Heng-Fu Lin

Laparoscopic versus open appendectomy for perforated appendicitis

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean ± SD =96.1±43.1 vs. 67.8±32.2 minutes, P<0.01). Return of oral intake was faster in the LA group (3.2±2.4 vs. 5.0±7.0 days, P<0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4±2.8 vs. 6.3±7.1 days, P<0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P<0.01). Hospital stay days were shorter for the LA group (6.3±2.9 vs. 9.3±8.6 days, P<0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.

Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band.

Acute small bowel obstruction is a common problem, especially for those patients with previous abdominal surgery that can cause postoperative adhesions. Acute, non-postoperative small bowel obstruction is less common and has various etiologies. We report a case of acute small bowel obstruction without previous abdominal surgery. The patient underwent laparoscopic exploration, and a congenital band was found to cause direct compression of the ileum and entrapment of a segment of bowel loop. There was evidence of bowel strangulation. The color and peristalsis of the entrapped bowel loop recovered gradually after division of the band, and segmental bowel resection was avoided. He has remained asymptomatic since the procedure. We suggest early and aggressive surgical intervention for patients with acute, non-postoperative small bowel obstruction to avoid possible complications of bowel strangulation and gangrene. A laparoscopic approach may be a safe, feasible, and favorable option for correct diagnosis and appropriate treatment in this situation.

Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis

BackgroundLaparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. Impact of previous abdominal surgery on laparoscopic appendectomy has not been previously reported.MethodsFrom January 2001 to December 2005, 2029 patients with clinically suspected acute appendicitis underwent laparoscopic surgery in our hospital. Of these, 234 patients (11.5%) were found to have other pathology by intraoperative or histologic findings and were excluded from the study. The 1795 patients who underwent laparoscopic appendectomy for acute appendicitis were divided into three groups: group 1, patients without a history of previous abdominal surgery (n = 1652, 92%); group 2, patients with a history of upper abdominal surgery (n = 20, 1.1%); group 3, patients with a history of lower abdominal surgery (n = 123, 6.8%). Data were collected retrospectively by chart review and analyzed for conversion rate, operative time, intraoperative and postoperative complications, and hospital stay.ResultsOf the 1795 patients, 13 (0.7%) were converted to open appendectomy because of technical difficulty. Overall mean operative time was 57.2 (range, 20–225) min. There was no mortality or intraoperative complications. Overall postoperative complication rate was 10.7% (n = 193): rate of surgical wound infection was 8.2 % (n = 147), surgical wound seroma 1.3% (n = 24), and intra-abdominal abscess 0.8% (n = 14). Overall postoperative hospital stay averaged 3.2 (range, 0–39) days. There were no significant differences between the three groups regarding the conversion rate (0.8% vs. 0% vs. 0%, p = 0.567), operative time (57.3 vs. 55.8 vs. 56.9 min, p = 0.962), postoperative complication rates (10.7 vs. 10 vs. 12.2%, p = 0.863), and hospital stay (3.2 vs. 3.6 vs. 3.1 days, p = 0.673).ConclusionsPrevious abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis.

Laparoscopic treatment of perforated appendicitis

The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.

Laparoscopic Surgery for Obturator Hernia with Necrotic Bowel Incarceration: Report of a Case

Obturator hernia is very rare. It remains a diagnostic and therapeutic challenge for clinicians. Most cases are diagnosed intraoperatively while treating small bowel obstruction of unknown cause. We present a patient with an incarcerated obturator hernia manifesting as a persistent small bowel obstruction that was finally diagnosed by computed tomography. Laparoscopic examination revealed an obturator hernia with necrotic and perforated bowel incarceration. We performed laparoscopy-assisted segmental bowel resection of the necrotic incarceration, then intracorporeal suture repair of the hernia defect successfully.

Laparoscopic Cholecystectomy for Traumatic Gallbladder Avulsion: A Case Report and Review of the Literature

Traumatic gallbladder avulsion following blunt abdominal injury is rare. In patients with stable hemodynamic status, the diagnosis is usually delayed. Diagnostic laparoscopy offers the chance to diagnose the condition in a timely fashion and reduce the possibility of complications. We report a patient presenting with blunt abdominal injury and liver laceration. Laparoscopic examination revealed gallbladder avulsion and cystic artery disruption. Laparoscopic cholecystectomy was performed without incident. The use of laparoscopy in patients with blunt abdominal injury is feasible and offers the opportunity to diagnose early intra-abdominal visceral injuries that mandate surgical intervention.

Laparoscopic Treatment of Bezoar-induced Small Bowel Obstruction: Report of a Case

Treatment of bezoar-induced intestinal obstruction is usually performed by an open approach, with either digital fragmentation or removal of the bezoar via enterotomy. Laparoscopy is gaining increased acceptance for diagnosis and treatment of selected cases of small bowel obstruction. We describe a 77-year-old male patient with small bowel obstruction, and the cause of intestinal obstruction was proved by diagnostic laparoscopy to be a bezoar, which was fragmented and milked into the colon smoothly with laparoscopic instruments. The patient had an uneventful recovery and was discharged from the hospital 4 days later after the procedure. A review of the literature shows that laparoscopic management is an alternative to conventional surgery, either by a totally laparoscopic approach or a laparoscopic-assisted procedure. Minimally invasive surgery is not only an excellent diagnostic tool for bezoar-induced small bowel obstruction, but also in some selected cases, a choice of treatment.