BACKGROUND: Studies comparing laparoscopic and open appendicectomy are difficult to interpret owing to several types of bias, and the results often seem of limited clinical importance. National audits can be valuable to provide insight into outcomes following appendicectomy at a population level. METHODS: A prospective, observational, resident-led, nationwide audit was carried out over a period of 2 months, including all consecutive adult patients who had surgery for suspected acute appendicitis. Complications after laparoscopic and open appendicectomy were compared by means of logistic regression analysis; subgroup analyses were performed for patients with complicated appendicitis. RESULTS: A total of 1975 patients were included from 62 participating Dutch hospitals. A normal appendix was seen in 3·3 per cent of patients. Appendicectomy was performed for acute appendicitis in 1378 patients, who were analysed. All but three patients underwent preoperative imaging. Laparoscopy was used in 79·5 per cent of patients; the conversion rate was 3·4 per cent. A histologically normal appendix was found in 2·2 per cent. Superficial surgical-site infection was less common in the laparoscopic group (odds ratio 0·25, 95 per cent c.i. 0·14 to 0·44; P < 0·001). The rate of intra-abdominal abscess formation was not significantly different following laparoscopic or open surgery (odds ratio 1·71, 0·80 to 3·63; P = 0·166). Similar findings were observed in patients with complicated appendicitis. CONCLUSION: Management of acute appendicitis in the Netherlands is preferably performed laparoscopically, characterized by a low conversion rate. Fewer superficial surgical-site infections occurred with laparoscopy, although the rate of abscess formation was no different from that following open surgery. A low normal appendix rate is the presumed effect of a mandatory preoperative imaging strategy.
BACKGROUND: Studies comparing laparoscopic and open appendicectomy are difficult to interpret owing to several types of bias, and the results often seem of limited clinical importance. National audits can be valuable to provide insight into outcomes following appendicectomy at a population level. METHODS: A prospective, observational, resident-led, nationwide audit was carried out over a period of 2 months, including all consecutive adult patients who had surgery for suspected acute appendicitis. Complications after laparoscopic and open appendicectomy were compared by means of logistic regression analysis; subgroup analyses were performed for patients with complicated appendicitis. RESULTS: A total of 1975 patients were included from 62 participating Dutch hospitals. A normal appendix was seen in 3·3 per cent of patients. Appendicectomy was performed for acute appendicitis in 1378 patients, who were analysed. All but three patients underwent preoperative imaging. Laparoscopy was used in 79·5 per cent of patients; the conversion rate was 3·4 per cent. A histologically normal appendix was found in 2·2 per cent. Superficial surgical-site infection was less common in the laparoscopic group (odds ratio 0·25, 95 per cent c.i. 0·14 to 0·44; P < 0·001). The rate of intra-abdominal abscess formation was not significantly different following laparoscopic or open surgery (odds ratio 1·71, 0·80 to 3·63; P = 0·166). Similar findings were observed in patients with complicated appendicitis. CONCLUSION: Management of acute appendicitis in the Netherlands is preferably performed laparoscopically, characterized by a low conversion rate. Fewer superficial surgical-site infections occurred with laparoscopy, although the rate of abscess formation was no different from that following open surgery. A low normal appendix rate is the presumed effect of a mandatory preoperative imaging strategy.
Authors: Carlos Augusto Gomes; Fikri M Abu-Zidan; Massimo Sartelli; Federico Coccolini; Luca Ansaloni; Gian Luca Baiocchi; Yoram Kluger; Salomone Di Saverio; Fausto Catena Journal: World J Surg Date: 2018-12 Impact factor: 3.352
Authors: J de Jonge; J C G Scheijmans; C C van Rossem; A A W van Geloven; M A Boermeester; W A Bemelman Journal: Int J Colorectal Dis Date: 2021-04-27 Impact factor: 2.571
Authors: David J Nijssen; Paul van Amstel; Joost van Schuppen; Laurens D Eeftinck Schattenkerk; Ramon R Gorter; Roel Bakx Journal: Pediatr Surg Int Date: 2021-03-07 Impact factor: 1.827
Authors: Jochem C G Scheijmans; Alexander B J Borgstein; Jan M Prins; Hester A Gietema; Jaap Stoker; Suzanne S Gisbertz; Marc G H Besselink; Marja A Boermeester; Carl A J Puylaert; Wouter J Bom; Said Bachiri; Eduard A van Bodegraven; Amarins T A Brandsma; Floor M Ter Brugge; Steve M M de Castro; Roy Couvreur; Lotte C Franken; Marcia P Gaspersz; Michelle R de Graaff; Hannah Groenen; Suzanne C Kleipool; Toon J L Kuypers; Milou H Martens; David M Mens; Ricardo G Orsini; Nando J M M Reneerkens; Thomas Schok; Wouter J A Sedee; Shahzad Tavakoli Rad; José H Volders; Pepijn D Weeder Journal: BMC Emerg Med Date: 2021-05-12
Authors: Thomas Jaschinski; Christoph G Mosch; Michaela Eikermann; Edmund Am Neugebauer; Stefan Sauerland Journal: Cochrane Database Syst Rev Date: 2018-11-28