Abstract
Amaç:
Akut apandisit acil cerrahide sık görülen patolojilerdendir. Genellikle genç yaşta görülen bir hastalıktır. Ortalama yaşam süresinin uzaması ile yaşlı hasta popu-lasyonunda akut apandisit görülme oranları giderek artmaktadır. Bu çalışmanın amacı, 65 yaş üstü akut apandisit nedeni ile cerrahi olarak tedavi edilen hastalarda laparos-kopik ve açık cerrahi yöntemlerin sonuçlarını karşılaştırmaktır.
Gereç ve Yöntemler:
2011-2018 yılları arasında Sakarya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Has-tanesi’nde akut apandisit nedeni ile cerrahi tedavi uygulanan 65 yaş üstündeki olgular çalışmaya dahil edildi. Olgular uygulanan cerrahi yönteme göre laparaskopik veya açık apendektomi ve komplike veya nonkomplike apandisit olarak değerlendirilerek sınıflandırıldı. Tüm gruplar yaş ortalaması, cinsiyet, beyaz küre (WBC) düzeyleri, ko-morbid hastalık varlığı, ASA skoru, operasyon süresi, oral alımın başlama zamanı, hastanede kalış süresi, postoperatif yoğun bakım gereksinimi, komplikasyon varlığı ve mortalite açısından değerlendirildi
Bulgular:
65 yaş üstü apendektomi yapılan 161 olgunun 98’i erkek (% 60,80), 63’ü kadındı (% 39,20). Olguların 109’una (% 67,70) açık apendektomi, 52’sine (% 32,29) laparoskopik apendektomi uygulandığı belirlendi. Açık operasyon uygulanan 109 olgunun 61’inin (% 55,91), laparoskopik apendektomi uygulanan 52 olgunun 22’sinin (% 42,32) komplike akut apandisit olduğu saptandı. Opere edilen olguların 24’ünde (% 14,94), kom-plikasyon geliştiği gözlendi. Komplikasyonlar açısından laparoskopik opere edilen gruplarla açık apendektomi grupları arasında anlamlı farklılık saptanmadı (P=0,873). Gruplar yaş, cinsiyet, yandaş hastalık, ASA skoru ve preoperatif laboratuvar değerleri açısından benzer özellikler göstermekteydi
Sonuç:
Laparoskopik apendektomi yaşlı ve komorbiditesi yüksek hasta populasyonunda güvenle uygulanabilir bir yöntemdir.
Keywords
References
- 1) Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly?. Am J Surg 2003;185:198–201.
- 2 Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg 2017 Oct;43(5):723-727. doi: 10.1007/s00068-016-0735-9. Epub 2016 Nov 2.
- 3) Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparo-scopic appendectomy in the elderly. Surgery 2004;135(5):479-488.
- 4) Kim MJ, Fleming FJ, Gunzler DD, Messing S, Salloum RM, Monson JRT. Laparo-scopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database. Surg Endosc 2011; 25(6):1802-1807.
- 5) Kirshtein B, Perry ZH, Mizrahi S, et al. Value of laparoscopic appendectomy in the elderly patient. World J Surg 2009; 33:918–922.
- 6) Dowgiałło-Wnukiewicz N, Kozera P, Wójcik W, Lech P, Rymkiewicz P, Michalik M. Surgical treatment of acute appendicitis in older patients. Pol Przegl Chir 2019 Feb 7;91(2):12-15. doi: 10.5604/01.3001.0012.8556. PMID: 31032807
- 7) Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery 2018; pii: S0039-6060(18)30196-X.
- 8) Frantz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg 1995; 61:40-4.
- 9) Addiss DG, Shaffer N, Fowler BS. The epidemiology of appendicitis and appen-dectomy in the United States. Am J Epidemiol 1990; 132:910-25.
- 10) Yeh CC, Wu SC, Liao CC, Su LT, Hsieh CH, Li TC. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc 2011 Sep; 25(9):2932-42. Epub 2011 Mar 18.
