Safety of incidental appendectomy. Wound sepsis after cholecystectomy. Influence of incidental appendectomy. Laparoscopy in children with complicated appendicitis. Non-operative management of early, acute appendicitis in children: is it safe and effective? The costs and effects of laparoscopic appendectomy in children. Resource utilization and outcomes from percutaneous drainage and interval appendectomy for perforated appendicitis with abscess. Open versus Laparoscopic Appendectomy in Children: A Comparison of Complications Laparoscopic versus open appendectomy: prospective randomized trial. Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. Prospective Randomized Comparison of Open versus Laparoscopic Appendectomy in Men Association between Appendectomy and Subsequent Colorectal Cancer Development: An Asian Population Study Comparison of post operative morbidity between laparoscopic and open appendectomy in children. Laparoscopic Appendectomy Using a Polymetric Clip to Close the Appendicular Stump Laparoscopic Appendectomy in Children: Evaluation of Different Techniques Outcomes after incidental durotomy during first-time lumbar discectomy. Single-site versus conventional laparoscopic appendectomy: comparison of short-term operative outcomes Laparoscopic appendectomy: An unnecessary and expensive procedure in children? 
Laparoscopic versus open appendectomy: What is the real difference? Results of a prospective randomized double-blinded trial Outpatient laparoscopic appendectomy should be the standard of care for uncomplicated appendicitis A Prospective Randomized Trial Comparing Open Versus Laparoscopic Appendectomy [Does laparoscopy increase the bacteriological risk of appendectomy? Results of a randomized prospective study]. Comparison of Intracorporeal Knot-tying Suture (Polyglactin) and Titanium Endoclips in Laparoscopic Appendiceal Stump Closure: A Prospective Randomized Study [Laparoscopic versus conventional appendectomy: a prospective randomized study].
Reports in the surgical literature are conflicting as to whether appendectomy " in passing " during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality . A chart survey of all appendectomies ( 342 for acute appendicitis and 146 as incidental procedures ) performed on the trauma service of Grady Memorial Hospital over a 40 month period appeared to indicate that the wound infection rate ( 6.8 percent ) was the same as that for acute simple or suppurative appendicitis ( 6.7 percent ) , whereas the intraabdominal sepsis rate ( 17.5 percent ) paralleled that for more advanced gangrenous or perforative appendicitis ( 18.6 percent ) . Since the validity of a retrospective review is always open to question , a prospect i ve , r and omized trial was carried out only on patients with a negative abdominal exploration for trauma over a 22 month interval at the same trauma service . An odd second from the last digit hospital number dictated appendectomy , provided the appendix was readily accessible ; an even digit in the same locus dictated retention of the appendix . In no patient did intraperitoneal sepsis develop , regardless of the procedure chosen . Wound infection rates were 1.8 percent for appendectomy ( 1 of 56 ) , if local anatomic considerations precluded an easy appendectomy ( 0 of 45 ) , and 3.6 percent for the control subjects without appendectomy ( 3 of 83 ) . There were no deaths . These data cast considerable doubt on the reliability of retrospective review s and support the generally accepted dictum that incidental appendectomy , especially in the trauma patient , can be a relatively innocuous procedure We undertook a prospect i ve study of the effect of incidental appendectomy on the safety of cholecystectomy  in patients under the age of 50 years . One hundred twenty patients were r and omized to have either cholecystectomy alone or cholecystectomy and appendectomy .  All patients received preoperative antibiotic cover . Both groups were well matched for age , sex , obesity , and length of hospital stay . Twelve patients were withdrawn from the trial .  Wound infections occurred in three of the 56 patients in the cholecystectomy group ( 5.3 % ) and in two of the 52 patients in the cholecystectomy plus appendectomy group ( 3.8 % ) . Incidental appendectomy is a safe addition to elective cholecystectomy BACKGROUND / PURPOSE Laparoscopic appendectomy is an accepted way of dealing with suspected uncomplicated appendicitis in children . The role of laparoscopy in complicated acute appendicitis is more controversial . The purpose of this trial was to compare laparoscopic appendectomy with open appendectomy in children with complicated appendicitis . METHODS A total of 102 children with suspected acute appendicitis were selected r and omly to undergo either a laparoscopic or an open appendectomy . The outcomes of 25 children with complicated appendicitis , 13 in the laparoscopic group and 12 in the open appendectomy group , were analyzed . Children , their parents , and research nurses were blinded to which procedure had been performed and remained blinded until the control visit 7 days after the operation . All 25 children completed