Our Summary

This research paper examines the challenges and results of implementing laparoscopic surgery for acute appendicitis in a teaching hospital in Brazil over 15 years. Laparoscopy is a minimally invasive surgery that uses a small camera and instruments passed through small incisions. This method is often preferred over traditional open surgery due to less pain, faster recovery, and fewer complications.

The study analyzed data from patients who underwent emergency appendectomy (removal of the appendix) from 2004 to 2018. It also examined the impacts of four significant changes to the hospital’s surgical service:

  1. Training for surgeons in minimally invasive surgery (2007)
  2. The use of metal clips to close the appendiceal stump (2008)
  3. 24/7 availability of laparoscopic instruments for emergency surgeries (2010)
  4. Outsourcing maintenance of the laparoscopic instruments and using polymeric clips for stump closure (2013)

The research found that these changes led to a significant increase in the use of laparoscopic appendectomies, from 11% in 2007 to 80% in 2016. The use of the hem-o-lok clip for the appendiceal stump made the procedure more feasible and reduced surgery time. It also increased the surgical team’s preference for this method, making it the chosen method in about 85% of cases from 2014 to 2018. The study found that 80% of these operations were performed by third-year resident physicians and there were no complications related to laparoscopic access, even in more complicated appendicitis cases. There were also no deaths, reoperations, or readmissions to the hospital during a 30-day postoperative period.

The study concludes that the development of a safe, feasible, and reproducible standard technique, along with continuous cost optimization, is essential for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.

FAQs

  1. What were the significant changes in the hospital’s surgical service that led to an increase in the use of laparoscopic appendectomies?
  2. What is the impact of using the hem-o-lok clip for the appendiceal stump in laparoscopic appendectomies?
  3. What were the outcomes for patients who underwent laparoscopic appendectomies, according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic appendectomy is to follow post-operative care instructions carefully, including taking prescribed pain medication as needed, keeping the incision sites clean and dry, avoiding heavy lifting or strenuous activities for a certain period of time, and attending follow-up appointments as scheduled. It’s also important to watch for signs of infection, such as increased pain, redness, swelling, or drainage at the incision sites, and to contact the doctor if any concerning symptoms arise. Following these guidelines can help ensure a smooth and successful recovery after laparoscopic appendectomy.

Suitable For

Patients who are typically recommended for laparoscopic appendectomy are those with uncomplicated acute appendicitis, which is the most common indication for this procedure. Laparoscopic appendectomy is also recommended for patients with complicated appendicitis, such as perforated appendicitis or appendiceal abscess, as it has been shown to have similar outcomes to open surgery but with less pain and faster recovery. Additionally, laparoscopic appendectomy may be recommended for patients who are obese or have other comorbidities, as it is associated with reduced postoperative complications compared to open surgery in these populations. Overall, laparoscopic appendectomy is a safe and effective option for a wide range of patients with appendicitis.

Timeline

Before laparoscopic appendectomy:

  1. Patient experiences symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever.
  2. Patient undergoes physical examination, blood tests, and imaging studies to diagnose appendicitis.
  3. Patient may be hospitalized and receive intravenous antibiotics and pain medication.
  4. Patient undergoes surgery preparation, including fasting and consent signing.

After laparoscopic appendectomy:

  1. Patient undergoes laparoscopic surgery, which involves small incisions and insertion of a camera and instruments to remove the appendix.
  2. Patient experiences less pain, faster recovery, and shorter hospital stay compared to traditional open surgery.
  3. Patient may experience some discomfort, bloating, and shoulder pain from the gas used during surgery.
  4. Patient is discharged from the hospital within a few days and instructed on postoperative care, including wound care, diet, and activity restrictions.
  5. Patient follows up with the surgeon for a postoperative visit to monitor healing and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laparoscopic appendectomy include:

  1. What are the benefits of laparoscopic appendectomy compared to traditional open surgery?
  2. Are there any risks or potential complications associated with laparoscopic appendectomy?
  3. How experienced is the surgical team in performing laparoscopic appendectomies?
  4. Will I need to stay in the hospital after the surgery, and if so, for how long?
  5. What is the expected recovery time and when can I return to normal activities?
  6. Are there any specific post-operative instructions or restrictions I should follow?
  7. Will I have a scar from the surgery, and if so, how noticeable will it be?
  8. What is the success rate of laparoscopic appendectomy for my specific case?
  9. Are there any alternative treatment options for appendicitis that I should consider?
  10. How can I prepare for the surgery, and what should I expect during the procedure?

Reference

Authors: Damous SHB, Menegozzo CAM, Rocha MC, Collet-E-Silva FS, Utiyama EM. Journal: Rev Col Bras Cir. 2023 May 19;50:e20233527. doi: 10.1590/0100-6991e-20233527-en. eCollection 2023. PMID: 37222347