The low rate of perioperative complications and of conversions to OA by extension of the subumbilical incision or to conventional LA by the introduction of 2 or more trocars, corroborate the finding that SPA remains a safe operative technique. The safety of OA is commonly accepted, and there are numerous studies underlining the reliability selleck and the safety of LA also in complicated appendicitis in children . However, SPA combines the advantages of both open and laparoscopic surgery and allows for use of both skills in open surgical and laparoscopy techniques. The need for only one single umbilical incision, one conventional laparoscopic instrument without any highly technical devices such as stapler, endoloop, and endobag reduce the time and the mean cost of the SPA-operation.
Furthermore, the SPA-technique is extensible allowing additional trocars or devices such as stapler. Notably, SPA can be converted to conventional LA at any time for the treatment of additional pathologies. 6. Conclusion SPA represents an expeditious and reliable technique for appendicitis in pediatric populations. In our opinion, SPA is a safe and cost-effective technique. The main negative features of conventional LA, that are longer operative time and operating room cost compared to OA , seem to be not attributable to SPA. Additional randomized trials are needed to verify this hypothesis. In our unit, SPA is the standard procedure for appendectomy in children.
Inguinal hernia repair is one of the most frequently performed operations in general surgery.
With the introduction of laparoscopy in hernia surgery in 1990s, laparoscopic posterior repair (transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP)) has gained increasing popularity and emerged as the procedure of choice over open conventional techniques due to its well-established advantages such as lower rates of postoperative pain, rapid return to normal activities, and a lower incidence of infections. The major concern after inguinal hernia repair is recurrence. Recurrence rate after laparoscopic repair is comparable to that of open conventional techniques; however, such recurrences do occur after a laparoscopic repair with a reported rate of up to 5% [1, 2]. It is recommended that anterior mesh repair be performed for a recurrent hernia after previous posterior repair due to the increased risk of complications associated with the repeated posterior repair .
However, repeated laparoscopic Carfilzomib treatment of hernia recurrences after previous posterior repair has become a relatively new concept and data on an increasing number of reported series has shown promising results with this approach in terms of safety, feasibility, and reliability [4�C11]. We performed the first laparoscopic inguinal hernia repair in 1993 and since then we have widely employed this approach in the treatment of both primary and recurrent inguinal hernias.