Transumbilical laparoscopically assisted appendectomy in children

Višnjić, Stjepan

doi:10.1007/s00464-007-9680-3

Cited by 75 publications

(69 citation statements)

References 22 publications

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“…This cost difference is due to expensive laparoscopic surgery consumables like endoloops and endoclips which are not required in LAA and OA and is in agreement with the findings of other researchers (13)(14).…”

Section: Discussionsupporting

confidence: 91%

Laparoscopically Assisted Appendicectomy in Adults: A comparative analysis

M.A¹

2013

IOSR-JDMS

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Section: Discussionsupporting

confidence: 91%

Laparoscopically Assisted Appendicectomy in Adults: A comparative analysis

M.A¹

2013

IOSR-JDMS

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“…13 Despite the lack of a clear outcome benefit of LA, most cost studies confirm the substantially greater expense associated with LA compared with OA, [14][15][16] with most of the cost differential attributable to the use of expensive disposable equipment, notably ES. 17 In this study, we sought to compare infectious outcomes between 2 established laparoscopic techniques of appendiceal stump closure: EL and ES. The technical preferences for stump closure among 3 surgeons who routinely performed LA for all cases of appendicitis at our centre enabled this comparison, as only 1 of the 3 used the ES in all cases.…”

Section: Discussionmentioning

confidence: 99%

Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy

2012

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Background: There is little information available to inform choice of technique for appendiceal stump control in pediatric laparoscopic appendectomy (LA). We compared complications (stump leak, intra-abdominal abscess formation [IAA], surgical site infection [SSI]) in children undergoing LA for perforated (PA) and nonperforated appendicitis (NPA) by technique of appendiceal stump control.Methods: All children who underwent LA for confirmed acute appendicitis between 2006 and 2009 were reviewed. Choice of stump control (endoloop [EL] or endostapler [ES]) was determined by surgeon preference. Interactions between stump closure techniques and other potential confounders (intra-abdominal drain, irrigation, different antibiotic regimens) were explored using a logistic regression model. Results:Of 242 patients undergoing LA, 57 (23.6%) had PA. In the PA group the appendiceal stump was closed with EL in 47 (82.5%) patients, while in the NPA group EL was used in 161 (87%) patients. Among PA patients, IAA was more common in the ES than the EL group (5 of 10 [50%] v. 6 of 47 [12.7%]). There was no significant difference in rates of SSI. Among NPA patients, there were no differences in rates of IAA or SSI. There were no stump leaks in either group. Logistic regression analysis confirmed the predictive effect of ES use on IAA formation in PA (adjusted odds ratio 7.09; 95% confidence interval 1.08-46.13; p = 0.042). Conclusion:Our data suggest that in most cases of PA, the appendiceal stump can be safely controlled with EL. Within the PA group, the higher rates of IAA seen in ES patients may be attributable to the quality of the appendiceal stump rather than the technique of closure. Résultats : Sur 242 patients qui ont subi une AL, 57 (23,6 %) avaient une AP. Chez les patients qui avaient une AP, le moignon de l'appendicite a été refermé par ligature EL dans 47 cas (82,5 %), tandis qu'on a utilisé la ligature EL chez 161 (87 %) des patients qui avaient une ANP. Chez les patients qui avaient une AP, l'ICO était plus fréquente chez ceux qui ont reçu des agrafes ES que chez ceux qui ont reçu une ligature EL (5 sur 10 [50 %] c. 6 sur 47 [12,7 %]). Il n'y avait pas de différence significative sur le plan des taux d'ICO. Chez les patients qui avaient une ANP, on n'a constaté aucune différence quant au taux d'apparition d'un AIA ou d'une ICO. Il n'y avait pas de fuite au niveau du moignon chez les membres des 2 groupes. L'analyse par régres-sion logistique a confirmé l'effet prédicteur de l'utilisation de l'agrafe ES sur l'apparition d'AIA dans les cas d'AP (ratio d'incidence ajusté 7,09; intervalle de confiance à 95 %, 1,08-46,13; p = 0,042).

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“…Although the above mentioned measures are expected to decrease the cost of LA in the near future, we feel that certain other modifications are still needed to make the existing techniques of LA more cost-effective. For example, the results of two ports 15,16 or a single 'all-in-one' port appendectomies are promising, as reported by Visnjic et al and Stylianos et al 11,17 As these studies demonstrate, the cost of a single port appendectomy is less than that of an appendectomy using 3 ports. Similarly, the use of a single ENDOLOOP® or endo stapler, 18 and avoiding the use of harmonic scalpels, are other possible ways to reduce the cost of LA.…”

Section: Discussionmentioning

confidence: 83%

Cost Comparison between Laparoscopic and Open Appendectomies in Children = مقارنة بين تكلفة عمليات إستئصال الزائدة عن طريق فتح البطن و المناظير عند الأطفال

Khan¹,

Al-Balushi²,

Bhatti³

et al. 2013

SQUMJ

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P = 0.32 ،11.7% ‫بالفتح‬ ‫بامل�شت�شفى.‬ ‫إقامة‬ ‫ال‬ ‫فرتة‬ ‫طول‬ ‫أو‬ ‫ا‬ ‫املرا�شة‬ ‫عمان.‬ ‫التكلفة؛‬ ‫وحتليل‬ ‫التكلفة‬ ‫الزائدة؛‬ ‫ا�شتئ�شال‬ ‫الزائدة؛‬ ‫التهاب‬ ‫الكلمات:‬ ‫مفتاح‬ abstract: Objectives: Laparoscopic appendectomy (LA) for children has become very popular and is routinely performed in most health care centres around the world. The cost of surgical procedures is always a concern for patients and health care providers. This study compares, the total cost of open appendectomy (OA) with LA in children who required an appendectomy for acute appendicitis. Suitable and safe cost-effective techniques were also explored to reduce the cost of these procedures. Methods: The medical records of all the children (ranging between 0 and 12 years) at Sultan Qaboos University Hospital in Oman, who required OA or LA from June 2009 to July 2011, were reviewed. Results: LA were performed in 75 patients while OA were done in 34. Patients from the OA and LA groups were age-and gender-matched. The average operative time was 76 minutes for LA and 49 minutes for OA (P <0.001) while the average hospital stay was 3.14 days for LA and 2.15 days for OA (P = 0.08). The average cost of the two procedures was Omani riyals (OMR) 534 for LA and OMR 343 for OA (P = 0.00). The complication rate following procedures was lower in the case of LA, however this was not statistically significant (LA = 8% versus OA = 11.7 %, P = 0.32). Conclusion: LA are costlier procedures than OA, however they are as safe as OA, and do not increase morbidity or the duration of hospital stay. Keywords

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Transumbilical laparoscopically assisted appendectomy in children

Cited by 75 publications

References 22 publications

Laparoscopically Assisted Appendicectomy in Adults: A comparative analysis

Laparoscopically Assisted Appendicectomy in Adults: A comparative analysis

Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy

Cost Comparison between Laparoscopic and Open Appendectomies in Children = مقارنة بين تكلفة عمليات إستئصال الزائدة عن طريق فتح البطن و المناظير عند الأطفال

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