4 research outputs found
Management of Acute Apendicitis in the New Millennium
The prevalence of acute appendicitis in The Netherlands is 16460 times a year, 8647 man and
7813 women in 2006 and is still increasing. The chance of undergoing an appendectomy is
higher in women than in men, 23 versus 12 percent, this is in contradiction with the chance
of developing acute appendicitis, 7 versus 9 percent, due to the number of incidental and unnecessary
appendectomies. In spite of the high incidence of acute appendicitis the percentage
appendices without signs of infl ammation during surgery remains high, between 5% and
30%. These data show the challenge to the clinician to diagnose acute appendicitis. Adjacent
to this are the costs involved with the diagnosis and treatment representin
Securing the appendiceal stump in laparoscopic appendectomy: Evidence for routine stapling?
Background: This metaanalysis aimed to compare endoscopic linear stapling and loop ligatures used to secure the base of the appendix. Methods: Randomized controlled trials on appendix stump closure during laparoscopic appendectomy were systematically searched and critically appraised. The results in terms of complication rates, operating time, and hospital stay were pooled by standard metaanalytic techniques. Results: Data on 427 patients from four studies were included. The operative time was 9 min longer when loops were used (p = 0.04). Superficial wound infections (odds ratio [OR], 0.21; 95% confidence interval (CI), 0.06-0.71; p = 0.01) and postoperative ileus (OR, 0.36; 95% CI, 0.14-0.89; p = 0.03) were significantly less frequent when the appendix stump was secured with staples instead of loops. Of 10 intraoperative ruptures of the appendix, 7 occurred in loop-treated patients (p = 0.46). Hospital stay and frequency of postoperative intraabdominal abscess also were comparable in loop-treated and staple-treated patients. Conclusions: The clinical evidence on stump closure methods in laparoscopic appendectomy favors the routine use of endoscopic staplers
Postoperative Complications, In-Hospital Mortality and 5-Year Survival after Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review
Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75 %. The random-effect model was used. Overall, 2643 studies were identified and after ful