- 11) Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radio 2012; 19:27-33.
- 12) Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A. Lapa-roscopic vs open appendectomy in older patients. Arch Surg 2012; 147: 557-562.
- 13) Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015; 15: 4
- 14) Markides G, Subar D, Riyad K. Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta-analysis. World Journal of Surgery 2010; 34: 2026-2040.
- 15) Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L. Complicated appendi-citis: laparoscopic or conventional surgery? World J Surg 2007; 31: 744-749.
- 16) Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM. Incidence of postopera-tive intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 2011; 25: 2678-2683.
- 17) Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H. Laparo-scopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 2016 May;30(5):1705-12. doi: 10.1007/s00464-015-4453-x. Epub 2015 Aug 15.
- 18) Gupta R, Sample C, Bamehriz F, Birch DW. Infectious complications following laparoscopic appendectomy. Can J Surg 2006; 49: 397-400.
- 19) Moore CB, Smith RS, Herbertson R, Toevs C. Does use of intraoperative irriga-tion with open or laparoscopic appendectomy reduce post-operative intraabdominal abscess? Am Surg 2011;77:78–80.
- 20) R. Galli • V. Banz • H. Fenner • J. Metzger. Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 2013; 27:2928–2933 DOI 10.1007/s00464-013-2858-y
- 21) Lin YM, Hsieh CH, Cheng CI, BL Tan, HT Liu. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 2012;35: 113–116.
- 22) Liu L, Lv N, Hou C. Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery: A retrospec-tive study. Medicine (Baltimore). 2019 Apr;98(14):e15112. doi: 10.1097/MD.0000000000015112. PMID: 30946379
Abstract
Objective:
Acute appendicitis rates are gradually increasing in the elderly people population with prolonged life expectancy. This study aims to compare applicability of laparoscopic and open surgical methods in patients treated surgically for acute appendicitis over 65 years of age.
Materials and Methods: Patients over 65 years old who underwent surgical treatment for acute appendicitis at the Sakarya University Hospital between 2011-2018 were included in the study. The patients were clas-sified according to the surgical method applied as laparoscopic or open appendectomy and complicated or non-complicated appendicitis. All groups were evaluated in terms of mean age, gender, white blood cell (WBC) levels, presence of comorbid disease, ASA score, operation time, the onset of oral intake, duration of hospital stay, postoperative intensive care require-ment, presence of complications and mortality.
Results:
Of the 161 patients who underwent appendectomy over 65, 98 were male (% 60,80) and 63 were female (% 39,20). It was determined that open appendectomy was per-formed in 109 (% 67,70) of the cases, and laparoscopic appendectomy in 52 (% 32,29). It was determined that 61 (% 55,91) of 109 cases undergoing open surgery and 22 (% 42,32) of 52 cases undergoing laparoscopic appendectomy were compli-cated acute appendicitis. Complications were observed in 24 (% 14,94) of one hun-dred and fifty patients. In terms of complications, no significant difference was found between laparoscopically operated groups and open appendectomy groups (P=0,873).
Conclusion:
Laparoscopic appendectomy is considered as a safely feasible method in the popu-lation of elderly and high comorbid patients.
Keywords
References
- 1) Storm-Dickerson TL, Horattas MC. What have we learned over the past 20 years about appendicitis in the elderly?. Am J Surg 2003;185:198–201.
- 2 Cohen-Arazi O, Dabour K, Bala M, Haran A, Almogy G. Management, treatment and outcomes of acute appendicitis in an elderly population: a single-center experience. Eur J Trauma Emerg Surg 2017 Oct;43(5):723-727. doi: 10.1007/s00068-016-0735-9. Epub 2016 Nov 2.
- 3) Guller U, Jain N, Peterson ED, Muhlbaier LH, Eubanks S, Pietrobon R. Laparo-scopic appendectomy in the elderly. Surgery 2004;135(5):479-488.
