Conventional vs. Laparoscopic Appendectomy in Emergency Patients. Is There a Better Approach?

Introduction: Surgical treatment of acute appendicitis is relatively easy with a minimally invasive approach. Laparoscopy produces a very good image; applies less trauma, has better cosmetics and patients recover more quickly. However, its routine use requires prepared laparoscopic sets, trained personnel and specific organization. The main difficulties of both methods are associated with atypical anatomical locations and complicated forms of the disease.Aim: The objective of the study is to compare the reasons influencing the decision to choose a laparoscopic or a conventional approach for appendectomy. Surgeries performed in the span of four years in II-nd Surgery, Hospital Alexandrovska (2012-2016) were evaluated.Materials and Methods: The study covered 67 patients with acute appendicitis. Of those 8 (11.9%) were operated on with a laparoscopic approach . The average age was 27.4 years. There were 23 men (34.3%) and 44 women (65.7%). The average conventional intervention duration was 70 minutes, while in the laparoscopic procedure it was 55 minutes (

Peutz-Jeghers syndrome: a rare condition

Peutz-Jeghers syndrome is a rare inherited condition characterized by hamartomatous gastrointestinal (GI) polyposis and mucocutaneous pigmentation. Most patients depict distinctive clinical signs, with episodes of gastrointestinal bleeding or polyp-induced bowel obstruction. The authors report a clinical case with typical features diagnosed before complication`s development. The patient had high surgical risk as a result of previous adolescent surgery. There were completely eliminated 14 polyps of upper and lower GI measuring up to 6 cm (in cecum) by repeated endoscopic interventions. Thus, prophylaxis of intestinal neoplasms was achieved. With a wide range of additional tests the presence of extra-GI tumours was excluded. An accurate screening mechanism for follow-up in the future was elaborated. Major therapeutic problems of the syndrome are the following complications which require urgent surgery: bleeding, obstruction and intussusceptions. Patients with Peutz-Jeghers syndrome have an increased risk of a number of epithelial malignancies. In conclusion, modern knowledge of the chromosome testing, laboratory, endoscopy and other examinations enables reducing the need of unnecessary laparotomies and postoperative complications. The genetically determined association of the syndrome with numerous neoplasms requires an adequate screening mechanism for prevention of tumour development

Optimizing the Learning Curve in Laparoscopic Colorectal Surgery

Introduction: In the recent decades, the surgical treatment of colorectal neoplasms is further developed with a minimally invasive approach, following the complex approach, modern guidelines and classic oncological principles. Any conventional operation can be performed via laparoscopy and in addition to that it produces a better image of the pelvis. Thus, a high-quality surgery, with a maximal sphincter conservation, minimal blood loss and quicker recovery of the patients can be carried out.Aim: The aim of this study was to analyze factors influencing the period of gaining experience with laparoscopic colorectal resections. We evaluated this surgery performed in the Second Surgery at the „Alexandrovska` Hospital (March, 2013-Februrary, 2016) for a period of three years.Materials and Methods: 317 patients with colonic and rectal neoplasms were operated on. Their average age was 61.4 and the gender distribution was - 172 males (54.3%) and 145 females (45.7%). Laparoscopic approach was planned in 37 (11.7%) of them. The following factors were taken into consideration: location of the tumor, the need to use automatic devices, duration of the surgery, etc. The compared indicators, related to decision making for laparoscopic approach, are the technique used and the obtained result, the duration of the intervention, financial resources and the number of conversions.Results: There were 5 are rectal amputations (13.5%), 14 anterior resection (37.8%) and two intersphincteric resections with coloanal anastomosis (5.4%), 6 (16.2%) right hemicolectomies, 5 left colectomies (13.5%) and three sigma resections (8.1%). The average postoperative stay reported was 6.2 days. The mean operative time was 212 minutes. A steady tendency to reduce it was observed (from 330 to 120 min.). Due to the advanced process, conversion was performed in 5 cases (13.5%).Conclusion: The use of automatic stapling devices and high-energy hemostatic devices predetermines the higher cost of the laparoscopic surgery. It gives the advantages of less postoperative pain and shortened hospitalization. The longer training curve depends on resource availability and personal technical skills. This use of this metehod gives the necessary advantage to patients without oncological safety compromise

Correction: Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study (World Journal of Surgery, (2022), 46, 9, (2021-2035), 10.1007/s00268-022-06649-z)

In the original online version of this article Oreste Claudio Buonomo’s family name was misspelled. The original article was corrected

Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Inequalities in screening policies and perioperative protection for patients with acute appendicitis during the pandemic: Subanalysis of the ACIE Appy study

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