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17.10.2016 | Review | Ausgabe 6/2017

Surgical Endoscopy 6/2017

Interventions to optimize recovery after laparoscopic appendectomy: a scoping review

Zeitschrift:
Surgical Endoscopy > Ausgabe 6/2017
Autoren:
James K. Hamill, Jamie-Lee Rahiri, Gamage Gunaratna, Andrew G. Hill
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-016-5274-2) contains supplementary material, which is available to authorized users.
Review registration PROSPERO, number CRD42016029901.

Abstract

Background

No enhanced recovery after surgery protocol has been published for laparoscopic appendectomy. This was a review of evidence-based interventions that could optimize recovery after appendectomy.

Methods

Interventions for the review Clinical pathway, fast-track or enhanced recovery protocols; needlescopic approach; single incision laparoscopic (SIL) approach; natural orifice transluminal endoscopic surgery (NOTES); regional nerve blocks; intraperitoneal local anaesthetic (IPLA); drains. Data sources MEDLINE, EMBASE, the Cochrane Library, and the Web of Science Core Collection. Study eligibility criteria Randomized controlled trial (RCT); prospective evaluation with historical controls for studies assessing clinical pathways/protocols. Participants People undergoing laparoscopic appendectomy for acute appendicitis. Study appraisal and synthesis methods Meta-analysis, random effects model.

Results

Clinical pathways for laparoscopic appendectomy were safe in selected patients, but may be associated with a higher readmission rate. Needlescopic surgery offered no recovery advantage over traditional laparoscopic appendectomy. SIL afforded no recovery advantage over conventional laparoscopic surgery, but may increase operative time in children. The search found no RCT on NOTES appendectomy. Transversus abdominis plane blocks did not significantly reduce pain after laparoscopic appendectomy. IPLA should be considered in laparoscopic appendectomy; studies in paediatric surgery are needed. The search found no RCT on the use of drains in appendectomy.

Conclusions

This review identified gaps in the literature on optimizing recovery after laparoscopic appendectomy and found the need for more randomized controlled trials on regional anaesthesia and intraperitoneal local anaesthesia in children.

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Zusatzmaterial
Supplementary material 1 (PDF 307 kb)
464_2016_5274_MOESM1_ESM.pdf
Literatur
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