a 30-day follow-up . RESULTS There were no differences in terms of patients ' age , sex , weight , height , and appendiceal histology between the 2 groups . All laparoscopic procedures were completed without conversion . The mean ( + /-SD ) operating time was 63 ( + /-31 ) minutes in the laparoscopic group and 37 ( + /-18 ) minutes in the open appendectomy group ( mean difference 26 minutes , 95 % CI 5 to 47 minutes , P = .02 ) . There were 2 major complications in the laparoscopic group in children with appendiceal masses . One child had an entero-cutaneous fistula of the residual appendiceal tip that needed open reoperation . Another child had a pelvic abscess that resolved with antibiotic treatment . Superficial wound infections were encountered in 2 patients in the open appendectomy group . CONCLUSIONS Laparoscopic appendectomy is an alternative to open procedure in children with complicated appendicitis . Good surgical judgement is necessary in patients with an established appendiceal abscess PURPOSE The purpose of this study was to determine if early , acute appendicitis in children can be safely and effectively managed with antibiotics alone . METHODS A retrospective review was performed of children ( < 18 yrs ) treated non-operatively ( NOM ) for early , acute appendicitis since May 2012 . These were compared to patients treated with appendectomy between January 2011 and October 2011 ( OM ) . Inclusion criteria included : ( a ) symptoms < 48 h , ( b ) localized peritonitis , and ( c ) ultrasound findings consistent with early , acute appendicitis . RESULTS Twelve patients ( 66 % female , mean age 12.2,SD=4.2 yrs ) were treated non-operatively , while 12 ( 50 % female , mean age 12.5,SD=3.2 yrs ) were treated operatively . Two NOM children ( 16.7 % ) required initial appendectomy . One patient developed recurrent appendicitis requiring appendectomy 7 months post-discharge . Four other NOM patients returned with symptoms but did not require admission or surgery . Two OM patients ( 8.3 % ) had hospital visits and admissions related to surgical site infections . Mean length of stay ( LOS ) for the first visit was 1.5 days ( SD=1.0d ) ( NOM ) vs. 1.3 days ( SD=0.5d ) ( OM ) ( p=0.61 ) . Including first and subsequent admissions , mean LOS was 1.8 days ( SD=1.1d ) ( NOM ) vs. 1.7 days ( SD=1.5d ) ( OM ) ( p=0.97 ) . CONCLUSION Early acute appendicitis in appropriately selected children can be successfully treated non-operatively . R and omized trials with longer follow-up are required BACKGROUND Laparoscopic procedures are performed commonly in children . In general , the cost containment of laparoscopic surgery  in children has not been evaluated . OBJECTIVE To compare the costs of laparoscopic appendectomy with those of open appendectomy . DESIGN Prospect i ve clinical trial between November 1 , 1997 , and April 30 , 2000 . For analysis , cost of supplies , operation room use , and recovery in the hospital and after discharge was evaluated . Costs common to both groups were not determined . SETTING Operations performed in a university hospital . Patients Eighty-seven children aged 4 to 15 years who underwent appendectomy for suspected appendicitis . Patients were r and omized to laparoscopic or open appendectomy .  Intervention Laparoscopic appendectomies performed with the same st and ard set of reusable equipment . MAIN OUTCOME MEASURES Cost surplus of the laparoscopic procedure and recovery after surgery were evaluated , to determine the costs and effects of  laparoscopic appendectomy  compared with those of open appendectomy in children . RESULTS Excess operating and complication costs per procedure were 96 euros ( EUR ) in laparoscopic appendectomy . The increased operative expenses were offset by a shorter hospital stay , result ing in a marginal difference of 53 EUR in itemized total costs between the 2 procedures ( total cost , 1023 EUR in the laparoscopic appendectomy group and 970 EUR in the open appendectomy group ) . After laparoscopic appendectomy , children returned to school and sports earlier than those who had had an open appendectomy . CONCLUSION Laparoscopic appendectomy was marginally more expensive , but it allowed earlier return to normal daily activities than open appendectomy OBJECTIVE Given the perceived technical dem and s of laparoscopic appendectomy and the expected postoperative morbidity in patients with a well-defined abscess , initial percutaneous drainage has become an attractive option in this patient population . This strategy allows for a laparoscopic appendectomy to be performed in an elective manner at the convenience of the surgeon . However , the medical burden on the patient and on the quality of patient outcomes has not been described in the literature . Therefore , we audited our experience with initial percutaneous drainage followed by laparoscopic interval appendectomy to evaluate the need for a prospect i ve trial . METHODS After institutional review board approval , a retrospective chart review was performed on all children who presented with perforated appendicitis and a well-defined abscess and were treated by initial percutaneous aspiration/drainage