Cases Of Appendectomy Research Articles

Appendicitis in children: correlation between the surgical and histological diagnosis

PurposeStudy was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA).MethodsIn a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed.ResultsAltogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon’s and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon’s diagnosis was less severe than the pathologist’s, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001).ConclusionsIn contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher.Level of evidence: II

Surgical and Pre-surgical Factors Affecting Appendectomy Outcomes in Jeddah, Saudi Arabia: A Retrospective Record Review.

Appendectomy is the preferred treatment for acute uncomplicated appendicitis and the most common emergency abdominal surgery. While previous studies have investigated variables affecting post-appendectomy complications, local research is limited, and data on complication rates are scarce. Therefore, this study aimed to investigate appendectomy outcomes and the factors influencing them. This retrospective record review included all patients who underwent appendectomies at our center between 2013 and 2023, excluding those who underwent appendectomies as part of other procedures. Data were retrieved from the hospital database and recorded on predesigned Google Forms. A total of 556 patients were included. Complications occurred in 60 patients (10.8%); the most common included intra-abdominal collections (n=19, 3.4%), postoperative fever (n=13, 2.3%), and surgical site infections (n=11, 2.0%). The most frequently documented histopathological diagnoses included acute appendicitis (n=402, 72.3%), perforated appendicitis (n=109, 19.6%), and gangrenous appendicitis (n=19, 4.4%). Surgical site infection rates were higher after open appendectomies (6.0% vs. 0.9%, P=0.006), while intra-abdominal collections were more frequent after laparoscopic appendectomies (4.1% vs. 0.0%, P=0.095). Additionally, histopathology results showing complicated or chronic appendicitis were associated with higher complication rates (P<0.001, odds ratio=3.793, 95% confidence interval=1.957-7.350). To the best of our knowledge, this is the largest retrospective review of appendectomy cases in Saudi Arabia. However, this study was conducted in a tertiary care center, which may have caused the rates of complications to appear lower than those in primary centers. We recommend a multi-center study be conducted to establish more accurate results.

Observation Safely Reduces the Use of the Computerized Tomography in Medium-to-Low-Risk Patients with Suspected Acute Appendicitis: Results of a Randomized Controlled Trial.

Objectives-The objective was to compare the effectiveness of observation in standard-of-care computed tomography (CT) in adult patients with suspected acute appendicitis (AA). Methods-Patients with clinically suspected AA and inconclusive diagnosis after primary clinical examination, laboratory examination, and transabdominal ultrasound (TUS) were eligible for the study, and they were randomized (1:1) to parallel groups: observation-group patients were observed for 8-12 h and then, repeated clinical and laboratory examinations and TUS were performed; CT group (control group) patients underwent abdominopelvic CT scan. The study utilized Statistical Analysis System 9.2 for data analysis, including tests, logistic regression, ROC analysis, and significance evaluation. Patients were enrolled in the study at Vilnius University Hospital Santaros Klinikos in Lithuania between December 2018 and June 2021. Results-A total of 160 patients (59 men, 101 women), with a mean age of 33.7 ± 14.71, were included, with 80 patients in each group. Observation resulted in a reduced likelihood of a CT scan compared with the CT group (36.3% vs. 100% p < 0.05). One diagnostic laparoscopy was performed in the observation group; there were no cases of negative appendectomy (NA) in the CT group. Both conditional CT and observation pathways resulted in high sensitivity and specificity (97.7% and 94.6% vs. 96.7% and 95.8%). Conclusions-Observation including the repeated evaluation of laboratory results and TUS significantly reduces the number of CT scans without increasing NA numbers or the number of complicated cases.

Meta-Analysis and Systematic Review of the Role of Appendectomy in the Pathogenesis of Colorectal Cancer

Aim. Given the potential for physiological alterations in the gastrointestinal tract following appendix removal, which may influence carcinogenesis, we embarked on a systematic review and meta-analysis to explore the possible association between appendectomy and the subsequent risk of colorectal cancer (CRC).Methods. Our systematic investigation utilized sources including the Cochrane Library, Embase, PubMed, ClinicalTrials.gov, and Web of Science, covering research up to February 1, 2023. We assessed the impact of appendectomy on colorectal cancer, employing a random effects model to calculate the pooled hazard ratio (HR) for developing CRC post-appendectomy and its 95 % confidence interval (CI).Results. This review and meta-analysis incorporated a total of 10 studies, comprising 1,001,693 cases of appendectomy and 39,463 instances of CRC. The meta-analysis revealed a pooled HR of 1.04 (95 % CI: 1.0–1.08) for developing CRC following appendectomy. Notably, the HR for CRC development increased to 1.20 (95 % CI: 0.69–1.69) when considering only cases with more than 10 years of follow-up.Conclusion. The findings indicate a marginally increased risk of colorectal cancer in cases without a specified follow-up period. However, this elevated risk did not persist over the long term (exceeding 10 years). The heterogeneity of the included studies appears to have influenced our results. Nevertheless, it is advisable for physicians to weigh the potential benefits of alternative therapies and consider the future complications that may arise from an unnecessary appendectomy.

