Appendicectomy for simple appendicitis: video-assisted or intracorporeal?
Girolamo Mattioli1, Marco Castagnetti, Vincenzo Jasonni
1Department of Paediatric Surgery, G. Gaslini Research Institute, University of Genoa, Genoa, Italy. girolamomattioli@ospedale-gaslini.ge.it
Background:
We reviewed our experience with laparoscopic appendicectomy (LA) to compare the video-assisted and intracorporeal approaches.
Materials And Methods:
One hundred and sixty-one (161) patients undergoing LA for simple appendicitis were considered. The procedure was video-assisted with an extracorporeal appendicectomy in 74 cases operated on during the first 5 years of our experience (group A), whereas it was entirely intracorporeal in the subsequent 87 (group B). In the latter group, the dissection of the mesoappendix was accomplished by using titanium clips in 38 cases, with monopolar coagulation in 42 and other devices in 7. The base of the appendix was closed by using endoloops in 11 patients and a stapler in 76. In all the intracorporeal LAs, the appendix was delivered through a port site. A very low position of the two accessory ports was adopted in 34 group B patients.
Results:
No difference in outcome was found between the two groups, except in operating time (48 vs. 29 minutes) and length of hospital stay (3 vs. 1 day). The complication rate was not statistically different among the various techniques used in group B to divide the mesoappendix and to close the base of the appendix. The cost of disposable instruments for intracorporeal LA was 3- to 6 folds higher than for the extracorporeal one. An extremely low position of the ports did not interfere with the procedure in any case.
Conclusions:
LA for simple appendicitis can be performed safely with many techniques. The intracorporeal procedure allows for a shorter operating time, but can dramatically increase the costs of the disposable instruments that are required.
Insights
Laparoscopic appendicectomy (LA) for simple appendicitis can be performed using video-assisted or intracorporeal methods. While intracorporeal LA offers shorter operating times, it significantly increases instrument costs.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Techniques
Background:
- Laparoscopic appendicectomy (LA) is a common procedure for simple appendicitis.
- Comparing video-assisted (extracorporeal) and entirely intracorporeal approaches is crucial for optimizing surgical practice.
Purpose of the Study:
- To compare the outcomes of video-assisted versus intracorporeal laparoscopic appendicectomy.
- To evaluate operating time, length of hospital stay, and complication rates for different LA techniques.
Main Methods:
- A retrospective review of 161 patients undergoing LA for simple appendicitis.
- Group A: 74 patients with video-assisted (extracorporeal) appendicectomy.
- Group B: 87 patients with entirely intracorporeal appendicectomy, utilizing various devices for mesoappendix dissection and base closure.
Main Results:
- No significant difference in overall outcome or complication rates between the two groups.
- Intracorporeal LA demonstrated a shorter operating time (29 minutes) compared to video-assisted (48 minutes).
- Hospital stay was shorter for intracorporeal LA (1 day) versus video-assisted (3 days), but disposable instrument costs were 3-6 times higher.
Conclusions:
- Laparoscopic appendicectomy for simple appendicitis can be safely performed using various techniques.
- The intracorporeal approach offers advantages in reduced operating time but incurs substantially higher costs for disposable instruments.
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