followed by interval appendectomy between January 2000 and September 2006 . Continuous variables are listed with st and ard deviation . RESULTS There were 52 patients with a mean age of 9.0 + /- 3.9 years and weight of 34.4 + /- 18.8 kg . The  mean duration of symptoms at presentation was 8.4 + /- 7.6 days . Percutaneous aspiration only was performed in 2 patients . The mean volume of fluid on initial aspiration/drain placement was 76.3 + /- 81.1 mL. The mean time to appendectomy was 61.9 + /- 25.2 days . The laparoscopic approach was used in 49 patients ( 94.2 % ) , of which one was converted to an open operation . The mean length of hospitalization after interval appendectomy was 1.4 + /- 1.4 days . A recurrent abscess developed in 17.3 % of the patients . Six patients ( 11.5 % ) required another drainage procedure . The mean total charge to the patients was $ 40,414.02 . There were 4 significant drain complications ( ileal perforation , colon perforation , bladder perforation , and buttock/thigh necrotizing abscess ) . The child with the ileal perforation after drain placement is the only patient who failed initial nonoperative therapy . CONCLUSIONS The use of initial percutaneous aspiration/drainage of periappendiceal abscess followed by interval appendectomy is an effective approach . However , this management poses complication risks and uses considerable re sources . Therefore , this strategy should be compared with early operation in a prospect i ve trial Although between 4 % and 20 % of all appendectomies in adults are performed laparoscopically , this procedure is rarely done in the pediatric age group because of the substantially more difficult technique , the expected risks and suspected higher rate of complications . In a prospect i ve study of 500 consecutive appendectomies , we tried to assess the actual rate of complications of each operative approach . We included 362 conventional and 138 laparoscopic appendectomies , the median age of the patients was 10.8 years . The mortality was 0 in both groups . We observed 89 minor and 11 major complications . All major complications ( wound infections needing re-operation under general anesthesia , intra-abdominal abscesses , ileus due to adhesions and a case of renal insufficiency because of glomerulonephritis ) occurred in the conventional group ( n=11 , ie , 3 % of 362 open appendectomies ) . Seventy-two minor complications were seen in the same group ( 20 % ) . In the laparoscopic group , there were 17 ( 13 % ) minor complications and no severe complications . This difference was statistically significant . We conclude that in children  laparoscopic appendectomy does not carry a greater risk of intra- or postoperative complications and can therefore safely be established as a st and ard procedure Although classic open surgery is simple , expeditious , and effective , it has some drawbacks , including wound sepsis , delayed recovery , operative difficulties , and possibility of unnecessary appendectomies for false appendicitis . The aim of this study was to assess the applicability and safety of laparoscopic appendectomy ( LA ) in a prospect ively r and omized trial . Seventy nonselective patients with suspected appendicitis were r and omized to laparoscopic ( n = 35 , 17 male ) or open appendectomy ( n = 35 , 15 male ) and operated on an emergency basis . Operative findings , operating time , postoperative complications , and length of hospital stay were compared . We found that LA is associated with a shorter hospital stay , fewer postoperative complications , and better diagnostic accuracy , and it is recommended as the procedure of choice for the diagnosis and management of acute appendicitis PURPOSE Several r and omized trials now have established guidelines regarding patient selection for  carotid endarterectomy ( CEA )  that have been widely accepted but have little relevance unless they are considered in the context of perioperative risk . The purpose of this study was to demonstrate the feasibility of early outcome assessment using a computerized data base . METHODS Since 1989 demographic information and in-hospital results for all surgical procedures performed by the members of our department have been entered into a prospect i ve registry . For the purpose of this report , we have analyzed the  stroke and mortality rates for 2228 consecutive CEAs ( 2046 patients ) , including 1924 that were performed as isolated operations and 304 that were combined with simultaneous coronary artery bypass grafting ( CABG ) .  