Enhanced recovery through fast-track pathway for patients undergoing emergency appendectomy: a quality improvement study

Introduction: Acute appendicitis is a highly prevalent condition, with an incidence ranging from 5.7 to 57 cases per 100,000 inhabitants per year. The average hospitalization duration for patients undergoing laparoscopic appendectomy is 2.08 days and 2.88 days for open appendectomy cases. The implementation of Enhanced Recovery After Surgery (ERAS) protocols for early patient recovery reduces hospital stay without an increase in complications or readmissions. The main objective of the study is to analyze the postoperative hospital stay in patients undergoing urgent appendectomy (open or laparoscopic) who follow the clinical pathway included in the ERAS bundle.&#x0D; Materials and methods: Prospective observational study conducted at the Hospital Universitari Parc Taulí, in Sabadell (Barcelona). The results of the patients included in the study were compared with the historical cohort of the hospital with inclusion criteria identical to the study.&#x0D; Results: Between May 2021 and February 2022, 50 patients (24 men and 26 women) were included. Laparoscopic appendectomy was performed in 47 patients and open appendectomy in 3 cases. The mean postoperative stay in the group that followed the clinical pathway was 23 hours, compared to 38 hours in the historical control group, with this difference being statistically significant (p 0.03), without observing an increase in morbidity.&#x0D; Conclusion: The use of clinical pathways in patients undergoing urgent surgery for acute appendicitis reduces the average hospital stay without increasing the risk of complications or readmissions.&#x0D;

Combination of clinical information and radiomics models for the differentiation of acute simple appendicitis and non simple appendicitis on CT images.

To investigate the radiomics models for the differentiation of simple and non-simple acute appendicitis. This study retrospectively included 334 appendectomy cases (76 simple and 258 non-simple cases) for acute appendicitis. These cases were divided into training (n = 106) and test cohorts (n = 228). A radiomics model was developed using the radiomic features of the appendix area on CT images as the input variables. A CT model was developed using the clinical and CT features as the input variables. A combined model was developed by combining the radiomics model and clinical information. These models were tested, and their performance was evaluated by receiver operating characteristic curves and decision curve analysis (DCA). The variables independently associated with non-simple appendicitis in the combined model were body temperature, age, percentage of neutrophils and Rad-score. The AUC of the combined model was significantly higher than that of the CT model (P = 0.041). The AUC of the radiomics model was also higher than that of the CT model but did not reach a level of statistical significance (P = 0.053). DCA showed that all three models had a higher net benefit (NB) than the default strategies, and the combined model presented the highest NB. A nomogram of the combined model was developed as the graphical representation of the final model. It is feasible to use the combined information of clinical and CT radiomics models for the differentiation of simple and non-simple acute appendicitis.

Appendiceal adenocarcinoma, diagnosed after acute perforated appendicitis: Potential contribution of HIPEC

IntroductionTreatment of peritoneal metastasis from appendicular adenocarcinoma consists of cyto-reductive surgery (CRS) and Hyperthermic IntraPEritoneal Chemotherapy (HIPEC). In case of acute appendicular syndrome (AAS) the tumor is likely to be perforated. In that case, there is no treatment recommendation. We propose CRS and HIPEC. Materials and methodWe listed 21 consecutive patients who were addressed for discovery of appendiceal adenocarcinoma. The emergency surgery was performed in a primary-care hospital. We evaluated the therapeutic algorithms, per operative decision, survival and recurrent rate. ResultsAmong the 21 patients, 4 patients were diagnosed as synchronous appendicular peritoneal metastasis, and underwent CRS and HIPEC.The other 17 patients with diagnosis of adenocarcinoma on anatomopathological samples, without peritoneal metastasis during appendectomy, were addressed. Between them 2 patients were denied CRS. Among the 15 operated patients, 8 patients had no peritoneal metastasis discovery during surgery, and therefore underwent prophylactic CRS and HIPEC. Peritoneal metastasis were discovered for the other 7 patients, who also underwent CRS and HIPEC.For the prophylactic group, the recurrence rate is 12,5 %, overall survival (OS) is 100 %.The rate of grade III-IV surgical complications after CRS and HIPEC was 36 % among the 19 patients who underwent surgery. ConclusionIn case of appendectomy in emergency situations for perforated adenocarcinoma, half of the patients may have peritoneal metastasis. In case of non-identified peritoneal metastasis during CRS, performing a prophylactic HIPEC seems to be associated with an encouraging rate of peritoneal disease free situation at 5 years.

