Appendectomy Research Articles

Evaluation of optimized sequential screening program of colorectal cancer in current China

To evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer, and provide evidence for the further optimization of colorectal cancer screening program. Using cluster sampling method, 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013. Volunteers of 40 to 74 years old in the census were recruited, and tested by both optimized sequential screening (including questionnaire survey and fecal occult blood test) and colonoscopy for colorectal cancer. Sensitivity and specificity of different screening methods were calculated, respectively. A total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time. 20 colorectal cancer cases, 85 advanced adenoma cases, 271 non-advanced adenomas cases, and 141 non-adenomatous polyps cases were detected. Sensitivity of optimized sequential screening for colorectal cancer, advanced adenomas, and non-advanced adenomas were 70.0% (14/20) , 57.6% (49/85) and 36.5% (99/271) , specificity was 68.7% (1 776/2 587) , 69.2% (1 746/2 522) and 68.9% (1 610/2 336) , respectively. Sensitivity of the fecal occult blood test of colorectal cancer, advanced adenomas and non-advanced adenomas were 70.0% (14/20) , 47.1% (40/85) and 26.6% (72/271), specificity was 79.4% (2 053/2 587), 79.9% (2 014/2 522) and 79.6% (1 860/2 336). The sensitivity of fecal occult blood test and those of optimized sequential screening for colorectal cancer, advanced adenomas was not significant (χ(2) = 0.00, 1.91, all P values > 0.05). Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10.0% (2/20), 14.1% (12/85), 12.9% (35/271), specificity was 87.6% (2 266/2 587), 87.7% (2 211/2 522), 87.6% (2 046/2 336). There were no significant difference between non-advanced adenomas. The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs: chronic diarrhea, chronic constipation, mucus or bloody history, history of chronic appendicitis or appendectomy surgery, chronic cholecystitis or gallbladder surgery, adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70.0% (14/20), 52.9% (45/85), 31.4% (85/271) (χ(2) = 0.38, 1.61, all P values > 0.05). Current optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity. However, further optimization is viable and necessary.

Comparison of the curative effect of transumbilical single hole and routine laparoscope appendectomy

Objective To compare the curative effect of transumbilical single port laparoscopic appendectomy and conventional laparoscope appendectomy .Methods 80 cases with acute appendicitis were divided into single hole group and routine group according to the operation mode ,40 cases in each group .The two groups were given transum-bilical single port laparoscopic appendectomy and conventional laparoscopic appendectomy ,respectively.The clinical efficacy was compared between the two groups .Results The patients in two groups were given successful operation without converted laparotomy .The postoperative anal exhaust time of the single hole group was （21.7 ±6.2）h,which was significantly shorter than that in the routine group [（26.9 ±7.3）h]（t=2.18,P〈0.05）.However,the operation time,intraoperative bleeding amount ,postoperative length of stay ,intraoperative and postoperative complication had no obviously statistical differences between two groups （P〉0.05）.The patients were followed up for 3-21 months,no appendix stump inflammation , appendiceal stump fistula , adhesive ileus and other remote complication appeared . Conclusion Transumbilical single hole has safe and minimal invasive advantages on appendectomy , which can be favorable for the postoperative recovery of bowel function and cosmetic result .If it′s difficult to excise appendix , relevant operation skills shall be applied in accordance with the appendiceal lesions ,which can effectively reduce the occurrence of complication . Key words: Appendectomy; Laparoscopy; Appendicitis; Controlled clinical trial

Clinical efficacy of single-incision and conventional three-port laparoscopic appendectomy: a Meta analysis

