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Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis

BACKGROUND: Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of lap...

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Autores principales: Gomes, Carlos Augusto, Junior, Cleber Soares, Costa, Evandro de Freitas Campos, Alves, Paula de Assis Pereira, de Faria, Carolina Vieira, Cangussu, Igor Vitoi, Costa, Luisa Pires, Gomes, Camila Couto, Gomes, Felipe Couto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2014
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039097/
https://www.ncbi.nlm.nih.gov/pubmed/24883151
http://dx.doi.org/10.14740/jocmr1837w
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author Gomes, Carlos Augusto
Junior, Cleber Soares
Costa, Evandro de Freitas Campos
Alves, Paula de Assis Pereira
de Faria, Carolina Vieira
Cangussu, Igor Vitoi
Costa, Luisa Pires
Gomes, Camila Couto
Gomes, Felipe Couto
author_facet Gomes, Carlos Augusto
Junior, Cleber Soares
Costa, Evandro de Freitas Campos
Alves, Paula de Assis Pereira
de Faria, Carolina Vieira
Cangussu, Igor Vitoi
Costa, Luisa Pires
Gomes, Camila Couto
Gomes, Felipe Couto
author_sort Gomes, Carlos Augusto
collection PubMed
description BACKGROUND: Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of laparoscopy in the management of complicated appendicitis according to laparoscopic grading system. METHOD: From January 2008 to January 2011, 154 consecutive patients who underwent a laparoscopic appendectomy for complicated appendicitis were evaluated in the prospective way. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 58.3% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix and were graded as 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis) and 5 (diffuse peritonitis). The outcomes including operative time, infection complication, operative complications and conversion rate were chosen to evaluate the procedure. RESULTS: The grade 3A was the most frequent with 50 (32.4%) patients. The mean operative time was 69.4 ± 26.3 minutes. The grade 4A showed the highest mean operative time (80.1 ± 26.7 minutes). The wound and intra-abdominal infection rates were 2.6 and 4.6%, respectively. The base necrosis was the most important factor associated with the conversion (5.2%). The grades 4A and 5 were associated with greater possibility of intra-abdominal collection. There were no operative complications. CONCLUSION: The laparoscopic management of all complicated grades of acute appendicitis is safe and effective and should be the procedure of first choice. The laparoscopic grading system allows us to assess patients in the same disease stage.
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spelling pubmed-40390972014-05-30 Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis Gomes, Carlos Augusto Junior, Cleber Soares Costa, Evandro de Freitas Campos Alves, Paula de Assis Pereira de Faria, Carolina Vieira Cangussu, Igor Vitoi Costa, Luisa Pires Gomes, Camila Couto Gomes, Felipe Couto J Clin Med Res Original Article BACKGROUND: Laparoscopy has not been consolidated as the approach of first choice in the management of complicated appendicitis. Methodological flaws and absence of disease stratification criteria have been implicated in that less evidence. The objective is to study the safe and effectiveness of laparoscopy in the management of complicated appendicitis according to laparoscopic grading system. METHOD: From January 2008 to January 2011, 154 consecutive patients who underwent a laparoscopic appendectomy for complicated appendicitis were evaluated in the prospective way. The patient’s age ranged from 12 to 75 years old (31.7 ± 13.3) and 58.3% were male. Complicated appendicitis refers to gangrenous and/or perforated appendix and were graded as 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis) and 5 (diffuse peritonitis). The outcomes including operative time, infection complication, operative complications and conversion rate were chosen to evaluate the procedure. RESULTS: The grade 3A was the most frequent with 50 (32.4%) patients. The mean operative time was 69.4 ± 26.3 minutes. The grade 4A showed the highest mean operative time (80.1 ± 26.7 minutes). The wound and intra-abdominal infection rates were 2.6 and 4.6%, respectively. The base necrosis was the most important factor associated with the conversion (5.2%). The grades 4A and 5 were associated with greater possibility of intra-abdominal collection. There were no operative complications. CONCLUSION: The laparoscopic management of all complicated grades of acute appendicitis is safe and effective and should be the procedure of first choice. The laparoscopic grading system allows us to assess patients in the same disease stage. Elmer Press 2014-08 2014-05-22 /pmc/articles/PMC4039097/ /pubmed/24883151 http://dx.doi.org/10.14740/jocmr1837w Text en Copyright 2014, Gomes et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Gomes, Carlos Augusto
Junior, Cleber Soares
Costa, Evandro de Freitas Campos
Alves, Paula de Assis Pereira
de Faria, Carolina Vieira
Cangussu, Igor Vitoi
Costa, Luisa Pires
Gomes, Camila Couto
Gomes, Felipe Couto
Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title_full Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title_fullStr Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title_full_unstemmed Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title_short Lessons Learned With Laparoscopic Management of Complicated Grades of Acute Appendicitis
title_sort lessons learned with laparoscopic management of complicated grades of acute appendicitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039097/
https://www.ncbi.nlm.nih.gov/pubmed/24883151
http://dx.doi.org/10.14740/jocmr1837w
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