L\u2019introduzione della chirurgia laparoscopica ha, anche nel caso del trattamento chirurgico dell\u2019appendicite acuta, introdotto la disputa su quale sia il pi\u00f9 efficace metodo di approccio a tale patologia. E\u2019 ormai noto come l\u2019approccio laparoscopico rispetto a quello \u201copen\u201d riduca in maniera significativa l\u2019incidenza della infezione della ferita chirurgica, il dolore postoperatorio, la durata della degenza ed il periodo di astensione dal lavoro, ma aumenti, al contrario, l\u2019incidenza degli ascessi intraddominali postoperatori, per la minore capacit\u00e0 insita nell\u2019approccio laparoscopico di garantire una sicura toilette del cavo addominale nelle peritoniti.
\nIn questo studio pubblicato sul British Journal of Surgery del mese di marzo viene confermata l\u2019utilit\u00e0 dell\u2019approccio laparoscopico senza evidenza di complicanze infettive post-operatorie.
\nMassimo Sartelli<\/b><\/p>\n
Changing trends in surgery for acute appendicitis.<\/strong> L\u2019introduzione della chirurgia laparoscopica ha, anche nel caso del trattamento chirurgico dell\u2019appendicite acuta, introdotto la disputa su quale sia il pi\u00f9 efficace metodo di approccio a tale patologia.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/posts\/7587"}],"collection":[{"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/comments?post=7587"}],"version-history":[{"count":2,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/posts\/7587\/revisions"}],"predecessor-version":[{"id":7590,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/posts\/7587\/revisions\/7590"}],"wp:attachment":[{"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/media?parent=7587"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/categories?post=7587"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.siccr.org\/en\/wp-json\/wp\/v2\/tags?post=7587"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nH. M. Paterson, M. Qadan, S. M. de Luca, S. J. Nixon, S. Paterson-Brown. British Journal of Surgery. Volume 95, Issue 3 , Pages 363 \u2013 368.<\/p>\n
\nBackground<\/strong>
\nLaparoscopic appendicectomy (LA) offers faster recovery times and a reduced rate of wound infection compared with open appendicectomy (OA) but may be associated with more intra-abdominal abscesses. This study examines the changing trends in management of appendicitis in a regional setting during service reorganization and compares infective complication rates for each procedure.
\nMethods<\/strong>
\nData were retrieved from the Lothian Surgical Audit database on 1824 patients treated for appendicitis by OA or LA during equal 31-month periods before and after service reorganization in August 2002. Outcome measures were duration of admission, recovery time from operation to discharge and reintervention for infective complications. Analysis was by intention to treat.
\nResults<\/strong>
\nThe rate of LA in Lothian increased from 29,9 to 39,4 per cent (P < 0,001) after subspecialist service reorganization. Recovery time from operation to discharge was significantly shorter after LA than OA when results were stratified with respect to sex (mean 2,5 versus 4,4 days respectively in women, P < 0,001; 2,7 and 3,1 days in men, P = 0,023), timing of surgery (2,7 versus 3,3 days before subspecialization, P = 0,007; 2,5 versus 3,6 days after subspecialization, P < 0,001) and whether appendicitis was associated with peritoneal contamination (2,2 versus 3,0 days for uncontaminated surgery, P < 0,001; 4,3 versus 5,1 days for contaminated surgery, P = 0,060). Peritoneal contamination at primary operation was the only independent risk factor that predicted reintervention for infective complications.
\nConclusion<\/strong>
\nLA is associated with a shorter hospital stay from operation to discharge than OA, with no evidence of an increased rate of intra-abdominal infective complications. <\/i><\/p>\n","protected":false},"excerpt":{"rendered":"