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Single port laparoscopic appendectomy vs conventional laparoscopic appendectomy: outcomes after multicenter randomized control trial
Vol. 221, No. 4S2, October 2015
for demographics and scores for QOL, fatigue and pain from the validated Linear Analog Self-Assessment questionnaire (LASA) during five time periods: preoperatively (baseline), 30 days postoperatively, 31-90 days, 91-180 days, and 181-360 days. For the 1-10 LASA scale, a QOL score of 7 denotes general population mean score, fatigue > 5 severe fatigue, 0.5 sd change from baseline mean is clinically meaningful. Statistical analysis was carried out with t-test, and ANOVA. RESULTS: Of 397 patients who underwent elective splenectomy, 143 patients had baseline and any postoperative LASA scores reported, 93 men (65%) and 50 women (35%), mean age 60 14 years. Eighty-seven patients (61%) underwent laparoscopic splenectomy, 56 (39%) open splenectomy. Indications were: lymphoma (55%), leukemia (11%), myelofibrosis (12%), ITP (3%), other (15%). Mean splenic weight was 15871327 g. Mean baseline QOL fatigue, and pain scores were 6.62.5, 4.72.6, 2.62.6, respectively. After 90 days, mean QOL improved and 67% of available patients had normal QOL. Mean fatigue scores improved significantly. The rate of patients with severe fatigue dropped from 41% at baseline to 20% at one year. CONCLUSIONS: QOL can be improved for patients with splenomegaly. Further studies should elicit factors which predict success in improving QOL. Pharmacological mobilization of endogenous stem cells increases wound tensile strength and reduces scarring in aged mouse model Yingjun Xie, Frank Lay, Zhaoli Sun, Russell N Wesson, MB, ChB, Qing Lin, MD, PhD, Ali Ahmed, Andrew M Cameron, MD, FACS, Robert E Montgomery, MD, FACS, John W Harmon, MD, FACS Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Impaired wound healing in the elderly presents a major clinical problem. Stem cell therapy can improve the quality of wound healing and increase wound tensile strength in aged mice. To avoid the preparation of stem cells, which is expensive and time-consuming, we proposed in this study to mobilize endogenous bone-marrow stem cells pharmacologically with AMD3100, an antagonist of CXCR4 and low-dose FK506.
Scientific Forum: 2015 Clinical Congress
e17
with the dual drugs. Searching for the mechanisms, we found that the dual drug therapy increased CD34+ and CD133+ stem cells in the wound sites, enhanced epithelial proliferation (Ki67+) and augmented angiogenesis (CD31+) in the granulation tissues at 7 days after wounding. CONCLUSIONS: Mobilization, recruitment, and retention of endogenous stem cells with AMD3100 plus low-dose FK506 results in restoring of tensile strength and minimizing scars in aged mouse model of incisional wounds. Single port laparoscopic appendectomy vs conventional laparoscopic appendectomy: outcomes after multicenter randomized control trial Guillermo Duza, MD, Mariano Palermo, MD, FACS, Elbert Khiangte, Mohammad Azfar, FRCSEd, FACS, Syed Amjad Ali Rizvi, FRCSEd, Nelson Trelles, MD, Luis A Blanco, MD, Jose Menendez, MD, Leonardo Abramson, MD, Mohamed Sbai-Idrissi, MD Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina; Parkijuli Christian Hospital, Parkijuli, Aligarh Hospital, Assam and Aligarh, India; PoissyeSaint Germain Hospital, Poissy, France INTRODUCTION: Acute appendicitis is the most common acute abdominal surgical pathology, with about 250,000 new cases per year. Laparoscopic appendectomy is the gold standard. The aim is to present the results comparing single incision laparoscopic appendectomy (SILA) vs conventional laparoscopic appendectomy (CLA). METHODS: Between October 2013 and June 2014, 147 patients (73 male and 74 female) were included in the trial. 75 were operated by SILA and 72 through CLA. The variables studied were: procedure’s time, length of hospital stay, pain and cosmetic satisfaction. Statistical analysis was analyzed using the software STATA 12Ò.
METHODS: Young and old C57BL6 mice underwent incisional wounds (4cm) and were divided randomly into four experimental groups as follows and received subcutaneous injections of saline or drugs for two weeks after wounding: (1) control-group treated with saline; (2) AMD3100-group treated every other day (1.0 mg kg1); (3) FK506-group treated daily (0.1 mg kg1); and (4) combination group given AMD3100 and FK506. All wound evaluations were double blinded.
RESULTS: Regarding duration of surgery in minutes, SILA: 42.97 minutes. Length of hospital stay average was 32.2 hours. The 12 hours postoperative pain scale average was 3.93. And an average of 2,33 when the patients were discharged home. The average of the cosmetic satisfaction scale was 9.55 a month after the surgery. In CLA were: 38.39 minutes (p¼0.5), hospitalization: 42.8 hours (p<0.0001); pain: 5.32 after 12 hours (p<0.0001); and 3.88 when discharged (p<0.0001); Costmetic results: 7.61 (p<0.0001). When comparing both techniques, the duration of surgery is higher in SILA but not significant. Other variables as hospitalization, pain and cosmesis are statistically significant in favor to SILA.
