were performed in U.S. hospitals, making it the 15th most expensive treatment in terms of total health care costs at USD 2441 million [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

et al. 2023

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Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

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Interventions to optimize recovery after laparoscopic appendectomy: a scoping review

Abstract: This review identified gaps in the literature on optimizing recovery after laparoscopic appendectomy and found the need for more randomized controlled trials on regional anaesthesia and intraperitoneal local anaesthesia in children.

Cited by 18 publications

References 64 publications

Thoracoscopy or Thoracotomy for Esophageal Atresia

Thoracoscopy or Thoracotomy for Esophageal Atresia

Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

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