[Show abstract][Hide abstract] ABSTRACT: Traditionally, three ports are used in laparoscopic appendicectomy. However to reduce surgical incision and cost, it is feasible to remove the appendix using fewer ports. In this study, we compared the efficacy of stepwise and standard approach in laparoscopic appendicectomies in children. Between August 2008 and September 2010, 378 children with appendicitis were allotted to either the stepwise or standard laparoscopy group depending on the operating surgeon’s preference. In the former group, an operating telescope was inserted first. The number of ports used was based on the pathology (stepwise approach). In the latter group, three ports were inserted in all patients (standard approach). The two groups were similar. In the stepwise group, we performed 95 single port (utilising a scope with an instrument channel), 37 two ports and 13 three ports appendicectomies. In the stepwise group, operating time was shorter (not yet statistically significant) and it reduced the port numbers by more than 50 %. The stepwise approach provides an evidence-based management of appendicitis with comparable outcomes. This procedure further reduces incision trauma, operating times and the cost of operation. However, the reduction of post-operative analgesic requirement needs further study.
No preview · Article · Jun 2014 · Indian Journal of Surgery
[Show abstract][Hide abstract] ABSTRACT: Appendicitis is the most common paediatric surgical emergency. In our institution, the majority of inter-hospital transfers are for suspected appendicitis. We undertook an audit to assess the accuracy of the provisional diagnosis of the transferred cases.
Retrospective electronic data of a tertiary referral centre and a single referring regional hospital were collected between January 2009 and December 2010. Primary outcome of surgery, inpatient observation or discharge was assessed. The final appendix pathology results were examined.
There were 187 paediatric surgical transfers (49% by ambulance) that were provisionally diagnosed as appendicitis. Of the 187 patients (M : F = 102 : 85, a median age of 11), 70% were admitted, 43% underwent appendicectomy, and only 40% had pathologically proven appendicitis.
Of the surgical referrals for appendicectomy, 60% did not have appendicitis. An improved assessment protocol is required to reduce the margin of diagnostic error and transfer cost, while maintaining clinical safety.
No preview · Article · Aug 2012 · Emergency medicine Australasia: EMA