Pure Transvaginal Appendectomy Versus Traditional Laparoscopic Appendectomy for Acute Appendicitis
2011; Lippincott Williams & Wilkins; Volume: 255; Issue: 2 Linguagem: Inglês
10.1097/sla.0b013e31823b2748
ISSN1528-1140
AutoresKurt E. Roberts, Daniel Solomon, Tamar L. Mirensky, Dan‐Arin Silasi, Andrew J. Duffy, Tom Rutherford, Walter E. Longo, Robert L. Bell,
Tópico(s)Diverticular Disease and Complications
ResumoIn Brief Objective: This report describes the first cohort study comparing pure transvaginal appendectomies (TVAs) to traditional 3-port laparoscopic appendectomies (LAs). Methods: Between August 2008 and August 2010, 42 patients were offered a pure TVA. Patients who did not wish to undergo a TVA underwent a LA and served as the control group. Demographic data, operative time, length of stay, patient controlled analgesia (PCA) 12-hour-morphine utilization, complications, return to normal activity, and return to work were recorded. Results: Eighteen of 40 enrolled patients underwent a pure TVA. Two patients refused to participate in this study. Mean age (TVA: 31.3 ± 2.5 years vs. LA: 28.2 ± 2.3 years, P = 0.36), mean body mass index (TVA: 23.7 ± 1.2 kg/m2 vs. LA: 23.6 ± 0.7 kg/m2, P = 0.96) mean operative time (TVA: 44.4 ± 4.5 minutes vs. LA: 39.8 ± 2.6 minutes, P = 0.38), and mean length of hospital stay (TVA: 1.1 ± 0.1 days vs. LA: 1.2 ± 0.1 days, P = 0.53) were not statistically significant. However, mean postoperative morphine-use (TVA: 8.7 ± 2.0 mg vs. LA: 23.0 ± 3.4 mg, P < 0.01), return to normal activity (TVA: 3.3 ± 0.4 days vs. LA: 9.7 ± 1.6 days, P < 0.01), and return to work (TVA: 5.4 ± 1.1 days vs. LA: 10.7 ± 1.5 days, P = 0.01) were statistically significant. One conversion in the TVA group to a LA was necessary because of inability to maintain adequate pneumoperitoneum. Four complications were observed: 1 intraabdominal abscess and 1 case of urinary retention in the TVA group; 1 early postoperative bowel obstruction and 1 case of urinary retention in the LA group. Conclusions: Pure TVA is a safe and well-tolerated procedure with significantly less pain and faster recovery compared to traditional LA. This study is registered with www.clinicaltrials.gov as NCT00806429. This report describes the first cohort study comparing pure transvaginal appendectomies (TVAs) to traditional 3-port laparoscopic appendectomies (LAs). The data suggests that TVA is a safe and well-tolerated procedure with significantly less pain and faster recovery compared to traditional LA.
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