This series incidentally contains a total of 153 reoperations for recurrent carotid stenosis . RESULTS The respective stroke and mortality rates were 0.5 % and 1.8 % for all isolated CEAs , 4.3 % and 5.3 % for all CEA-CABG procedures , and 4.6 % and 2.0 % for carotid reoperations . According to a multivariable statistical model , the composite stroke and mortality rate for isolated CEA was significantly influenced by female gender ( p = 0.050 ) , by the urgency of intervention ( p = 0.026 ) , and by carotid reoperations ( p = 0.024 ) . Gender ( p = 0.030 ) and urgency ( p = 0.040 ) also were associated with differences in the stroke rate alone ; furthermore , the incidence of perioperative stroke was higher in conjunction with synthetic patching ( odds ratio , 2.6 ; 95 % confidence interval , 1.2 to 5.3 ) and was marginally higher with primary arteriotomy closure ( odds ratio , 2.7 ; 95 % confidence interval , 0.8 to 9.5 ) compared with vein patch angioplasty ( 1.3 % ) . The method used to repair the arteriotomy was the only independent factor that qualified for the multivariable composite stroke and mortality models that were applied to the combined CEA-CABG procedures , but too few patients in this cohort had synthetic patches or primary closure to vali date the perceived superiority of vein patching . CONCLUSIONS Prospect i ve outcome assessment is essential to reconcile the indications for CEA with its actual results , and it may lead incidentally to important observations concerning patient care Abstract . A prospect i ve , r and omized trial was performed to compare open appendectomy with laparoscopic appendectomy  in men with a clinical diagnosis of acute appendicitis . Sixty-four patients with a median age of 25 years ( range 18–84 years ) were r and omized to open appendectomy ( n = 31 ) or laparoscopic ( n = 33 ) appendectomy . Of the 64 men , 56 ( 87.5 % ) had appendicitis ( 27 open , 29 laparoscopic procedures ) .  The mean operating times were 50.6 ± 3.7 minutes ( ± SEM ) for open and 58.9 ± 4.0 minutes for laparoscopic appendectomy ( p = 0.13 ) . Five ( 15 % ) patients r and omized to laparoscopic appendectomy had an open operation . The mean postoperative hospital stay was significantly longer for open appendectomy ( 3.8 ± 0.4 days ) than for laparoscopic appendectomy ( 2.9 ± 0.3 days ) ( t = 2.05,df = 62,p = 0.045 ) . The complication rate after open appendectomy ( 25.8 % ) was not significantly different from that after laparoscopic appendectomy ( 12.1 % ) . There was a single postoperative death due to a pulmonary embolus in the laparoscopic group and a single death due to cardiac and renal failure in the open group . The mean time to return to normal activities was significantly longer following open appendectomy ( 19.7 ± 2.4 days ) than after laparoscopic appendectomy ( 10.4 ± 0.9 days ) , ( t = 3.75,df = 49,p = 0.001 ) . In conclusion , laparoscopic appendectomy  in men has significant advantages in terms of a more rapid recovery compared to open appendectomy . There were no significant disadvantages to laparoscopic appendectomy compared to open appendectomy Objectives The appendix may modulate colon microbiota and bowel inflammation . We investigated whether appendectomy alters colorectal cancer risk . Methods We identified a cohort of 75979 patients who underwent appendectomy between 1997 and 1999 based on the insurance cl aims of Taiwan . A comparison cohort of 303640 persons without appendectomy was selected r and omly , frequency matched by age , sex , comorbidity and entry year was also selected . We monitored subsequent colorectal cancer development in both cohorts . Results The overall colorectal cancer incidence was 14 % higher in the appendectomy patients than in the comparison cohort ( p < 0.05 ) : the highest incidence was observed for rectal cancer , and the lowest incidence was observed for cancer of the cecum-ascending colon for both cohorts . Men were at higher risk than women . Subjects ≥ 60 years had an HR of 12.8 compared to those < 60 years . The incidence of colorectal cancer was much higher in 1.5 - 3.5 years post appendectomy follow-up than for the comparisons ( HR of 2.13 ) . Patients who received an incidental appendectomy had an HR of 2.90 when compared to the comparisons . Conclusions Results of our study suggest that appendectomy in patients with appendicitis is likely associated with the development of colorectal cancer in the post-surgery period This prospect i ve comparative study was conducted in the department of Pediatric Surgery , Dhaka Shishu ( children ) Hospital during the period of June 2007 to September 2008 with the children of < 12 years , diagnosed as acute Appendicitis . Patient selection was done by simple r and om technique by means of lottery . For open Appendectomy ( OA ) conventional method & for Laparoscopic Appendectomy ( LA ) 3 trocher technique was applied . Data was analyzed with the help of SPSS version 10 . In this study 60 cases with acute Appendicitis including both gender were studied by two groups , group-A include 30 cases for laparoscopic and group-B include 30 cases for open appendectomy .  