Appendicitis ; complications ; Humans ; Infant, Newborn ; Intussusception ; complications

PURPOSE: Recently, single incision laparoscopic surgery (SILS) has been studied for its being less invasive surgery and having cosmetic improvement. We investigated the application of SILS for an appendectomy (SILS-A) in cases of complicated appendicitis and compare it with a conventional laparoscopic appendectomy (C-LA). METHODS: This study involved a total of 40 patients who underwent C-LA or SILS-A in patients with complicated appendicitis; 25 patients received a C-LA, and the other 15 patients received a SILS-A. The clinical outcomes and cosmetic results were compared between the groups. RESULTS: The SILS-A procedures were performed successfully in patients with complicated appendicitis, but 6 patients who underwent SILS-A needed an additional port for dissection and drainage. Clinical outcomes and postoperative complications were similar in both study groups. The SILS-A group showed significantly higher numbers of pain control than the C-LA group, and the one port SLLS-A group showed significantly better cosmetic result than the C-LA group. CONCLUSION: SILS-A is technically feasible and safe in patients with complicated appendicitis. However, SILS-A has more postoperative pain than C-LA, and more active pain control should be considered for patients undergoing SILS-A.
Appendectomy ; Appendicitis ; Cosmetics ; Drainage ; Humans ; Laparoscopy ; Pain, Postoperative ; Postoperative Complications

PURPOSE: In recent years, single-port laparoscopic appendectomy (SPLA) has been gaining in popularity and there have been many reports on the results of SPLA. The purpose of this study is to investigate feasibility, safety, and cosmetic satisfaction with SPLA in treatment of perforated appendicitis. METHODS: From September 2012 to March 2015, 227 patients underwent SPLA at Damsoyu hospital. The patients were divided into the simple and gangrenous appendicitis group (the S & G group) and the perforated appendicitis group (the P group). Operation time, hospital stay, drain insertion rate, surgical complication, and cosmetic satisfaction were evaluated. RESULTS: A total of 227 patients consisted of 32 patients in the P group and 195 patients in the S & G group. There were no significant differences in the demographic data of the patients. The operation time and hospital stay were significantly longer in the P group (p=0.002 and p<0.0001, respectively). The rate of drain insertion was also higher in the P group (p=0.0002). However, no differences in postoperative complications (p=0.281) and cosmetic satisfaction (p=0.090) were observed between the two groups. CONCLUSION: SPLA for perforated appendicitis is a feasible, safe, and cosmetically acceptable procedure. However, longer operation time and hospital stay and higher drain insertion rate should be considered for patients undergoing SPLA for perforated appendicitis.
Appendectomy ; Appendicitis* ; Humans ; Laparoscopy* ; Length of Stay ; Postoperative Complications

BACKGROUND: It is controversial whether the delay of surgery for acute appendicitis by physician results in higher morbidity. Our present study explores this problem of physician delay on the postoperative outcome of patients with acute appendicitis. MATERIAL AND METHODS: Among 432 patients admitted for the presumptive diagnosis of acute appendicitis between Jan., 1995 and Dec., 1997, 358 patients with pathologically proven acute appendicits were analyzed. Physician delay from the hospital admission to the surgery was evaluated in relation to the stage of the disease at operation and postoperative outcome. RESULTS: Postoperative complications occurred signifficantly higher in advanced appendicitis group, than in simple appendicitis group. Postoperative oral consumption started significantly later and hospital days are significantly prolonged in those group. Both patient and physician delays significantly affect the stage of the disease. The finding that physician delay correlated with the stage, however, was denied by multivariate analysis. CONCLUSION: On the contrary to the patient delay, physician delay does not affect the stage of the acute appendicitis nor lead to increased incidence of postoperative complication. Physician delay to clarify the diagnosis is a reasonable strategy and it does not affect the outcome adversely.
Appendicitis* ; Diagnosis ; Humans ; Incidence ; Multivariate Analysis ; Postoperative Complications

PURPOSE: With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis. METHODS: A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted. RESULTS: The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours. CONCLUSION: Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.
Appendectomy ; Appendicitis ; Humans ; Length of Stay ; Pathology ; Postoperative Complications ; Retrospective Studies

Recent reports have demonstrated a negative association between appendectomy and ulcerative colitis. Many retrospective studies have shown that appendectomy appears to be protective against ulcerative colitis. Although the function of appendix is not known, all these studies have suggested that alterations in mucosal immune responses leading to appendicitis or resulting from appendectomy may negatively affect the pathogenic mechanisms of ulcerative colitis. Herein, we report a 45-year-old man who was diagnosed as severe ulcerative colitis 2 years ago. Colonoscopy revealed a feature of pancolitis. He has been treated with several courses of corticosteroids over 2 years. However, dosage of steroid was not tappered down because of the recurrence of symptoms. He was admitted with a diagnosis of acute appendicitis, and underwent appendectomy. Two months after the appendectomy, clinical symptoms and colonoscopic findings improved gradually. Two years after the appendectomy, the patient improved without the recurrences of symptoms, and is stably treated with sulfasalazine alone.
*Appendectomy ; Appendicitis/complications/*surgery ; Colitis, Ulcerative/complications/*physiopathology ; Humans ; Male ; Middle Aged