EVALUATION OF ALVARADO SCORE IN DIAGNOSIS OF ACUTE APPENDICITIS

Background: Abdominal pain is frequently caused by acute appendicitis, which can be diagnosed early and result in a lower morbidity and death rate. Improved diagnostic procedures should minimize the progression to complicated appendicitis as well as reduce the number of unwanted surgical interventions. However, even with the advancements in diagnostic laboratory tests and contemporary radiographic imaging, appendicitis diagnosis is still primarily clinical. Different scoring methods were developed to reduce the negative appendectomy rate and raise the positive diagnosis rate of appendicitis such as Alvarado score. The present study aimed to evaluate the sensitivity and specificity of the Alvarado score as a method for the diagnosis of acute appendicitis. Methods: A total of 146 operated cases of appendectomy in Zawia Medical Center, Libya were studied. All patients presented during a period from July 2018 to July 2019 with symptoms and signs of acute appendicitis, and after that, they were operated on by the conventional method of open appendectomy. The relevant data was collected and analyzed, and the efficiency of the Alvarado scoring system was assessed by calculating sensitivity, positive predictive value, and negative appendectomy rate. Results: In this study, 100% of patients reported pain as their primary presenting symptom; presentations occurred between one and seven days, with a mean of two days; 100% of patients had surgery; and the overall negative appendectomy rate in Alvarado ≥7 was 5% and 72.5% was the positive predictive value (PPV).Conclusion: Our findings suggest that the Alvarado score has a very high positive predictive value, i.e., diagnostic accuracy. Also, with the help of the Alvarado score, we can reduce the number of negative appendectomies. Besides that, this scoring system is an easy, simple, cheap, reliable, safe, and fast tool in the preoperative diagnosis of acute appendicitis and can work effectively in routine practice.

A case of laparoscopic appendectomy for appendiceal bleeding

BackgroundAppendiceal bleeding is very rare, accounting for about 0.4% of all lower gastrointestinal bleeding. We present a case of laparoscopic appendectomy in a patient with a diagnosis of appendiceal bleeding.Case presentationA 71-year-old man came to our hospital with a complaint of bloody stools. He had progressive anemia and persistent fresh bloody stools, so he underwent lower gastrointestinal endoscopy. Active bleeding was confirmed from the orifice of the appendix, but the bleeding could not be stopped even with clips, so an emergency laparoscopic appendectomy was performed. His postoperative course was good, and he was discharged on the third postoperative day. Although the pathology results did not allow identification of the source of the bleeding, an appendiceal diverticulum was observed, and appendiceal diverticular bleeding was suspected.ConclusionAppendiceal bleeding is often difficult to stop endoscopically, so appendectomy should be performed as soon as possible.

Laparoscopic versus open appendectomy in the management of chronic appendicitis

Background The term ‘chronic appendicitis’ (CA) is still clearly undefined. However, once established, it necessitates appendectomy, which could be performed via open or laparoscopic approaches. Comparisons between the two approaches have been made in acute appendicitis cases, with no previous trials including CA patients. That is why we conducted this study to compare these two approaches in the management of CA patients. Methodology 50 CA were included in our prospective trial, and they were randomly assigned into two groups; the OA group (25 open appendectomy patients) and the LA group (25 laparoscopic appendectomy cases). Results The statistical analysis revealed no significant differences between the two groups regarding most preoperative characteristics. The laparoscopic approach was associated with significant prolongation in operative time that had an average of 1 h in the LA group, while it ranged between 0.5 and 1 h in the OA group (P = 0.005). Nonetheless, laparoscopy led to a significantly better postoperative recovery profile, manifested in the shorter hospitalization period (1 vs. 2 days in the open approach) and less postoperative pain (all patients with mild pain compared with moderate pain in the open group). Only 2 (8%) casesexperienced temporary vomiting in the OA group. Conclusion Laparoscopy is superior to the open approach in the management of chronic appendicitis patients. It is associated with a better analgesic profile, a shorter hospitalization period, and a better chance of detecting other concomitant intraabdominal pathologies. However, the increased operative time should be considered.

