Faculty of Medicine
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Item type:Publication, Laparoscopic revision of open appendectomy complicated by high-output colo-cutaneousfistula:acasereport(Oxford University Press and JSCR Publishing Ltd., 2025-12); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, LAPAROSCOPIC AND OPEN APPENDECTOMY IN PEDIATRIC PATIENTS –OPERATIVE AND POSTOPERATIVE EXPERIENCE(2022-09); ; Risto SimeonovObjective: Acute appendicitis is very frequently encountered in children. Despite many scientific controversies in supporting classical or laparoscopic appendectomy, there is still no official consensus on this issue. This study aimed to present our experience from the comparison of operative and postoperative effects of laparoscopic and open appendectomy in pediatric patients with acute appendicitis. Materials and methods: The analytical cross-sectional study was conducted at the University Clinic for Pediatric Surgery, Ss. Cyril and Methodius University in Skopje, the Republic of N.Macedonia during the period 2015/2022. The study sample covered 184 hospitalized pediatric patients aged 4-14 years treated with laparoscopic (LA) or open appendectomy (OA). The data of interest included demographic characteristics, and selective operative and postoperative parameters. Results: The average age of the children in LA vs. OA group was 9.63±2.70 with min/max of 4/14 vs. 9.16±2.91 with min/max 2/14 respectively. Postoperative complications were detected in 1 (0.90%) of LA patients and 3 (4.11%) of OA patients with no significant association. Analgesics’ treatment received 57 (51.35%) of the children from LA group and all of the children from OA group. Conversion from LA to OA happen only in 1 (0.54%) child. The evaluation of parents/guardians related to the satisfaction from the cosmetic appearance of the scar the significantly higher level of satisfaction from the scare after LA compared to OA intervention. Conclusions: Laparoscopic appendectomy was found to be feasible and comparable to open approach in terms of operative time and offers advantages over the latter in terms of postoperative pain, length of hospital stay and earlier return of bowel function to normal. It is a safe approach in all types of appendicitis, with an overall better complication profile than OA. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Вредноста на лапароскопската апендектомија во третманот на комплициран апендицитис(2021-06)Introduction Acute appendicitis is defined as acute appendicular inflammation which represents one of the most common surgical conditions that require operative treatment (laparoscopic and open appendectomy). The acute inflamation is represented in two forms: noncomplicated and complicated. The last one is further divided into 4 subgroups: appendicular gangrene, perforation/rupture, periappendicular abscess and secondary diffuse peritonitis. Aim This study measures the value of laparoscopic appendectomy in the treatment of complicated appendicitis through a comparation with the open appendectomy. Preoperative serum levels of Leucocyte count, CRP, total bilirubin, ALT and AST were measured; the intraoperative finding and the operative time were noted. In the postoperative period the following parameters were analyzed: the conversion rate, the correlation between the serum levels of Leucocyte count, CRP, total bilirubin, ALT and AST with the grade of intraoperative finding; overall morbidity (postoperative complications, sterile wound collections, wound infections, intraabdominal abscess occurrence); additional interventions were noted and length of stay was compared between the two groups of patients. Material and methods Operated patients with complicated appendicitis were analyzed in this prospective interventional clinical study conducted in the University Clinic “Sv. Naum Ohridski” – Skopje in the period of May 2019 – February 2021. The patients were operated with standard three-port laparoscopic technique and with the open Mc Burney access. Results Total number of 77 patients with complicated appendicitis were operated (44 laparoscopically and 33 with the open method). Positive correlation of the preoperative serum levels with the intraoperative grade is confirmed as statistically significant only for the values of CRP (p = 0.012). Operative time was statistically shorter in the laparoscopic group (67.4 ± 22.9 min. and 77.9 ± 17.9 min., p = 0.033). Overall morbidity was 25.97%. Postoperative complications occurred in 10 patients in the laparoscopic group (20.8%) and in 10 patients in the open group (30.3%). Wound infection was noted only in the open group (p = 0.018). Intraabdominal abscess occurred in one patient from the laparoscopic group (p = 0.38). There was one patient with postoperative bowel obstruction in the laparoscopic group (p = 0.38) and one patient with appendicular stump leak in the open group (p = 0.38). Length of stay was shorter in the laparoscopic group (p = 0.00009). Conclusion The method of laparoscopic appendectomy presented statistically significant advantages over the open appendectomy in the treatment of complicated appendicitis in terms of operative time, wound infection and the length of stay. Complicated appendicitis remains unexplored clinical entity that require new research studies in different medical disciplines in the future. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, RISING TREND OF USING LAPAROSCOPY IN THE TREATMENT OF COMPLICATED APPENDICITIS IN OUR INSTITUTION DURING JANUARY 2017-MAY 2019(Македонско лекарско друштво = Macedonian Medical Association, 2019); ; Abstract Introduction. Laparoscopic appendectomy was performed for the first time in the University Clinic for Surgery “St. Naum Ohridski” back in 2003 by the pediatric surgeons. At the moment it is still unrecognized by many senior surgeons as a reliable and safe alternative procedure for acute appendicitis. The end-point of this study is to present the rising trend of using laparoscopy in the treatment of complicated appendicitis. Methods. In the period between January 2017 and May 2019 a total number of 403 patients were operated on due to a preoperative diagnosis of acute appendicitis (270 with open and 133 with laparoscopic appendectomy) and were retrospectively analyzed. Results. Simple appendicitis was diagnosed intraoperatively in 248 patients and complicated appendicitis was diagnosed in 141 patients. The rising trend for overall use of laparoscopy for acute appendicitis was seen during the study period (20.9%, 32.2% and 63.3% in 2017, 2018 and 2019, respectively). In terms of complicated appendicitis, a drastic positive trend followed in favor of laparoscopy (8.9%, 24.6% and 36.7% in 2017, 2018 and 2019, respectively). The negative appendectomy rate with other intraoperative finding was 3.46% (14 cases). The conversion rate was 2.25%. Conclusion. We can finally conclude that the laparoscopic appendectomy is recognized as an effective and safe alternative in the treatment of complicated appendicitis in our institution.