The presence of a malrotation of the midgut in adults is identified in asymptomatic patients most commonly as an incidental finding during a workup for an unrelated disease. We report here a rare case of acute perforated appendicitis in a patient with nonrotation of the midgut. A 28-year-old man was referred to our hospital with lower abdominal pain. The radiological examination, including abdominal computed tomography, ultrasonography, an upper gastrointestinal series, and a barium enema, revealed acute perforated appendicitis accompanied by nonrotation of the midgut. Emergency surgery revealed a complicated appendix located in the middle area of the lower abdomen with a periappendiceal abscess and nonrotation of the midgut. An ileocecal resection was performed with no postoperative complication. In this case, the atypical position of the appendix led to confusion regarding the diagnosis and to a more invasive surgical intervention.
Abdomen ; Abdominal Pain ; Abscess ; Adult ; Appendicitis ; Appendix ; Barium ; Emergencies ; Enema ; Humans ; Incidental Findings ; Postoperative Complications

PURPOSE: The advantage of a laparoscopic appendectomy for acute appendicitis in children is controversial, with no consensus among most pediatric surgeons, particularly with regard to the operative time and hospital costs in complicated cases. The objective of this study was to examine the safety, efficacy and complications of a laparoscopic appendectomy in children compared with an open appendectomy. METHODS: Our clinical experiences of laparoscopic appendectomy (LA) and open appendectomy (OA) for simple appendicitis (SA), complicated appendicitis (CA) and no evidence of appendicitis (NA) in children, between November, 2003 and October, 2006, were reviewed. Ninety- three (93) patients underwent a LA (58 boys, 35 girls) and 194 patients an OA (128 boys, 66 girls). The mean ages of the patients having undergone LA and OA were 9.6 and 8.9 years, respectively. RESULTS: The mean operation times were similar between the LA and OA in the SA and NA groups, but was shorter for a LA than an OA in the CA group, which was also statistically significant (P=0.007). There were statistically significant differences in the postoperative duration of hospital stay between a LA and an OA in all groups (in SA, 2.8 versus 4.5 days, P<0.001 and in CA, 4.5 versus 8.4 days, P<0.001). The rates of postoperative complications were different between a LA and an OA were: for the SA group, 1.7 versus 1.0%, P=1.000; for the CA group, 0 versus 22.4%, P=0.006. CONCLUSION: Our experiences suggest that a laparoscopic appendectomy was a safe and effective procedure for any type of appendicitis in children, with a shorter hospital stay and lower rate of postoperative complications.
Appendectomy* ; Appendicitis* ; Child* ; Consensus ; Hospital Costs ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications

PURPOSE: This study evaluated the feasibility of a laparoscopic approach in children with generalized peritonitis secondary to perforated appendicitis. MATERIALS AND METHODS: We retrospectively analyzed the medical records of patients who underwent laparoscopic appendectomy with drainage for generalized peritonitis secondary to perforated appendicitis at our hospital between September 2001 and April 2012. Laparoscopic outcomes were compared with outcomes of an open method for perforated appendicitis. RESULTS: Ninety-nine patients underwent laparoscopic appendectomy (LA) for generalized peritonitis from perforated appendicitis, and 87 patients underwent open appendectomy (OA) for perforated appendicitis. Wound infection was more common in the OA group (12.6%) than in the LA group (4.0%; p=0.032). The incidence of intestinal obstruction during long-term follow-up was significantly higher in the OA group (4.6% vs. 0.0% in the LA group; p=0.046). LA was possible in most patients for whom LA was attempted, with a conversion rate of 10.8%. Conversion to OA was affected by the preoperative duration of symptoms and the occurrence of intraoperative complications. CONCLUSION: LA is feasible for use in children with generalized peritonitis from perforated appendicitis, with reasonable open conversion and perioperative complication rates comparable to those of the OA group.
Appendicitis/*complications/*etiology/*surgery ; Child ; Child, Preschool ; Female ; Humans ; Laparoscopy/*methods ; Male ; Retrospective Studies ; Treatment Outcome

PURPOSE: There have been several reports claiming benefits for the simplified method of appendectomy over the traditional method of embedding suture at the stump, without contradictory opinions ever having been published. Nevertheless, most surgeons continue to carry out purse-string sutures in daily practices of open appendectomy as long as the stump situation permits. In case where the cecum near the stump is friably swollen due to the spread of inflammation in advanced appendicitis, we have often faced uncomfortable pulling of cecal stitches during embedding procedures experiencing tearing or incomplete approximation of the pulled wall. To avoid this difficulty and shorten the procedure, we have been performing simple double ligations of the stump and observed the results. METHODS: Prospectively we assigned patients to an operative method of either simple ligations or embedding sutures, alternatively upon admission, and performed this method of stump management with two surgeons for 4 years, and postoperative complications were observed in 362 and 273 cases respectively. RESULTS: There was no advantage of one method over the other in recovery course, and in view of the complication rates associated with stump inadequacy and adhesive ileus, even in cases of perforated appendicitis also. CONCLUSION: When possible, Stump ligations simplify appendectomy procedure without increased operative sequelae, even in cases of perforated appendicitis. So this procedure could be recommended instead of purse-string sutures, especially in cases of thick and friable cecal wall due to acutely disseminated appendiceal inflammation.
Adhesives ; Appendectomy* ; Appendicitis ; Cecum ; Humans ; Ileus ; Inflammation ; Ligation* ; Postoperative Complications ; Prospective Studies ; Sutures*