Low-grade appendiceal mucinous neoplasms: Histomorphological spectrum in a tertiary care hospital.

Low-grade appendiceal mucinous neoplasms (LAMNs) are benign non-invasive epithelial proliferations of the appendix. These usually present clinically as mucoceles and these rarely exceed 2 cm in diameter. Lesions confined to the lumen are labelled as LAMN; however those in which mucin spreads outside the peritoneum are labeled as pseudomyxoma peritonei (PMP). A retrospective study was conducted over a period of three years and all cases of appendectomies were studied. Twelve cases of LAMN were identified, which is a diagnostic dilemma for the pathologists and clinicians. LAMN was identified based on the histopathological features. Out of the 12 cases, 9 were classified as LAMN and 3 as appendiceal neoplasm with PMP. There was villous or flat proliferation of epithelial lining, loss lymphoid aggregates, and dissecting mucin within muscularis. LAMNs are rare neoplasms of the appendix, with clinical presentation similar to acute appendicitis. Mucinous collections within the appendiceal wall should be extensively searched for mucosal changes and, if found, should prompt a careful search for pushing invasion of LAMNs. A thorough and vigilant gross examination can be of great help. Appendicectomy is the treatment of benign and grossly intact mucinous neoplasm.

Appendiceal collision tumors: case reports, management and literature review.

Appendiceal tumors are incidentally detected in 0.5% cases of appendectomy for acute appendicitis and occur in approximately 1% of all appendectomies. Here, we report two cases of appendiceal collision tumors in two asymptomatic women. In both cases, imaging revealed right-lower-quadrant abdominal masses, which were laparoscopically resected. In both cases, histological examinations revealed an appendiceal collision tumor comprising a low-grade appendiceal mucinous neoplasm and well-differentiated neuroendocrine neoplasm (NEN). For complete oncological control, right hemicolectomy was performed in one patient for the aggressive behavior of NEN; however, histology revealed no metastasis. The other patient only underwent appendectomy. No further treatment was recommended. According to the latest guidelines, exact pathology needs to be defined. Proper management indicated by a multidisciplinary team is fundamental.

A Comparative Study of Propofol and Sevoflurane for General Anesthesia in Laparoscopic Appendectomy

Introduction: Anesthesia plays a vital role in the success of surgical procedures, with the choice of anesthetic agents influencing patient recovery and postoperative complications. Propofol and sevoflurane are two commonly used anesthetic agents, each with distinct properties and implications on patient outcomes. The primary objective of this study was to compare the effects of propofol and sevoflurane on intraoperative hemodynamic parameters, recovery profiles, and postoperative complications in patients undergoing laparoscopic appendectomy. Methods: This prospective randomized trial was conducted over 2 years at Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, and included 180 laparoscopic appendectomy cases. Participants were randomized into two groups: 90 receiving propofol and 90 receiving sevoflurane for general anesthesia. The study received ethical approval from the hospital's review committee. Result: The mean age of patients in the Propofol group was 59.5 years (SD=2.6), while in the Sevoflurane group, it was 56.3 years (SD=7.9). Intraoperative heart rate and recovery profiles showed statistically significant differences between the two groups (p&lt;0.05). The time to eye opening was 6.8 minutes (SD=1.5) for Propofol and 7.4 minutes (SD=1.7) for Sevoflurane. Postoperative complications were significantly higher in the Sevoflurane group: pain (35.56% vs. 24.44%), nausea and vomiting (27.78% vs. 16.67%), and analgesic requirements (44.44% vs. 30.00%). Conclusion: The findings of this study suggest that propofol may be a more favorable anesthetic agent compared to sevoflurane in laparoscopic appendectomy procedures. Propofol demonstrated better intraoperative heart rate control, faster recovery profiles, and reduced postoperative complications, potentially enhancing overall patient outcomes and satisfaction.

