Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Esposito, C; Escolino, M; Till, H; Bertozzi, M; Riccipetitoni, G; Settimi, A; Varlet, F.
One-trocar versus multiport hybrid laparoscopic appendectomy: What's the best option for children with acute appendicitis? Results of an international multicentric study.
Surg Endosc. 2016; 30(11):4917-4923
Doi: 10.1007/s00464-016-4832-y
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Till Holger
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- Abstract:
- One-trocar laparoscopic appendectomy (OTA) is routinely adopted in children with acute appendicitis. In case of a difficult appendectomy, it is necessary to add additional trocar/s to safely complete the procedure. This technique is called multiport hybrid laparoscopic appendectomy (HLA). We aimed to compare the outcome of multiport HLA versus OTA. We retrospectively reviewed the data of 1,092 patients underwent LA in 5 European centers of pediatric surgery in the last 5 years. We compared 2 groups: G1 of 575 patients (52.6 %) (average age 10 years) underwent OTA and G2 of 517 patients (47.4 %) (average age 8.2 years) underwent multiport HLA. No intra-operative complications occurred in both groups. An additional pathology was treated in 12 cases (8 Meckel's diverticulum, 2 carcinoids, 2 ovarian cysts) in G2. Operative time was significantly shorter in G2 compared to G1 (47.8 vs 58.6 min; p < .001). The average analgesic requirement was significantly shorter in G2 compared to G1 (44 vs 56 h; p < .001). As for postoperative complications, the incidence of port-site infections was similar between the two groups, while the incidence of postoperative abdominal abscesses (PAA) was significantly higher in G1 compared to G2 (4.7 vs 0.2 %; p < .001). The cosmetic outcome was excellent in all patients of both groups. A subgroup analysis between complicated and uncomplicated appendicitis showed that only in complicated cases, the average operative time, the average VAS pain score, the average analgesic requirements and the incidence of PAA were significantly higher in OTA group compared to multiport HLA group (p < .001). Our results suggest that OTA is a valid and safe procedure for the uncomplicated cases, while additional trocars are required in case of complicated appendicitis. Multiport HLA significantly reduces the operative time, the incidence of abdominal abscesses and the analgesic requirements compared to OTA.
- Find related publications in this database (using NLM MeSH Indexing)
- Abdominal Abscess - epidemiology
- Acute Disease -
- Appendectomy - methods
- Appendicitis - complications
- Appendicitis - surgery
- Carcinoid Tumor - complications
- Carcinoid Tumor - surgery
- Child -
- Europe -
- Female -
- Humans -
- Incidence -
- Intraoperative Complications - epidemiology
- Laparoscopy - methods
- Male -
- Meckel Diverticulum - complications
- Meckel Diverticulum - surgery
- Operative Time -
- Ovarian Cysts - complications
- Ovarian Cysts - surgery
- Pain Measurement -
- Pain, Postoperative - epidemiology
- Pain, Postoperative - physiopathology
- Postoperative Complications - epidemiology
- Postoperative Period -
- Retrospective Studies -
- Safety -
- Surgical Instruments -
- Find related publications in this database (Keywords)
- Appendectomy
- Trocars
- Hybrid
- Ports
- Children