RESULTS: In older mice, tensile strength of healing wounds was significantly lower than that in younger mice at 21 days post-operation. Older mice treated with the dual drug showed significant increases in tensile strength (3.820.36N vs 2.060.23N, p¼0.000503) restoring the strength to that observed in younger mice. Histological analysis showed less scarring in mice treated
CONCLUSIONS: CLA is the gold stardard technique but single port has a place in the treatment of acute apendicitis. While duration of surgey is longer in the single incisio´n technique, on the other hand, length of stay, postoperative pain and cosmetic satisfaction, this technique impresses provide better results than the CLA, being statistically significant.
for demographics and scores for QOL, fatigue and pain from the validated Linear Analog Self-Assessment questionnaire (LASA) during five time periods: preoperatively (baseline), 30 days postoperatively, 31-90 days, 91-180 days, and 181-360 days. For the 1-10 LASA scale, a QOL score of 7 denotes general population mean score, fatigue > 5 severe fatigue, 0.5 sd change from baseline mean is clinically meaningful. Statistical analysis was carried out with t-test, and ANOVA. RESULTS: Of 397 patients who underwent elective splenectomy, 143 patients had baseline and any postoperative LASA scores reported, 93 men (65%) and 50 women (35%), mean age 60 14 years. Eighty-seven patients (61%) underwent laparoscopic splenectomy, 56 (39%) open splenectomy. Indications were: lymphoma (55%), leukemia (11%), myelofibrosis (12%), ITP (3%), other (15%). Mean splenic weight was 15871327 g. Mean baseline QOL fatigue, and pain scores were 6.62.5, 4.72.6, 2.62.6, respectively. After 90 days, mean QOL improved and 67% of available patients had normal QOL. Mean fatigue scores improved significantly. The rate of patients with severe fatigue dropped from 41% at baseline to 20% at one year. CONCLUSIONS: QOL can be improved for patients with splenomegaly. Further studies should elicit factors which predict success in improving QOL. Pharmacological mobilization of endogenous stem cells increases wound tensile strength and reduces scarring in aged mouse model Yingjun Xie, Frank Lay, Zhaoli Sun, Russell N Wesson, MB, ChB, Qing Lin, MD, PhD, Ali Ahmed, Andrew M Cameron, MD, FACS, Robert E Montgomery, MD, FACS, John W Harmon, MD, FACS Johns Hopkins University School of Medicine, Baltimore, MD INTRODUCTION: Impaired wound healing in the elderly presents a major clinical problem. Stem cell therapy can improve the quality of wound healing and increase wound tensile strength in aged mice. To avoid the preparation of stem cells, which is expensive and time-consuming, we proposed in this study to mobilize endogenous bone-marrow stem cells pharmacologically with AMD3100, an antagonist of CXCR4 and low-dose FK506.
Scientific Forum: 2015 Clinical Congress
e17
with the dual drugs. Searching for the mechanisms, we found that the dual drug therapy increased CD34+ and CD133+ stem cells in the wound sites, enhanced epithelial proliferation (Ki67+) and augmented angiogenesis (CD31+) in the granulation tissues at 7 days after wounding. CONCLUSIONS: Mobilization, recruitment, and retention of endogenous stem cells with AMD3100 plus low-dose FK506 results in restoring of tensile strength and minimizing scars in aged mouse model of incisional wounds. Single port laparoscopic appendectomy vs conventional laparoscopic appendectomy: outcomes after multicenter randomized control trial Guillermo Duza, MD, Mariano Palermo, MD, FACS, Elbert Khiangte, Mohammad Azfar, FRCSEd, FACS, Syed Amjad Ali Rizvi, FRCSEd, Nelson Trelles, MD, Luis A Blanco, MD, Jose Menendez, MD, Leonardo Abramson, MD, Mohamed Sbai-Idrissi, MD Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina; Parkijuli Christian Hospital, Parkijuli, Aligarh Hospital, Assam and Aligarh, India; PoissyeSaint Germain Hospital, Poissy, France INTRODUCTION: Acute appendicitis is the most common acute abdominal surgical pathology, with about 250,000 new cases per year. Laparoscopic appendectomy is the gold standard. The aim is to present the results comparing single incision laparoscopic appendectomy (SILA) vs conventional laparoscopic appendectomy (CLA). METHODS: Between October 2013 and June 2014, 147 patients (73 male and 74 female) were included in the trial. 75 were operated by SILA and 72 through CLA. The variables studied were: procedure’s time, length of hospital stay, pain and cosmetic satisfaction. Statistical analysis was analyzed using the software STATA 12Ò.
METHODS: Young and old C57BL6 mice underwent incisional wounds (4cm) and were divided randomly into four experimental groups as follows and received subcutaneous injections of saline or drugs for two weeks after wounding: (1) control-group treated with saline; (2) AMD3100-group treated every other day (1.0 mg kg1); (3) FK506-group treated daily (0.1 mg kg1); and (4) combination group given AMD3100 and FK506. All wound evaluations were double blinded.
RESULTS: Regarding duration of surgery in minutes, SILA: 42.97 minutes. Length of hospital stay average was 32.2 hours. The 12 hours postoperative pain scale average was 3.93. And an average of 2,33 when the patients were discharged home. The average of the cosmetic satisfaction scale was 9.55 a month after the surgery. In CLA were: 38.39 minutes (p¼0.5), hospitalization: 42.8 hours (p<0.0001); pain: 5.32 after 12 hours (p<0.0001); and 3.88 when discharged (p<0.0001); Costmetic results: 7.61 (p<0.0001). When comparing both techniques, the duration of surgery is higher in SILA but not significant. Other variables as hospitalization, pain and cosmesis are statistically significant in favor to SILA.
RESULTS: In older mice, tensile strength of healing wounds was significantly lower than that in younger mice at 21 days post-operation. Older mice treated with the dual drug showed significant increases in tensile strength (3.820.36N vs 2.060.23N, p¼0.000503) restoring the strength to that observed in younger mice. Histological analysis showed less scarring in mice treated
CONCLUSIONS: CLA is the gold stardard technique but single port has a place in the treatment of acute apendicitis. While duration of surgey is longer in the single incisio´n technique, on the other hand, length of stay, postoperative pain and cosmetic satisfaction, this technique impresses provide better results than the CLA, being statistically significant.