Negative Appendectomies: Evaluating Diagnostic Imaging Techniques at General versus Pediatric Emergency Departments

BackgroundAlthough appendicitis is the most common pediatric surgical emergency, the path to diagnosis remains equivocal, with utilization of imaging modalities largely institution dependent. ObjectivesOur objective was to compare imaging practices and negative appendectomy rates between patients transferred from nonpediatric hospitals to our pediatric hospital and primary patients presenting directly to our institution. MethodsWe retrospectively reviewed all laparoscopic appendectomy cases performed at our pediatric hospital in 2017 for imaging and histopathologic results. Two-sample z-test was used to examine negative appendectomy rates between transfer and primary patients. The negative appendectomy rates of patients who received different imaging modalities were analyzed using the Fisher's exact test. ResultsOf 626 patients, 321 (51%) were transferred from nonpediatric hospitals. The negative appendectomy rate for transfer patients was 6.5% and 6.6% for primary patients (p = 0.99). Ultrasound (US) was the only imaging obtained in 31% of transfer and 82% of primary patients. The negative appendectomy rate of US performed at transfer hospitals compared with our pediatric institution was not significantly different (11% vs. 5%, p = 0.06). Computed tomography (CT) was the only imaging obtained in 34% of transfer and 5% of primary patients. Both US and CT were completed for 17% of transfer and 19% of primary patients. ConclusionThe negative appendectomy rates of transfer and primary patients were not significantly different despite more frequent CT use at nonpediatric facilities. It may be valuable to encourage US utilization at adult facilities given the potential to safely reduce CT use in the evaluation of suspected pediatric appendicitis.

The other colon cancer: a population-based cohort study of appendix tumour trends and prognosis.

Appendiceal neoplasms are rare subtypes of colorectal tumours that mainly affect younger patients some 20 years earlier than other colon tumours. The aim of this study was to gain more insight into the histological subtypes of this rare disease and include cases previously excluded, such as mucinous neoplasia. The cohort study included 1097 patients from the Munich Cancer Registry (MCR) diagnosed between 1998 and 2020. Joinpoint analysis was used to determine trend in incidence. Baseline demographic comparisons and survival analyses using competing risk and univariate/multivariate methods were conducted according to tumour histology: adenocarcinoma (ADENO), neuroendocrine neoplasia (NEN), mixed adeno-neuroendocrine carcinoma (MANEC), and low- (LAMN) and high-grade mucinous neoplasia (HAMN). Up to 2016 the number of cases increased significantly [annual per cent change (APC)=6.86, p< 0.001] followed by a decline in the following years (APC=-14.82, p= 0.014; average APC=2.5, p= 0.046). Comparison of all patients showed that NEN (48.4%) and mucinous neoplasms (11.6%) had a considerably better prognosis than ADENO (36.0%) and MANEC (3.0%, p< 0.0001). A multivariate analysis within the NEN and ADENO subgroups revealed that further histological classification was not prognostically relevant, while older age and regional tumour spread at diagnosis were associated with a poor prognosis. ADENO histology with high tumour grade and appendectomy only was also associated with poorer survival. Appendiceal neoplasms are histologically heterogeneous; however, this diversity becomes less relevant compared with the marked difference from cancers of the remaining colon. The previously observed increase in cases appears to be abating; fewer cases of appendicitis and/or appendectomies or changes in histopathological assessment may be behind this trend.

Application of Cold Drink in Post Operation Nausea and Vomiting (PONV) Appendectomy Cases in Lubuklinggau

Introducition: Post Operative Nausea and Vomiting (PONV) is one of the most common complications after surgery, it affects the patient's time recovery and causes discomfort including: pain, electrolyte imbalance, dehydration, risk of aspiration, risk of wound opening and bleeding. The purpose of this study was to see a decrease in postoperative nausea and vomiting scores.&#x0D; Methods: The research design used was quasi-experimental with 2 pre-post test groups. The sample in this study were 42 people with a total of 21 people in the intervention group and 21 people in the control group. The variable in the study looked at the score of postoperative nausea and vomiting. Instruments used by Rhodes INVR. Data analysis used SPSS test with Mann-Withney.&#x0D; Results: There was a significant difference in respondents' scores (p-value = 0.000, &lt; 0.05). In addition, it showed a difference in the average score of the test between the control group (19.00) and the invention group (3.00), with an average difference of 16.00.&#x0D; Conculsion: The application of cold drinks in PONV has proven to be more effective in reducing vomiting nausea. This method can be used as an alternative method in meeting the needs of body fluids when getting complaints of nausea vomiting. To achieve the goal of preventing the occurrence of the impact of vomiting nausea such as preventing dehydration.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution.