Objective To compare the efficacy and safety of single-incision and conventional three-port laparoscopic appendectomy.Methods According to the Cochrane systematic review methods,literatures on the comparison of the effects of single-incision laparoscopic appendectomy (SILA) and conventional three-port laparoscopic appendectomy (CTLA) were searched for in the PubMed,EMBASE,the Cochrane Controlled Trials Register,CNKI,CBM and VIP database.Data including the operation time,pain visual analogue scales scores,duration of postoperative hospital stay,incidence of postoperative complications,mean time of hospital stay and cost between the SILA and CTLA were compared by 2 reviewers.RevMan 4.2 software was used for Meta analysis,and the heterogeneity of the study was analyzed using the 12 test.Categorical variables were presented by odds ratio and 95％ confidence interval (95％ CI),and continuous variables were presented by weighted mean difference (WMD) and 95％C1.Results Eight randomized controlled trials including 1 444 patients were selected.All the patients were subdivided into the adults group (760 patients) and the children group (684 patients).A total of 721 patients received SILA (SILA group) and 723 received CTLA (CTLA group).The operation time of patients who received SILA in the adults group and the children group were significantly longer than those who received CTLA (WMD =4.40,7.39,95％ CI:2.14-6.66,2.16-12.61,P ＜0.05).There were no significant difference in the pain visual analogue scales scores,incidence of postoperative complications and duration of hospital stay between patients who received SILA and CTLA in the adults group and the children group (WMD =-0.34,95 ％ CI:-1.02-0.33,OR=0.97,95％CI:0.64-1.47; WMD=-0.19,95％CI:-1.14-0.76,P＞0.05).The cost of patients who received SILA was significantly higher than those who received CTLA in the children group (WMD =0.87,95 ％ CI:0.26-1.48,P ＜ 0.05).Conclusions There is no obvious advantages of SILA in perioperative and postoperative outcomes when compared with CTLA.Therefore,SILA is only a possible alternative to CTLA other than the preferred method. Key words: Appendicitis; Appendectomy; Laparoscopy, single-incision ; Randomized controlled trials ; Meta analysis

When Diagnosing Appendicitis, Skip the Enteral Contrast

To determine if the addition of enteral contrast improves sensitivity of computed tomography (CT) imaging with intravenous (IV) contrast for diagnosing acute appendicitis, researchers evaluated medical records for 9047 patients who underwent nonelective appendectomies at 56 hospitals in Washington State during 2010 and 2011. Most patients (89%) …

Comparison of the effect of laparoscopic appendectomy and laparotomy surgery in the treatment of chronic appendicitis

Objective To compare the effect of laparoscopic appendectomy and laparotomy surgery in the treatment of chronic appendicitis .Methods According to the different operation mode , 148 patients with chronic appendicitis were divided into the laparoscopic operation group （62 cases） and abdominal operation group （86 cases）. The operation time ,bleeding volume ,the first time of anal exhaust ,hospitalization time and postoperative complications were observed.The patients were followed up for 6 months to 2 years,the postoperative abdominal adhesion and pain were observed .Results The bleeding volume ,the first time of anal exhaust ,hospital stay and hospitalization expenses in the laparoscopic operation group were significantly less than those in the abdominal operation group （ t=3.307, 2.682,2.703,2.830,all P〈0.05）.The operation time of the two groups had no statistical difference （t=0.506,P〉0.05）.After surgery,the number of patients with abdominal abscess ,intestinal obstruction,infection of incision had no statistically significant differences between the two groups （χ2 =1.132,1.305,1.287,all P〉0.05）.The number of patients with chronic pain in laparoscopic operation group was 6 （10.2%）,which was significantly less than that in the control group （19 cases,22.6%） （χ2 =3.956,P〈0.05）.Conclusion The laparoscopic appendectomy has small trauma,quick recovery,that can be widely explored during resection of abdominal adhesion ,with low incidence rate of postoperative chronic pain ,better therapeutic effect . Key words: Appendicitis; Laparoscopes; Surgical procedures

