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      A Simple Vacuum Dressing Reduces the Wound Infection Rate of Single-Incision Pediatric Endosurgical Appendectomy

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          Abstract

          A simple, low-cost umbilical vacuum dressing was found to decrease the wound infection rate after single-incision pediatric endosurgical appendectomy.

          Abstract

          Background and Objectives:

          After introducing single-incision pediatric endosurgical (SIPES) appendectomy at our institution, we noticed an increased number of postoperative umbilical infections. This study evaluates the impact of a simple, low-cost wound vacuum dressing on the wound infection rate.

          Methods:

          Umbilical wounds after single-incision laparoscopic appendectomy were covered with standard dressing (approximating strips), or the new umbilical vacuum dressing. A wound infection was defined as an infected umbilicus requiring antibiotics, or incision and drainage. The wound infection rate was compared between both groups. Statistical analysis was performed using Fischer's exact test. Continuous variables were compared using the Student t test.

          Results:

          Included in this study were 183 children, 97 of whom were treated with the vacuum dressing. The study populations were no different in terms of age, weight, operative time, blood loss, length of stay, or proportion of acute versus perforated appendicitis. A total of 7 (3.8%) wound infections occurred, 1 in the vacuum dressing group (1%), versus 6 in the conventional dressing group (7%, P=0.038).

          Conclusions:

          This simple, low-cost umbilical vacuum dressing decreased the wound infection rate after SIPES appendectomy, possibly by absorbing secretions from the base of the wound. It may be equally effective for other indications.

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          Most cited references8

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          Single-port transumbilical laparoscopic appendectomy: 43 consecutive cases.

          In this modern era of minimally invasive surgery, cosmesis and early recovery are strongly emphasized. To reduce abdominal trauma and improve cosmesis, surgeons have adopted a single-port laparoscopic appendectomy for patients with acute appendicitis. From August to December 2008, 43 cases of appendectomy were managed using the single-port transumbilical laparoscopic technique. A multichannel single port was created using a surgical glove (no. 6), three trocars, one-three-way catheter, and a wound retractor (Alexis). An umbilical incision (1.5-2.0 cm) was made transumbilically or infraumbilically. The intraabdominal procedures were almost identical to those for conventional laparoscopic appendectomy. The methods for mesenteric dissection and appendiceal stump ligation were identical. Despite slight discomforts with retraction and visualization, the procedure was nevertheless possible. A resected appendix was put into a finger of the single-port glove. The 43 study cases included 23 men and 20 women with a mean age of 31 years (range, 9-65 years) and a mean body mass index (BMI) of 22.3 kg/m(2) (range 15-29.7 kg/m(2)). The mean operative time was 61.3 min (range 24-120 min). Drainage was used in two cases with perforated appendicitis. Bowel movement returned at a mean of 1.2 days, and oral feeding was resumed on postoperative day 1.2. The pathology showed negative inflammation in 4 cases (9.3%), suppurative appendicitis in 29 cases (67.4%), gangrenous appendicitis in 8 cases (18.6%), and perforated appendicitis in 2 cases. Only one patient required readmission due to pericecal inflammation and pain, and another patient needed a percutaneous drainage of fluid collection. Three minor umbilical wound complications were controlled conservatively. Single-port appendectomy may require a longer operative time than laparoscopic appendectomy, but it is a feasible technique with good cosmetic results. It could be one of the alternative methods for treating acute appendicitis.
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            Laparoscopic transumbilical single-port appendectomy: initial experience and comparison with three-port appendectomy.

            Laparoscopic appendectomy usually needs 3 ports, 1 for the videoscope and 2 as working channels. The aim of this study was to compare the feasibility and postoperative outcomes of laparoscopic transumbilical single-port appendectomy with conventional three-port appendectomy. From October 2008 to January 2009, 35 patients underwent single-port appendectomy (SA). Surgical outcomes such as operation time, number of times of parenteral analgesic injected, complication, and hospital stay of 35 patients receiving SA were analyzed and compared with those of 37 patients receiving three-port appendectomy (TA) during the same period. Comparing SA with TA, there were no statistically significant differences in operation time (75.9+/-27.4 vs. 66.4+/-21.7 min), times of injected analgesic (0.86+/-1.3 vs. 0.97+/-1.47 times), complication rate (8.6% vs. 2.7%), and hospital stay (3.0+/-1.3 vs. 3.2+/-1.4 d). The most common complication was wound infection (2 cases for SA and 1 for TA). One instance of intra-abdominal fluid accumulation occurred in a patient with perforated appendicitis during SA, and this was managed with image-guided drainage. In contrast to the TA, the abdominal scar in SA was nearly inconspicuous. This study showed SA to be feasible, and it did not show any difference in postoperative outcomes compared with TA. Moreover, SA can produce scarless surgery without the need for specialized instrumentation.
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              V.A.C. Therapy in the management of paediatric wounds: clinical review and experience.

              Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure (V.A.C. Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C. Therapy System.
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                Author and article information

                Contributors
                Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
                Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Apr-Jun 2011
                : 15
                : 2
                : 147-150
                Affiliations
                Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
                Division of Pediatric Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
                Author notes
                Address correspondence to: Oliver J. Muensterer, MD, PhD, Division of Pediatric Surgery, Weill Cornell Medical College, 525 East 68 th Street, Box 209, New York, NY 10065, USA. Telephone 212 746 2705, Fax: 212 746 3884, E-mail: oliver.muensterer@ 123456att.net
                Article
                10-10151
                10.4293/108680811X13071180406592
                3148860
                21902964
                2bbfd3f9-4a40-4630-afa6-25bc22908387
                © 2011 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Scientific Papers

                Surgery
                vacuum dressing,single incision laparoscopy,appendectomy,wound infection
                Surgery
                vacuum dressing, single incision laparoscopy, appendectomy, wound infection

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