Postoperative pain was assessed in both groups by using FLACC scale and compared at 1st 6-hours , 24 hours , 72 hours , 96 hours & at day 7 . At 1st 6-hours , most of the children 24(80 % ) of group A had moderate pain whereas 17(56.7 % ) children of group B had severe pain ( p<0.001 ) . At 24 hours most of the patient 17(56.7 % ) of group A had mild pain compared to 27 ( 90 % ) patients of group B had moderate pain ( p<0.0001 ) . At 48 hours in group A most of the children 23(76.7 % ) had mild pain compared to moderate pain in 18(60 % ) children of group B ( p<0.0001 ) . Subsequently at 72 hours and at 96 hours most of the patients of LA group were free of pain compared to OA group . At final follow-up on day 7 , 29(96.7 % ) children of group A had no pain compared to 26(86.7 % ) of group B. Regarding analgesics requirement both qualitative & quantitative requirements of analgesics were less in LA group than OA group . About post operative wound infection in group A only 1(3.3 % ) case had developed post operative wound infection whereas in group B 7(23.3 % ) cases had . The mean ( + /-SD ) of post operative length of hospital stay was 52.00+/-11.62 ( range 48 - 96 ) hours for group A and 76.00+/-12.74 ( range 48 - 96 ) hours for group B children ( p<0.001 ) . Laparoscopic Appendectomy is more effective , preferable & superior procedure than that of open Appendectomy to reduce the post operative morbidity in children undergone appendectomy for acute appendicitis Background : The objectives of this study were to establish whether the occlusion of the appendicular stump by using nonabsorbable polymeric clips is technically feasible and whether differences exist in the postoperative course of patients to whom polymeric clips are applied compared with patients whose appendicular stump is closed with a surgical stapler . Methods : This was a prospect i ve study in 2 stages . In phase 1 , 28 patients operated on for resection of the appendix between March 2002 and September 2003 were assigned to 1 of 2 groups . In 14 patients , the appendicular base was occluded by using an endoscopic linear cutting stapler . In the remaining 14 , the appendicular base was ligated by using nonabsorbable polymeric clips ( Hem-o-lock ) . We compared the surgical time , hospital stay , hospital costs , and complications . In phase 2 , 250 patients were analyzed who underwent laparoscopic appendectomies performed between March 2002 and 2006 using a Harmonic scalpel for the section and hemostasis of the appendicular mesentery . Ligation of the appendicular stump was performed with Hem-o-lock clips . Results : We found a significant difference in procedure costs , with the endoscopic staplers being more expensive . Conclusion : The use of polymeric clips is feasible , safe , and an economic alternative for ligation of the appendicular stump during laparoscopic appendectomies Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis . Clinical studies have shown this approach to be a reasonable alternative to open appendectomy . The objective of the current study was to assess the outcome of laparoscopic appendectomy using three different techniques . The study sample consisted of 150 children with acute appendicitis who underwent surgery at Al-Azhar University Hospitals , Cairo , Egypt , and at Al Mishary Hospital in Riyadh , Saudi Arabia , between October 1997 and October 1999 . The patients were allocated to undergo extracorporeal laparoscopic appendectomy , Endoloop laparoscopic appendectomy , or EndoGIA ( Ethicon Endo-surgery , Inc. , Cincinnati , OH , USA ) laparoscopic appendectomy . All patients were assessed for the severity of the disease at baseline using clinical and hematologic indicators . The ages of the children ranged from 7 to 14 years , with a mean of 10 years ( SD , 2.14 years ) . Of the children , 55.3 % were female . The results showed that children who underwent laparoscopic appendectomy using the EndoGIA had statistically significant shorter operating times , did not have complications , and had the shortest duration of hospital stay ( although duration of hospital stay did not reach the statistically significant level of P > 0.05 ) . Therefore , the study showed that laparoscopic appendectomy using the EndoGIA is the procedure that is most recommended , except for the relatively high cost of the disposable material s. Endoloop laparoscopic technique was the second most preferable procedure , and the least preferred procedure was extracorporeal laparoscopically assisted appendectomy . The major drawback of the last technique is the high frequency of complications .  Endoloop laparoscopic appendectomy with a purse-string suture can be performed safely if the EndoGIA is not available OBJECT Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery . The effect of a durotomy on long-term outcomes is , however , controversial . The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome . METHODS Spine Patient Outcomes Research Trial ( SPORT ) participants who had a confirmed diagnosis of intervertebral disc herniation and were undergoing st and ard first-time open discectomy  were followed up at 6 weeks and at 3 , 6 , and 12 months after surgery and annually thereafter at 13 spine clinics in 11 US states . Patient data from this prospect ively gathered data base were review ed . As of May 2009 , the mean ( ± SD ) duration of follow-up among all of the intervertebral disc herniation patients whose data were analyzed was 41.5 ± 14.5 months ( 41.4 months in those with no durotomy vs 40.2 months in those with durotomy , p < 0.68 ) . The median duration of follow-up among all of these patients was 47 months ( range 1 - 95 months ) . RESULTS A total of 799 patients underwent first-time lumbar discectomy . There was an incidental durotomy in 25 ( 3.1 % ) of these cases . There