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Laparoscopic-assisted Versus Open Appendicovesicostomy Procedure in Patients With Prior Abdominal Surgeries: A Comparative Study - 28/05/18

Doi : 10.1016/j.urology.2018.02.036 
Michael E. Chua a, Jessica M. Ming a, Jin K. Kim b, Martin A. Koyle a, b, Luis H. Braga c, Armando J. Lorenzo a, b, *
a Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada 
b Department of Surgery, University of Toronto, Toronto, Ontario, Canada 
c McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada 

*Address correspondence to: Armando J. Lorenzo, M.D., M.Sc., F.R.C.S.C., F.A.A.P., F.A.C.S., Division of Urology, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada.Division of UrologyThe Hospital for Sick Children555 University Ave.TorontoOntarioM5G 1X8Canada

Abstract

Objective

To determine the differences in perioperative and postoperative outcomes between laparoscopic-assisted approach and open approach for appendicovesicostomy operations without concomitant procedures, among patients with prior abdominal surgeries.

Methods

A Research Ethics Board-approved retrospective cohort study was performed to review all laparoscopic-assisted vs open appendicovesicostomy procedures performed without concomitant procedure in patient with prior abdominal surgeries from January 2000 to January 2015 in our institution. We evaluated the baseline characteristics, perioperative and postoperative outcomes such as operative time, hospital stay, estimated blood loss, complications, and long-term continence. Fisher exact test and Mann-Whitney U test were performed to compare the 2 surgical groups.

Results

A total of 23 patients (11 open and 12 laparoscopic-assisted) were included. Baseline characteristics between the groups were not significantly different. Procedure time was comparable (Open median 289 [interquartile range {IQR} 230-335] vs laparoscopic-assisted median 231 [IQR 170.5-284]; P = .090). Significantly lower estimated blood loss and shorter hospital stay were noted among the laparoscopic-assisted group (median 100 [IQR 75-200] vs 50 [IQR 25-100], P = .048; median 6 [IQR 5-8] vs 3.5 [IQR 3-5], P = .029; respectively). Complication rates of Clavien-Dindo class 3 in both groups were not significantly different (6 of 11 vs 8 of 12, P = .68). Stomal stenosis and continence rates were also not significantly different between the groups (36.4% vs 25%, P = .667 and 63.3% vs 83.3%, P = .371).

Conclusion

Laparoscopic-assisted approach to create catheterizable stomas among patients with prior abdominal surgeries seems to be comparable to the open technique with the advantage of lower blood loss and shorter hospital stay.

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 Financial Disclosure: The authors declare that they have no relevant financial interests.
 Funding Support: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
 Ethical Approval: Approved by Institutional Research Ethics Board Review (REB# 1000054451).


© 2018  Elsevier Inc. Tutti i diritti riservati.
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P. 93-98 - giugno 2018 Ritorno al numero
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