Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil

ABSTRACT Background: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. Materials and Methods: retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. Results: we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p

摘要 背景：公立教学医院开展急诊腹腔镜手术的障碍涉及住院医师学习曲线、资源成本与可及性等问题。本研究旨在阐述巴西单一学术中心15年间，急性阑尾炎腹腔镜手术开展过程中面临的各类问题。材料与方法：本研究为回顾性研究，纳入2004年至2018年接受急诊阑尾切除术的患者。将临床数据与急诊外科团队实施的四项关键举措进行对比：住院医师微创手术培训（2007年）、使用金属夹行腹腔镜残端闭合（2008年）、急诊手术腹腔镜器械24小时全天候可及（2010年），以及腹腔镜器械维护第三方外包合同与采用高分子夹实施残端闭合（2013年）。本研究评估了上述重大变革实施后腹腔镜阑尾切除术占比的提升情况。结果：本研究周期内共纳入1168例阑尾切除术病例，其中开放手术691例（59%）、腹腔镜手术465例（40%）、中转手术12例（1%）。自2004年起推行上述关键举措后，腹腔镜阑尾切除术占比从2007年的11%提升至2016年的80%。上述举措对于急性阑尾炎腹腔镜手术的广泛应用起到了决定性作用（p