- 4) Kim MJ, Fleming FJ, Gunzler DD, Messing S, Salloum RM, Monson JRT. Laparo-scopic appendectomy is safe and efficacious for the elderly: an analysis using the National Surgical Quality Improvement Project database. Surg Endosc 2011; 25(6):1802-1807.
- 5) Kirshtein B, Perry ZH, Mizrahi S, et al. Value of laparoscopic appendectomy in the elderly patient. World J Surg 2009; 33:918–922.
- 6) Dowgiałło-Wnukiewicz N, Kozera P, Wójcik W, Lech P, Rymkiewicz P, Michalik M. Surgical treatment of acute appendicitis in older patients. Pol Przegl Chir 2019 Feb 7;91(2):12-15. doi: 10.5604/01.3001.0012.8556. PMID: 31032807
- 7) Renteria O, Shahid Z, Huerta S. Outcomes of appendectomy in elderly veteran patients. Surgery 2018; pii: S0039-6060(18)30196-X.
- 8) Frantz MG, Norman J, Fabri PJ. Increased morbidity of appendicitis with advancing age. Am Surg 1995; 61:40-4.
- 9) Addiss DG, Shaffer N, Fowler BS. The epidemiology of appendicitis and appen-dectomy in the United States. Am J Epidemiol 1990; 132:910-25.
- 10) Yeh CC, Wu SC, Liao CC, Su LT, Hsieh CH, Li TC. Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study. Surg Endosc 2011 Sep; 25(9):2932-42. Epub 2011 Mar 18.
- 11) Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radio 2012; 19:27-33.
- 12) Southgate E, Vousden N, Karthikesalingam A, Markar SR, Black S, Zaidi A. Lapa-roscopic vs open appendectomy in older patients. Arch Surg 2012; 147: 557-562.
- 13) Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 2015; 15: 4
- 14) Markides G, Subar D, Riyad K. Laparoscopic Versus Open Appendectomy in Adults with Complicated Appendicitis: Systematic Review and Meta-analysis. World Journal of Surgery 2010; 34: 2026-2040.
- 15) Kirshtein B, Bayme M, Domchik S, Mizrahi S, Lantsberg L. Complicated appendi-citis: laparoscopic or conventional surgery? World J Surg 2007; 31: 744-749.
- 16) Asarias JR, Schlussel AT, Cafasso DE, Carlson TL, Kasprenski MC, Washington EN, Lustik MB, Yamamura MS, Matayoshi EZ, Zagorski SM. Incidence of postopera-tive intraabdominal abscesses in open versus laparoscopic appendectomies. Surg Endosc 2011; 25: 2678-2683.
- 17) Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H. Laparo-scopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 2016 May;30(5):1705-12. doi: 10.1007/s00464-015-4453-x. Epub 2015 Aug 15.
- 18) Gupta R, Sample C, Bamehriz F, Birch DW. Infectious complications following laparoscopic appendectomy. Can J Surg 2006; 49: 397-400.
- 19) Moore CB, Smith RS, Herbertson R, Toevs C. Does use of intraoperative irriga-tion with open or laparoscopic appendectomy reduce post-operative intraabdominal abscess? Am Surg 2011;77:78–80.
- 20) R. Galli • V. Banz • H. Fenner • J. Metzger. Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection? Surg Endosc 2013; 27:2928–2933 DOI 10.1007/s00464-013-2858-y
- 21) Lin YM, Hsieh CH, Cheng CI, BL Tan, HT Liu. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg 2012;35: 113–116.
- 22) Liu L, Lv N, Hou C. Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery: A retrospec-tive study. Medicine (Baltimore). 2019 Apr;98(14):e15112. doi: 10.1097/MD.0000000000015112. PMID: 30946379
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | March 22, 2021 |
| Submission Date | August 5, 2020 |
| Published in Issue | Year 2021 Volume: 11 Issue: 1 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.