Application of a needle loop retractor in appendectomy

Objective To investigate the value of a needle loop retractor in the appendectomy.Methods The clinical data of 50 patients with appendicitis who were admitted to the Chongqing Ninth People's Hospital from January 2011 to June 2012 were retrospectively analyzed.Two-port laparoscopic appendectomy with the needle loop retractor was performed to all the patients,and its efficacy was analyzed.Patients were followed up at the out-patient department or via telephone till December 2012.Results The operation was successfully completed on all the patients.One patient received triple-port laparoscopic appendectomy because of incomplete exposure.The operation time the time for was (35 ±4)minutes (range,25-75 minutes),the intra-operative blood loss was 5-8 mL,and the time of postoperative anal exhaust was (10.0 ± 1.6) hours (range,6.0-20.0 hours).No complications such as intestinal fistula,incisional infection and abdominal abscess was detected.The results of postoperative pathological examination confirmed that 27 patients were with suppurative appendicitis,13 with perforative appendicitis,10 with acute appendicitis.All the patients were followed up with a mean time of 10 months (range,6-18 months),and no long-term complications such as incisional hernia or adhesive ileus occured.Conclusion Needle loop retractor is simple,economical and practical in appendectomy. Key words: Appendicitis; Appendectomy; Laparoscopy; Two-port

Clinical analysis on umbilical hole laparoscopic appendectomy

Objective To evaluate the clinical curative effect of umbilical hole laparoscopic appendectomy.Methods From October 2012 to December 2013 80 cases of chronic or acute simple appendicitis patients in our hospital were randomly divided into two groups,inclnding 41 cases in the observation group using the umbilical hole laparoscopic appendectomy,while 39 cases in control group,used laparoscopic resection three holes,the two groups were observed and compared on operative time,blood loss,intestinal recovery time,incision scars,surgical complications and patients' satisfaction evaluation index.Results The mean operative time,blood loss,recovery time and scar in observation group were better than those of the control group,operative time,blood loss,intestinal recovery time and scar in two groups mean showed statistical significant difference (P ＜ 0.05),the proportion of total excellent in observation group was higher than that of control group,the two groups were evaluated satisfaction with surgery and showed statistical significant difference (P ＜ 0.05).Conclusion The umbilical hole laparoscopic appendectomy has good clinical effects,with short operation time,a small amount of bleeding in patients with high satisfaction for surgery,deserved to be in clinical practice. Key words: Appendicitis; Umbilical hole; Laparoscopy

Clinical and pathological characteristics in acute complicated appendicitis

To find out the clinical and pathological characteristics in acute complicated appendicitis. A retrospective clinical analysis was made on 742 cases of acute appendicitis from January 2003 to December 2012. All cases underwent appendectomy. Patients were allocated to the acute complicated appendicitis (ACA) group and the acute uncomplicated appendicitis group based on pathological reports. The χ² test was used to check for differences between proportions. Multivariate analysis was made through the Logistic regression. Of 742 patients, 533 were allocated to the ACA group, including acute suppurative appendicitis 306 patients, acute gangrenous appendicitis 100 patients, appendicitis with perforation 59 patients, appendicitis with abscess formation 6 patients and appendicitis with tumor 5 patients. Statistical result shows that the patients of ACA group usually had higher total WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid. Logistic regression also indicated that ACA were mathematically related to high level white blood cell count (>20 × 10⁹/L, OR = 2.717, 95%CI: 1.834-4.027, P < 0.05), local or diffuse muscle guarding (OR = 1.649, 95%CI: 1.047-2.597, P < 0.05), intraluminal stercolith (OR = 2.939, 95%CI: 1.607-5.377, P < 0.05) and periappendiceal fluid (OR = 3.273, 95%CI: 1.424-7.525, P < 0.05). Patients with high level WBC count, local or diffuse muscle guarding, intraluminal stercolith or periappendiceal fluid are likely suffering from acute complicated appendicitis. Appendectomy must be considered as first-line therapy other than conservative antibiotic therapy under these situations.