This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

Altered gut microbiome composition by appendectomy contributes to colorectal cancer

Appendectomy impacts the homeostasis of gut microbiome in patients. We aimed to study the role of appendectomy in colorectal cancer (CRC) risk through causing gut microbial dysbiosis. Population-based longitudinal study (cohort 1, n = 129,155) showed a 73.0% increase in CRC risk among appendectomy cases throughout 20 years follow-up (Adjusted sub-distribution hazard ratio (SHR) 1.73, 95% CI 1.49–2.01, P < 0.001). Shotgun metagenomic sequencing was performed on fecal samples from cohort 2 (n = 314). Gut microbial dysbiosis in appendectomy subjects was observed with significant enrichment of 7 CRC-promoting bacteria (Bacteroides vulgatus, Bacteroides fragilis, Veillonella dispar, Prevotella ruminicola, Prevotella fucsa, Prevotella dentalis, Prevotella denticola) and depletion of 5 beneficial commensals (Blautia sp YL58, Enterococcus hirae, Lachnospiraceae bacterium Choco86, Collinsella aerofaciens, Blautia sp SC05B48). Microbial network analysis showed increased correlation strengths among enriched bacteria and their enriched oncogenic pathways in appendectomy subjects compared to controls. Of which, B. fragilis was the centrality in the network of the enriched bacteria. We further confirmed that appendectomy promoted colorectal tumorigenesis in mice by causing gut microbial dysbiosis and impaired intestinal barrier function. Collectively, this study revealed appendectomy-induced microbial dysbiosis characterized by enriched CRC-promoting bacteria and depleted beneficial commensals, signifying that the gut microbiome may play a crucial role in CRC development induced by appendectomy.

Meteorological and demographic factors associated with the onset of acute appendicitis in rural islands of Japan

Emergency surgery and hospitalisation has become a burden in rural areas owing to a shortage of surgeons. Acute appendicitis is a common emergency disease. Understanding the aetiology of acute appendicitis could predict emergency surgeries to optimise resource allocation in rural areas. Several studies have pointed out that some meteorological factors are associated with acute appendicitis; however, there is no consensus about these factors. With the geographical advantages, homogenous meteorological effects, and overwhelming medical data collection in the area, this study aimed to explore meteorological and demographic factors associated with acute appendicitis by focusing on the onset day of acute appendicitis. Miyako islands is in southern Japan and it has a subtropical climate. Okinawa Miyako prefectural Hospital (OMH) is the only hospital in the area that conducts emergency surgery. A total of 212 acute appendectomy cases collected over 6 years were analysed for sex, age, onset date, pathology type, perforation, and fecaliths. Meteorological factors (air pressure, air temperature, humidity, precipitation, wind speed, sunlight hours, and lunar age) on the onset day of acute appendicitis were analysed. Significant differences between air temperature 6 and 7 days before onset and the onset day were observed. Higher air temperature, compared to the average value, was significant in acute appendicitis cases. Pathological types were associated with age group, perforation, and fecaliths. Age group was also associated with existing perforation. Increase in temperature throughout the week prior to onset could be an anticipating factor for the onset of acute appendicitis. The meteorological and demographic features associated with the onset of acute appendicitis could become keys to evaluating acute appendicitis risk in the future and contribute to reasonable allocation of scarce surgical resources to rural areas.

Laparoscopic appendectomy in a child with hemophilia A with inhibitors receiving prophylactic treatment with emicizumab

Surgeries in patients treated prophylactically with emicizumab (including surgical procedures with a high risk of postoperative bleeding) are not associated with higher risks or technical difficulties compared with operations in patients receiving standard replacement therapy. On the contrary, the presence of emicizumab in the blood and its maintenance of permanent basic hemostasis allow for the reduction of doses and infusion time of bypassing agents. Patients undergoing surgical procedures with a high risk of postoperative bleeding require an additional hemostatic treatment during the first two or three days after the surgery. Then the duration of hemostatic treatment should be determined individually. We recommend the use of recombinant activated factor VII for the prevention/control of postoperative bleeding in patients with hemophilia A with inhibitors who are currently receiving emicizumab or have received it in the past 6 months. If treatment with anti-inhibitor coagulant complex is required, the daily dose should not exceed 100 units/kg. Here we report the first case of laparoscopic appendectomy in an 8-year-old child with hemophilia A with inhibitors receiving prophylactic treatment with emicizumab. The patient's parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.