Statement of the Problem: Although laparoscopic appendectomy has been widely performed since 1987, concerns over potential spillage of mucus into the peritoneal cavity during laparoscopic manipulation have prevented the use of laparoscopic surgery (LS) for appendiceal mucocele. The purpose of the present study was to evaluate the safety, feasibility, and short-term perioperative outcomes of LS for appendiceal mucocele. Methodology & Theoretical Orientation: A retrospective review was performed to identify patients diagnosed with appendiceal mucocele based on their imaging studies and who underwent surgery at one of six Hallym-University-affiliated hospitals between January 2007 and June 2016. Patient demographics, surgical outcomes, and postoperative outcomes were retrospectively analyzed. Findings: A total of 96 patients were evaluated, of whom 58 underwent LS (LS group) and 38 underwent open surgery (OS; OS group). There were no significant differences in patient characteristics between groups. The operation time was similar in both groups (P = 0.399). Intraoperative rupture occurred in two patients in each group (no significant difference, P = 0.647). Time to flatus, time to soft food intake, and length of hospital stay were shorter in the LS group than in the OS group (2.4 vs. 3.2 days, P = 0.003; 3.6 vs. 4.5 days, P = 0.024; 6.5 vs. 8.8 days, P = 0.011, respectively). The rate of postoperative complications was similar between the groups (P = 0.786). Univariate analysis revealed that rupture of appendiceal mucocele was associated with white blood cell count >10,000/ïL (P = 0.032) but not with LS (P = 0.647). Conclusion & Significance: The results showed that LS is safe and feasible for the surgical treatment of appendiceal mucocele. An elevated WBC count was associated with a risk of appendiceal mucocele rupture.
Jong Wan Kim has expertise in colorectal cancer and minimal invasive surgery, including laparoscopic and robotic surgery. Jong Wan Kim was supported by Hallym University Research Fund 2017 (HURF-2017-28).to all stakeholders and has a different way of focusing.
Sung Min Kim
Hallym University College of Medicine South Korea
Title: Safety and feasibility of laparoscopic surgery for small bowel obstruction: A
Statement of the Problem: Laparoscopic adhesiolysis is increasingly used to treat patients with small bowel obstruction (SBO), however, its safety of laparoscopic surgery (LS) with bowel resection in SBO is unclear. The purpose of the present study was to compare the perioperative outcomes of LS with those of open surgery (OS) for SBO and to evaluate the risk factors of 30-day postoperative morbidity and recurrence. Methodology & Theoretical Orientation: We retrospectively reviewed medical records of patients who had been diagnosed with SBO and underwent surgery at four Hallym-University-affiliated hospitals between January 2013 and December 2016. The rates of 30-day postoperative complications and recurrence were compared between groups using univariate and multivariate analysis. Propensity score matching was performed to compare the outcome. Findings: A total of 117 patients with SBO were included in the present study, of which 86 underwent OS and 31 underwent LS. Time to water intake, time to soft diet, and postoperative hospital stay were significantly shorter in the LS group (P = 0.002, 0.003, and 0.027, respectively). The complication (P =0.249) and recurrence rate (P = 0.679) were similar between the two group. Propensity score matching analysis demonstrated that laparoscopic surgery showed quicker recovery and similar complication and recurrence rate. In multivariate analysis, LS was not associated with either complications (P = 0.806) or recurrence (P = 0.831). Conclusion & Significance: LS is associated with several perioperative advantages for the treatment of SBO without affecting the risk of 30-day postoperative complications or recurrence. Therefore LS can be a safe and feasible option for treating SBO.
Sung Min Kim is currently working in Hallym University College of Medicine, South Korea