Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review

Kovi E. Bessoff, MD, PhD; Jeff Choi, MD; Christopher J. Wolff, MD; Aditi Kashikar, MBBS; Garrison M. Carlos, MD; Luke Caddell, MD; Rida I. Khan; Christopher D. Stave, MLS; David A. Spain, MD; Joseph D. Forrester, MD, MSc

Surgery Open Science (Oct 2021)

Evidence-based surgery for laparoscopic appendectomy: A stepwise systematic review

Kovi E. Bessoff, MD, PhD,
Jeff Choi, MD,
Christopher J. Wolff, MD,
Aditi Kashikar, MBBS,
Garrison M. Carlos, MD,
Luke Caddell, MD,
Rida I. Khan,
Christopher D. Stave, MLS,
David A. Spain, MD,
Joseph D. Forrester, MD, MSc

Affiliations

Kovi E. Bessoff, MD, PhD: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA; Corresponding author at: 300 Pasteur Drive, Room H3680, Stanford, CA 94305-5641.
Jeff Choi, MD: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
Christopher J. Wolff, MD: Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA; Digestive Diseases and Surgery Institute, Cleveland Clinic Akron General, Akron, OH
Aditi Kashikar, MBBS: Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA; Department of Surgery, Emory University School of Medicine, Atlanta, GA
Garrison M. Carlos, MD: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
Luke Caddell, MD: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
Rida I. Khan: Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA; University of California Berkeley, Berkeley, CA
Christopher D. Stave, MLS: Lane Medical Library, Stanford School of Medicine, Stanford, CA
David A. Spain, MD: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA
Joseph D. Forrester, MD, MSc: Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA; Students and Surgeons Writing About Trauma, Department of Surgery, Stanford University, Stanford, CA, USA

Journal volume & issue: Vol. 6
pp. 29 – 39

Abstract

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Introduction: Appendectomy is a common emergency surgery performed globally. Despite the frequency of laparoscopic appendectomy, consensus does not exist on the best way to perform each procedural step. We identified literature on key intraoperative steps to inform best technical practice during laparoscopic appendectomy. Methods: Research questions were framed using the population, indication, comparison, outcome (PICO) format for 6 key operative steps of laparoscopic appendectomy: abdominal entry, placement of laparoscopic ports, division of mesoappendix, division of appendix, removal of appendix, and fascial closure. These questions were used to build literature queries in PubMed, EMBASE, and the Cochrane Library databases. Evidence quality and certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) definitions. Results: Recommendations were rendered for 6 PICO questions based on 28 full length articles. Low quality evidence favors direct trocar insertion for abdominal entry and establishment of pneumoperitoneum. Single port appendectomy results in improved cosmesis with unclear clinical implications. There was insufficient data to determine the optimal method of appendiceal stump closure, but use of a specimen extraction bag reduces rates of superficial surgical site infection and intra-abdominal abscess. Port sites made with radially dilating trocars are less likely to necessitate closure and are less likely to result in port site hernia. When port sites are closed, a closure device should be used. Conclusion: Key operative steps of laparoscopic appendectomy have sufficient data to encourage standardized practice.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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