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Feasibility of Laparoscopic Interval Appendicectomy as a Day Case Procedure - Abstract

Caroline Pardy, Anies Mahomed

 

Abstract

Introduction: The role of interval appendicectomy in the management of appendix mass remains controversial. Advocates argue that the risk of recurrent appendicitis justifies an elective procedure, whilst others believe that this risk is low enough for an appendix mass to be managed conservatively . Our centre is a proponent of interval appendicectomy and sought to determine the feasibility of performing interval appendicectomy as a day case procedure.

Methods: We performed a prospective data collection for children undergoing elective laparoscopic interval appendicectomy for appendix mass, managed by a single surgeon over a 9 year period. Statistical analysis was performed using Mann-Whitney U Test using Graphpad Prism version 6.

Results: Sixteen children with a median age of 9 (2-16), 10 of whom were female, underwent elective laparoscopic interval appendicectomy between January 2005 – September 2014. Operating time was a median of 45 minutes (20-60 minutes). 2 cases were performed using Single Incision Laparoscopic Surgery (SILS). There were no conversions, and no intra-operative complications. Nine patients (56%) were discharged the day of their procedure. One patient undergoing SILS was discharged the same day, the other patient was discharged the following day. The median length of stay for patients who could not be discharged on the day of surgery was 1 day (1-4). One patient who was discharged on day 1 post-surgery was re-admitted 3 days after discharge with pain and vomiting that settled with antibiotics. There was a trend towards younger patients being able to be managed as a day case procedure (median 9 years vs. 11 years), although this was not statistically significant (P = 0.31). Perhaps not surprisingly, patients who were discharged the day of surgery had shorter operating time (P = 0.03, median 30 minutes vs. 60 minutes), likely to reflect a less technically challenging procedure, and although not significant (P = 0.15), trended towards a shorter time to full feeds (median 6 hours vs. 8 hours).

Conclusions: This series has demonstrated that just over half of patients undergoing elective laparoscopic interval appendicectomy can be discharged safely on the day of surgery. It appears that the surgeon alone may be the best judge of whether a patient is suitable for discharge on the day of surgery, depending on the technical difficulty and length of procedure.

Keywords: interval appendicectomy, laparoscopy, day case surgery.

 

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