were no significant differences between the durotomy and no-durotomy groups with respect to age , sex , race , body mass index , herniation level or type , or the prevalence of smoking , diabetes , or hypertension . When outcome differences between the groups were analyzed , the durotomy group was found to have significantly increased operative duration , operative blood loss , and length of inpatient stay . However , there were no significant differences in incidence rates for nerve root injury , postoperative mortality , additional surgeries , or SF-36 scores for Bodily Pain or Physical Function , or Oswestry Disability Index scores at 1 , 2 , 3 , or 4 years . CONCLUSIONS Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients Background Recent developments in minimally invasive surgery have introduced scarless surgeries such as natural orifice transluminal endoscopic surgery ( NOTES ) and single-site laparoscopic surgery . Among surgical procedures , the appendectomy is one of those targeted for early adoption of new minimally invasive surgical techniques . To date , however , only a limited number of case series have been reported . Thus , the current study aim ed to evaluate the safety and feasibility of single-site laparoscopic appendectomy ( SSLA ) compared with conventional laparoscopic appendectomy ( CLA ) . Methods The study enrolled 43 patients who consecutively received laparoscopic appendectomy and divided them into SSLA and CLA groups . The clinical characteristics and short-term operative outcomes of these patients were review ed and compared . Results The 23 patients receiving SSLA  did not differ from the 20 patients receiving CLA  in terms of clinical characteristics including gender , age , body mass index ( BMI ) , location of appendix , and severity of inflammation . Likewise , operation times and postoperative complication rates did not differ between the two groups . Short-term operative outcomes such as visual analog pain score and hospital stay were not different . The incision was shorter  for SSLA ( 22.9 ± 3.9 mm ) than for CLA ( 29.0 ± 3.0 mm ) ( p < 0.001 ) . Conclusions The results of the current study suggest that SSLA is a feasible surgical alternative to CLA with an equivalent level of safety . The data also suggest that SSLA results in better cosmetic outcomes than CLA . Data from larger research studies are necessary to confirm these results and vali date the use of SSLA over CLA BACKGROUND / PURPOSE Laparoscopic Appendectomy ( LA ) is a safe procedure in adults result ing in shorter hospitalization and sooner return to activity . The relative merits of LA and open appendectomy ( OA ) are evaluated in this first prospect i ve and r and omized study in children . METHODS A total of 129 children with appendicitis were included . Forty-three boys and 45 girls , age 1 to 16 years , were enrolled . R and omization was determined by sealed assignment card . OA utilized a 3- to 4-cm right lower quadrant , muscle-splitting incision . Wounds were closed without drains . Antibiotics , when used , consisted of gentamycin , clindamycin , and ampicillin . LA was performed by experienced surgeons utilizing a 3-trocar technique with reusable instruments . Twenty-one children ( 24 % ) were perforated . Patients were discharged as soon as they were taking a diet and afebrile . Statistical comparisons were by Fisher 's Exact and Wilcoxon rank-sum tests . RESULTS There were no differences in postoperative analgesia , resumption of oral intake , length of hospitalization , return to normal activities , or morbidity .  Laparoscopic appendectomy was associated with longer operating times and increased cost . CONCLUSIONS Laparoscopic appendectomy  in children is not associated with the same advantages reported in adults . LA is a more expensive alternative and offers no advantages related to pain relief , length of stay , return to normal activities , or morbidity Background : The comparison of laparoscopic to open appendectomy has been review ed in many retrospective and prospect i ve studies . Some report shorter hospital stays , less postoperative pain , and earlier return to work while others fail to demonstrate such differences . We performed a prospect i ve , r and omized double-blinded trial to evaluate this ongoing debate . Methods : Fifty-two consecutive men presenting with signs and symptoms suggestive of acute appendicitis were r and omized to undergo either laparoscopic appendectomy or open appendectomy .  