Using Sugammadex in a Patient With Friedreich Ataxia: A Case Report

Friedreich a taxia is a rare autosomal recessive disease characterized by demyelination of the nervous system, affecting both genders equally, starting in childhood with muscular coordination deficits that may also cause comorbidities such as cardiomyopathy and diabetes. The disease especially affects anesthesia management in patients planning to receive neuromuscular blockers. We aim to discuss the management of anesthesia technique in such a patient that underwent an appendectomy under general anesthesia. J Med Cases. 2014;5(4):232-233 doi: http://dx.doi.org/ 10.14740 / jmc1722w

Effects of unilateral ovariectomy on female fertility outcome

To compare the fertility outcome among women subjected to unilateral ovariectomy and other abdominal or non-gynaecologic pelvic surgery. In this retrospective cohort study, 113 fertile women, surgically treated between 1990 and 2001 at Sapienza University of Rome with unilateral ovariectomy (UO), appendectomy (AP) or cholecystectomy (CO) for benign disease, were analysed for fertility outcome. Patients with assessed pre-surgical fertility defects, previous abdominal or pelvic surgeries and post-surgical contraception were not included. Thirty-five women underwent UO, 39 were subjected to AP and 39 were treated with CO. After a minimum 10-year post-surgical interval, the overall number of successful pregnancies was 75. The rate of women who experienced at least one post-operative successful pregnancy was: 48.5 % in UO, 41 % in AP and 53.8 % in CO (UO vs. AP, P = 0.55; UO vs. CO, P = 0.99; AP vs. CO, P = 0.53). One patient (2.8 %) in UO, one patient (2.6 %) in AP and two patients (5.1 %) in CO underwent Assisted Reproductive Technology to become pregnant. The rate of women who reported at least one miscarriage was: 10/35 (28.5 %) in UO, 11/39 (28.2 %) in AP, 12/39 (30.8 %) in CO (UO vs. AP, P = 0.93; UO vs. CO, P = 0.89; AP vs. CO, P = 0.81). One ectopic pregnancy was reported in CO group and one stillbirth occurred in one AP patient. No statistical difference in terms of post-operative fertility outcome between patients subjected to UO, AP or CO was found, thus allowing to suppose that the removal of one ovary does not significantly worsen the female fertility outcome respect to other abdominal or pelvic procedures.

A Comparison of Laparoscopic Versus Open Appendectomy for The Treatment of Acute Appendicitis in Children

Bulgular: Klinigimizde Nisan 2011-Haziran 2012 tarihleri arasinda akut apandisit tanisiyla 52 hastaya (36 E, 16 K) cerrahi tedavi uygulanmistir. Yas ortalamasi 10±3.8 yildir (2-17y). Hastalarin 30’una laparoskopik, 22’sine acik apendektomi uygulanmistir. Laparoskopik baslanan 31 hastanin 30’unda islem laparoskopik olarak sonlandirilmistir. Ortalama ameliyat suresi LA grubunda 43±11 dk., AA grubunda 41±22 dk. saptanmistir (p>0.05). Ameliyat sonrasi beslenmeye baslama zamani LA grubunda ortalama 1 gun, AA grubunda 1.2 gundur (p>0.05). Hastanede yatis suresi LA grubunda 2.4±0,5 gun, AA grubunda 3±1 gun saptanmistir (p>0.05). Ameliyat sirasinda gelisen komplikasyon olarak bir hastada laparoskopi sirasinda endoskopik aletin ucunun kirilip batina dusmesi nedeniyle aciga gecilmesi gerekmistir. Ameliyat sonrasi komplikasyon olarak LA grubunda bir hastada intraabdominal apse ve bir hastada yara yeri enfeksiyonu gozlenmistir. AA grubunda postoperatif komplikasyonla karsilasilmamistir. Her iki grupta da ameliyat sonrasi intestinal yapisiklik ve insizyonel herni gozlenmemistir. Ameliyat sonrasi ortalama takip suresi 7±3.4 aydir (1-14 ay). Hicbir hastada mortalite izlenmemistir.

