Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

腹腔镜下全胃切除术后应用线性吻合器进行功能性食管空肠端端吻合术

限制腹腔镜下全胃切除术（LTG）在临床广泛运用的主要原因是技术上存在腔镜下行Roux—en—Y消化道重建的难度。报道称，诸如吻合口瘘或狭窄等重建相关并发症的发生率较远端胃切除术高。为了克服技术上的瓶颈并建立起标准的重建方法，我们于2006年9月引入使用线性吻合器行体内功能性食管一空肠端端吻合术（FETE）。