Length of operative times , hospital stay , lost work days , visual analog pain scores , and operative costs were compared . Results : Length of stay averaged 21.5 h for the laparoscopic group and was not statistically different when compared to the open group . Perceived postoperative pain on postoperative days 1 and 7 were not statistically different between the two groups . Mean time to return to work was 11 days , and there was no statistical difference between groups . Operative costs were > $ 600 greater for the laparoscopic approach . Conclusions : In this prospect i ve r and omized double-blinded trial , laparoscopic appendectomy appears to confer no significant advantage over open appendectomy for postoperative pain or lost work days . It does carry an increase in operating room costs and , contrary to other reports , hospital stay is not shortened . Further studies are needed to determine if specific population s , such as the obese or women , may benefit from a minimally invasive approach to appendicitis BACKGROUND In 2012 , a protocol for routine  outpatient laparoscopic appendectomy for uncomplicated appendicitis was published reflecting high success , low morbidity , and significant cost savings . Despite this , national data reflect that the majority of laparoscopic appendectomies are performed with overnight admission . This study up date s our experience with outpatient appendectomy  since our initial report , confirming the efficacy of this approach . METHODS In July 2010 , a prospect i ve protocol for outpatient  laparoscopic appendectomy  was adopted at our institution . Patients were dismissed from the postanesthesia recovery room or day surgery if they met predefined criteria for dismissal . Patients admitted to a hospital room as either full admission or observation status were considered failures of outpatient management . An institutional review board – approved retrospective review of patients undergoing laparoscopic appendectomy for uncomplicated appendicitis from July 2010 through December 2012 was performed to analyze success of outpatient management , postoperative morbidity and mortality , as well as readmission rates . RESULTS Three hundred forty-five patients underwent laparoscopic appendectomy for uncomplicated appendicitis during this time frame . There were 166 men and 179 women , with a mean age of 35 years . Three hundred five patients were managed as out patients , with a success rate of 88 % . Forty patients ( 12 % ) were admitted for preexisting comorbidities ( 15 patients ) , postoperative morbidity ( 6 patients ) , or lack of transportation or home support ( 19 patients ) . Twenty-three patients ( 6.6 % ) experienced postoperative morbidity . There were no mortalities . Four patients ( 1 % ) were readmitted for transient fever , nausea/vomiting , partial small bowel obstruction , and deep venous thrombosis . CONCLUSION Outpatient laparoscopic appendectomy can be performed with a high rate of success , a low morbidity , and a low readmission rate . This study reaffirms our original pilot study and should serve as the basis for a change in the st and ard of care for appendicitis . LEVEL OF EVIDENCE Therapeutic study , level Objective The authors determined whether there was an advantage to laparoscopic appendectomy when compared with open appendectomy . Summary / Background Data The advantages of laparoscopic appendectomy versus open appendectomy were question ed because the recovery from open appendectomy is brief . Methods From January 15 , 1992 through January 15 , 1993 , 75 patients older than 9 years were entered into a study r and omizing the choice of operation to either the open or the laparoscopic technique . Statistical comparisons were performed using the Wilcoxon test . Results Thirty-seven patients were assigned to the open appendectomy group and 38 patients were assigned to the laparoscopic appendectomy group .  Two patients were converted intraoperatively from laparoscopic appendectomies to open procedures . Thirty-one patients ( 81 % ) in the open group had acute appendicitis , as did 32 patients ( 84 % ) in the laparoscopic group . Mean duration of surgery was 65 minutes for open appendectomy and 87 minutes for laparoscopic appendectomy ( p < 0.001 ) . There were no statistically significant differences in length of hospilalization , interval until resumption of a regular diet , or morbidity . Duration of both parenteral and oral analgesic use favored laparoscopic appendectomy ( 2.0 days versus 1.2 days , and 8.0 days versus 5.4 days , p < 0.05 ) . All patients were instructed to return to full activities by 2 weeks postoperatively . This occurred at an average of 25 days for the open appendectomy group versus 14 days for the laparoscopic appendectomy group ( p < 0.001 ) . Conclusions Patients who underwent laparoscopic appendectomies have a shorter duration of analgesic use and return to full activities sooner postoperatively when compared with patients who underwent open appendectomies . The authors consider laparoscopic appendectomy to be the procedure of choice in patients with acute appendicitis OBJECTIVE The authors compare the risk of bacteraemia in  open  and  laparoscopic appendectomy  in a prospect i ve r and omized study . METHODS 35 patients with a presumptive diagnosis of acute appendicitis were r and omized to have conventional open or laparoscopic surgical procedures . Before r and omization , patients signed a consent form to participate in the study . Patients who were converted from laparoscopic to open appendectomy ( 3 cases ) , HIV+ , allergic to Augmentin or who had contraindications to laparoscopic surgery were excluded from the study . A total of 32 patients were r and omized : 17 to open ( group I ) and 15 to laparoscopic surgery ( group II ) . There were no significant differences with regard