Nursing study on the integrated traditional Chinese and western medicine for postoperative infection of incision after the excision of acute appendicitis on children

Objective To explore clinical effect and nursing experience of integrated traditional Chinese and western medicine in the treatment of postoperative infection of incision after the excision of acute appendicitis in children .Methods Totals of 122 cases of acute appendicitis in children were randomly divided into treatment group and control group .All the patients were given operation appendectomy and conventional anti-infection treatment after surgery .Treatment group （ n =61 ） was treated with astragalus injection plus individualized systematic nursing intervention .The infection of incision and healing of incision were observed and compared.Results The incidence of incision infection and abscess in treatment group were 6.6%（4/61） and 3.3%（2/61）, which were significantly lower than those in control group 19.7%（12/61） and 13.1%（8/61）, with significant differences （χ2 =4.60,3.92,respectively;P 0.05）.The healing of incision of treatment group was better than that of control group （Z =2.51,P<0.05）.Conclusions Integrated traditional Chinese and western medicine combined with intensive care can effectively control postoperative infection of incision after the excision of acute appendicitis in children, and improve the healing of incision . Key words: Traditional Chinese medicine; Appendicitis; Nursing; Children; Infection of incision

Invited commentary on: Hornby et al. “Delay to surgery does not influence the pathological outcome of acute appendicitis” Is it Safe to Postpone Surgery for Acute Appendicitis?

The development of necrosis of the appendix increases the risk of perforation with peritonitis. Mechanical obstruction of the lumen, inflammation-induced ischemia, thrombosis, and bacterial overgrowth together contribute to the development of gangrene. In addition, genetic factors may play a protecting role in response to local infection, thus preventing progression of inflammation into gangrene (1). Necrosis does not develop during the earliest phase of the inflammation. If necrosis of the appendix develops, it does not immediately proceed to perforation as many non-perforated appendices have gangrene in pathological examination. On the contrary, perforation occurs always at the site of gangrenous wall of the appendix. A number of earlier studies have demonstrated that longer duration of symptoms before surgery is associated with perforation of the appendix (1–3). Early diagnosis and surgical removal of the appendix has therefore been a gold standard in patients with appendicitis in order to prevent perforation and peritonitis. Hornby and colleagues report results of a registry-based study of over 2400 patients operated on for suspected appendicitis. The main finding in the study was that the proportion of patients having their normal appendix removed increased as the time interval to surgery increased but the proportion of necrotic appendicitis did not change. These results most likely reflect problems in diagnostic workup in patients with suspected appendicitis. The decision to operate was most probably done earlier in those patients with typical signs and symptoms whereas in other patients more follow-up or other diagnostic workup may have been needed before the decision to operate was done. The high proportion of normal appendices found at surgery probably indicates that computed tomography (CT)-scan was not used in patients with suspected appendicitis during the

Could a White Blood Cell Cutoff Reduce Negative Appendectomy Rates in Children

To identify clinical predictors of negative pediatric appendectomies, investigators retrospectively reviewed charts for 847 children (median age, 13

A Very Rare Complication After Appendectomy in a Young Adult Patient: Abscess of the Greater Omentum

An 18-year-old male patient was operated on for perforated appendicitis. An appendectomy combined with an omental resection was performed. On the 6th postoperative day, chickenpox was diagnosed, and the patient was transferred to an infectious diseases hospital. On the 16 th postoperative day, the patient was readmitted with pain in the area of the postoperative scar, and body temperature of 38 o C . Substantial tenderness in the right iliac fossa without rigidity and peritoneal irritation was found on examination. By ultrasonography, a non-homogeneous hypoechoic mass measuring 40 × 37 mm without clear borders in the right iliac fossa was visualized, with a small amount of free fluid. The patient was reoperated on. An abscess of the greater omentum was found, and resection of an omental mass with the abscess cavity was performed. The postoperative course was uneventful, and the patient was discharged on the 15 th day. We discuss previously published data on postoperative omentitis and omental abscess. Our case is a very rare case of an omental abscess that developed after appendectomy in a young adult patient. J Med Cases. 2014;5(1):36-39 doi: http://dx.doi.org/10.4021/jmc1654e

