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Interventions to optimize recovery after laparoscopic appendectomy: a scoping review
James K Hamill1,2, Jamie-Lee Rahiri3, Gamage Gunaratna4
1Department of Surgery, Starship Hospital, Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand. jham011@aucklanduni.ac.nz.
Enhanced recovery after surgery protocols for laparoscopic appendectomy are not well-established. While clinical pathways show promise, more research is needed on regional and intraperitoneal anesthesia, especially in pediatric patients.
Area of Science:
- Surgical Innovation
- Evidence-Based Medicine
- Anesthesiology
Background:
- No established enhanced recovery after surgery (ERAS) protocols exist for laparoscopic appendectomy.
- This review examines evidence-based interventions to optimize post-appendectomy recovery.
Purpose of the Study:
- To review current evidence on interventions that can optimize recovery after laparoscopic appendectomy.
- To identify gaps in the literature regarding ERAS protocols for this procedure.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and prospective studies.
- Searched MEDLINE, EMBASE, Cochrane Library, and Web of Science.
- Included studies on clinical pathways, minimally invasive techniques, regional nerve blocks, and local anesthesia.
Main Results:
- Clinical pathways are safe but may increase readmissions.
- Needlescopic and single-incision laparoscopic (SIL) surgery offer no recovery advantage.
- Transversus abdominis plane blocks showed no significant pain reduction; intraperitoneal local anesthesia (IPLA) warrants consideration.
Conclusions:
- Gaps exist in optimizing laparoscopic appendectomy recovery.
- Further RCTs are needed for regional and intraperitoneal anesthesia, particularly in pediatric populations.
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