Laparoscopic Assisted or Total Laparoscopic Appendectomy
Condition: Acute Appendicitis
MeSH terms: Appendicitis
Study type: Observational

Summary: 
      Acute appendicitis (AA), is a common intra-abdominal surgical pathology with the overall
      incidence of approximately 7% and mortality of 0.2-0.8%. Treatment of choice is the surgical
      removal of the inflamed appendix by using open or laparoscopic appendectomy.

      Following laparoscopic appendectomy (LA) proved to be a feasible and at least as safe as the
      corresponding open procedure, it has rapidly gained worldwide acceptance. The traditional
      approach to LA uses three ports. Over the past decade, successful attempts to perform the
      procedure with fewer ports have been reported.

      The authors' primary objectives were to 1) identify a simple, safe and feasible way to
      perform laparoscopic appendectomy in patients with uncomplicated acute appendicitis. 2)
      determine the health related quality of life of the patients and calculate the cost per
      quality adjusted life years (QALYs) gained after the procedures (LAA and TLA). 3) Purpose a
      surgical algorithm when approaching to acute appendicitis with the consideration of quality
      of health and cost.
    

Detailed description: 
      Acute appendicitis (AA), is a common intra-abdominal surgical pathology with the overall
      incidence of approximately 7% and mortality of 0.2-0.8%. Treatment of choice is the surgical
      removal of the inflamed appendix by using open or laparoscopic appendectomy. Until the first
      laparoscopic removal of an inflamed appendix by Kurt Semm in 1980, the gold standard for
      surgical treatment of acute appendicitis remained open appendectomy as first described by
      McBurney in 1891.

      At the beginning, LA remained questionable whether the benefits of the procedure outweigh
      over its disadvantages. However, since laparoscopic technology advances and surgeons'
      expertise increases, many surgeons have successfully performed a multitude of laparoscopic
      procedures for AA, with a continued increasing trend in its use. Eventually, after LA proved
      to be a feasible and at least as safe as the corresponding open procedure, it has rapidly
      gained worldwide acceptance.

      There are more techniques for LA in the literature but only a few of them have gained to
      access and described in modern textbooks. The traditional approach to LA uses three ports.
      Over the past decade, successful attempts to perform the procedure with fewer ports have been
      reported which include two-port techniques, single-port techniques, and hybrid approaches.
      The two-port appendectomy technique consist of one port providing access for a rigid
      telescope with a working channel, and second port for a grasping forceps that is used to
      retract the appendix. In the single-port assisted technique, after a stitch is placed between
      the appendix and the anterior abdominal wall to pull the appendix and create a tension to
      facilitate dissection, and then appendectomy is performed intracorporeally. The hybrid
      technique formed from the combination of both open and laparoscopic approaches. Namely the
      appendix is pulled out through the only or one of the port, and a traditional open
      appendectomy is then performed extracorporeally.

      The authors' primary objectives were to 1) identify a simple, safe and feasible way to
      perform laparoscopic appendectomy in patients with uncomplicated acute appendicitis. 2)
      determine the health related quality of life of the patients using Euro Qol (EQ) - 5
      Dimensions (5D) - 3 Levels (3L) (EQ-5D-3L) and Visual Analogue Scale (VAS) and calculate the
      cost per quality adjusted life years (QALYs) gained after the procedures (LAA and TLA). 3)
      Purpose a surgical algorithm when approaching to acute appendicitis with the consideration of
      quality of health and cost. For these purposes, a case-control study was designed in January
      2015 to investigate these issues.
    

Intervention name(s): Laparoscopic appendectomy
Intervention type(s): Procedure
Intervention description(s): Two types of laparoscopic surgery were performed. Total laparoscopic appendectomy or laparoscopic assisted appendectomy
Other intervention name(s): laparoscopic assisted appendectomy
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        The control group (Group 1) comprised 108 matched-cases of uncomplicated appendicitis
        operated with total laparoscopic appendectomy within the period January 2008 through July
        2011.

        The study group (Group 2) is represented by 108 consecutive patients diagnosed with
        uncomplicated acute appendicitis, operated with lap assisted appendectomy.

        Group 3 consisted of 211 patients with uncomplicated appendicitis, in whom Lap assisted ap
        were unsuccessful because of several reasons, were underwent to Total Lap App within the
        same period
      
Biospecimen description: 
      appendectomy material
    
Keywords: appendectomy; laparoscopy; laparoscopic assisted appendectomy; cost utility