Routine use of laparoscopic techniques in daily practice improves outcomes after appendectomy

Abstract

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.

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“…Acute appendicitis (AA) is one of the most frequent causes of acute abdominal pain and is one of the main indications for urgent surgery worldwide; according to this, appendectomy is a high-volume procedure, and the laparoscopic approach (laparoscopic appendectomy, LA) has shown advantages in terms of clinical results and cost-effectiveness, above all if the endo-loop is used as the device chosen to ligate the appendiceal stump [ 18 , 19 ].…”

Abordagem Cirúrgica Laparoscópica Versus Laparotômica– Panorama De 30 Anos Da Implantação Da Videolaparoscopia No Brasil

“…A apendicectomia é uma das principais cirurgias gastrointestinais realizadas de urgência, principalmente na criança, adolescente e adulto jovem 12 . Sua via operatória de preferência atualmente é a laparoscópica, devido a se tratar de uma abordagem menos invasiva, apresentar menos complicações, menor tempo de recuperação e internação hospitalar, baixa ocorrência de infecção da ferida cirúrgica e redução de dor pós operatória 5,13 . Também é possível optar pela via laparotômica, geralmente através da incisão de McBurney (cirurgia aberta) 13,14 .…”