Surgeons’ attitudes during laparoscopic appendectomy: do subjective intraoperative assessments affect the choice of peritoneal irrigation? A spin-off analysis from the REsiDENT-1 multicentre prospective observational trial

Aims Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn’t show a statistical advantage to prevent infectious complications. This study...

Full description

Saved in:

Bibliographic Details
Published in:	Surgical endoscopy 2023, Vol.37 (1), p.729-740
Main Authors:	Cioffi, Stefano Piero Bernardo, Granieri, Stefano, Scaravilli, Luca, Molteni, Mattia, Altomare, Michele, Spota, Andrea, Virdis, Francesco, Bini, Roberto, Renzi, Federica, Reitano, Elisa, Ragozzino, Roberta, Gupta, Shailvi, Chiara, Osvaldo, Cimbanassi, Stefania
Format:	Article
Language:	eng
Subjects:	2022 EAES Oral Abdominal Abscess - etiology Abdominal Surgery Acute Disease Appendectomy Appendectomy - methods Appendicitis Appendicitis - surgery Decision making Gangrene Gangrene - surgery Gastroenterology Gynecology Hepatology Histology Humans Laparoscopy Laparoscopy - methods Medicine Medicine & Public Health Observational studies Peritoneal Lavage - adverse effects Postoperative Complications - surgery Proctology Prospective Studies Regression analysis Reproducibility of Results Retrospective Studies Subjectivity Surgeons Surgery
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Aims Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn’t show a statistical advantage to prevent infectious complications. This study aims to investigate surgeons’ perceptions during LA, comparing intraoperative findings with histological results, and exploring how surgeons’ subjectivity influences the decision-making process on PL. Methods Data were extracted from the two-year data lock from REsiDENT-1 registry, a prospective resident-led multicentre observational trial. This study investigates the relationships between PL and postoperative intraabdominal abscesses (pIAA) introducing a classification for AA to standardize the intraoperative grading. We included pre, intra, and postoperative variables. We applied our classification proposal, used a five-point Likert scale (Ls) to assess subjective LA difficulty and ran a concordance analysis between the assessment of AA and histology. Subsequently, a multivariate logistic regression model was built to find factors influencing PL. Results 561 patients were enrolled from twenty-one hospitals and 51 residents. 542 procedures were included in the logistic regression analysis and 441 in the concordance analysis, due to missing data. PL was used in 222 LA (39, 6%). We discovered a moderate positive monotonic relationship between surgical evaluation and histology, p
ISSN:	0930-2794 1432-2218