to age , ASA score , symptoms or macroscopic aspect of the appendix . Two patients had a normal appendix , 12 had acute appendicitis , 14 gangrenous appendicitis and 4 ruptured or abscessed appendicitis . All patients received preoperative antibiotic prophylaxis ( Augmentin ) after blood cultures ( H1 ) were drawn . Five other blood cultures were performed in st and ard medium and medium neutralizing Augmentin : at the time of opening the peritoneum ( H2 ) , after appendectomy ( H3 ) , after closure of the abdomen ( H4 ) , and at 6 ( H5 ) and 12 hours ( H6 ) after the operation . Bacterial cultures from the appendix site were performed before ( P1 ) and after ( P2 ) appendectomy . RESULTS The operative mortality rate after conventional or laparoscopic appendectomy was nil . The incidence of post-operative morbidity was 4 cases in group I and 2 cases in group II . No positive bacterial culture was obtained in 17 patients . The distribution of these patients was similar in groups I and II . Sample s P1 and P2 were positive in 5 cases . Nine of 27 cases with negative P1 became positive in P2 ( 33 % ) . There was no significant difference between the two groups with regard to the appearance of the appendix . Only two patients had positive blood cultures at H1 . One of them had blood cultures at H3 , H4 positive for a second germ . CONCLUSION A low risk of bacteraemia exists for both open and laparoscopic appendectomy . This risk did not appear to increase for laparoscopy . Conventional and laparoscopic surgical procedures led to positive peritoneal bacterial cultures after appendectomy in 33 % of cases Background : Laparoscopic appendectomy is a well-described surgical technique . However , concerns still exist regarding whether the closure of the appendiceal stump should be done with a clip , an endoloop , staples , or other techniques . Therefore , several modifications to the original technique with new material s have been introduced for appendiceal stump closure . The aim of this study was to compare intracorporeal ( polyglactin ) knot-tying suture with titanium endoclips in appendiceal stump closure during laparoscopic appendectomy . Methods : The study was carried out as a prospect i ve r and omized clinical trial between April 2010 and February 2011 . Patients with a presentation of appendicitis were included into the study . Two groups were defined— patients with the titanium endoclip and patients with the knot-tying ( polyglactin ) suture . The results in terms of operating time , complication rates , and hospital stay were analyzed . Results : Sixty-one patients who underwent laparoscopic appendectomy were enrolled in the titanium endoclip group ( n=30 ) or the knot-tying ( polyglactin ) suture group ( n=31 ) . No statistically significant differences were detected between the groups in terms of the distribution of age , sex percentage , appendix localization , and histopathologic diagnosis ( P>0.05 ) . One patient required a second operation on postoperative day 10 because of intraperitoneal abscess . The mean operative time for the endoclip group ( 41.27±12.2 min ) was shorter than that for the knot-tying group ( 62.81±15.4 min ) ( P=0.001 ) . No statistically significant differences were detected between the groups in terms of hospital stay , follow-up time , and preoperative and postoperative complications ( P>0.05 ) . Conclusions : In laparoscopic appendectomy , using a titanium endoclip for optimizing and controlling the appendiceal stump closure is safe and is associated with shorter operation time . This also simplifies the procedure , so it can be a useful alternative to intracorporeal knot-tying for appendiceal stump closure The discussion about laparoscopic appendectomy  has increased since the introduction of this method . R and omized comparisons are still feasible , whereas this can not be stated for other laparoscopic procedures ( e.g. , laparoscopic cholecystectomy ) . This r and omized controlled trial included 170 patients . Open appendectomy  was employed in 83 patients , and 87 were treated laparoscopically . The treatment groups were comparable regarding age , sex , Broca index , ASA classification , preliminary operations , and preoperative leucocytes . No statistically significant differences could be found with respect to surgical and general complications , operating time , consumption of analgesics and antibiotics , and return to work . The analysis revealed a statistically significant shorter hospital stay , a shorter time until return to normal physical activity , and a shorter duration of complaints for the laparoscopic group . We were unable to demonstrate any statistically significant advantage in using the open procedure
Morbidity was minimal at all ages .
: The data from the current survey and literature review support incidental removal of the appendix in the young patient ( < 35 years old ) .
However , routine incidental appendectomy can not be justified in patients greater than age 50
The results of the two review s were analyzed to formulate guidelines for the appropriateness of performing incidental appendectomy in association with other operative procedures .