Amyand Herni: Olgu sunumu

Existence of non-inflamed or inflamed vermiform appendix in an inguinal hernia is named Amyand’s hernia. A 37-year-old male patient with a slight right groin pain and swelling was presented to our clinic, and found to have reducible right inguinal hernia. He underwent surgery under spinal anesthesia, and inflamed appendix were explored within the hernia sac. Appendectomy and hernioraphy without prostetic mesh was performed. The patient was discharged on the postoperative 3. day uneventfully.

Introduction of a New Policy of no Nighttime Appendectomies: Impact on Appendiceal Perforation Rates and Postoperative Morbidity

Working hour limitations and tight health care budgets have posed significant challenges to emergency surgical services. Since 1 January 2010, surgical interventions at Berne University Hospital between 23:00 and 08:00 h have been restricted to patients with an expected serious adverse outcome if not operated on within 6 h. This study was designed to assess the safety of this new policy that restricts nighttime appendectomies (AEs). The patients that underwent AE from 1 January 2010 to 31 December 2011 ("2010-2011 group") were compared retrospectively with patients that underwent AE before introduction of the new policy (1 January 2006-31 December 2009; "2006-2009 group"). Overall, 390 patients were analyzed. There were 255 patients in the 2006-2009 group and 135 patients in the 2010-2011 group. Patients' demographics did not differ statistically between the two study groups; however, 45.9 % of the 2006-2009 group and 18.5 % of the 2010-2011 group were operated between 23:00 and 08:00 h (p < 0.001). The rates of appendiceal perforations and surgical site infections did not differ statistically between the 2006-2009 group and the 2010-2011 group (20 vs. 18.5 %, p = 0.725 and 2 vs. 0 %, p = 0.102). Additionally, no difference was found for the hospital length of stay (3.9 ± 7.4 vs. 3.4 ± 6.0 days, p = 0.586). However, the proportion of patients with an in-hospital delay of >12 h was significantly greater in the 2010-2011 group than in the 2006-2009 group [55.6 vs. 43.5 %, p = 0.024, odds ratio (95 % confidence interval 1.62 (1.1-2.47)]. Restricting AEs from 23:00 to 08:00 h does not increase the perforation rates and occurrence of clinical outcomes. Therefore, these results suggest that appendicitis may be managed safely in a semielective manner.

Clinical analysis of 29 cases with neuroendocrine neoplasm in the digestive system

To investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system. Clinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification. There were 19 males and 10 females and the average age was 46.5 years. All the patients had no clinical manifestations of carcinoid syndrome, and they all received surgical treatment. Two cases were gastric neuroendocrine carcinoma(NEC), who received radical total gastrectomy and distal gastric resection respectively. Three cases had neoplasm in the duodenum, including 2 NEC and 1 neuroendocrine tumor(NET), and they all underwent Whipple's procedure. Two cases were small intestine NEC, who received partial small intestine resection. Three cases had neoplasm in the appendix, including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy. One case was ascending colon NEC, who received right hemicolectomy. Eighteen cases had neoplasm in the rectum, including 4 NEC treated with low anterior resection and abdominoperineal resection respectively, and 14 cases of NET underwent low anterior resection, local resection, and endoscopic resection respectively. The 1- and 3- year survival rates of 13 NEC cases were 38.4% and 7.7% respectively. The 5-year survival rate of 16 NET cases was 81.3%. NEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific. Radical resection of NEN is the preferred treatment. The prognosis of NEC is poor, and that of NET is better.

Clinical analysis on laparoscopic appendectomy and open appendectomy for acute appendicitis

Objective To investigate the application of laparoscopic appendectomy (LA) and open appendectomy (OA) for acute appendicitis.Methods A retrospective data collection was carried out to patients undergoing either an LA or OA at our surgical department from July 2010 to Jan 2013.Results The operative time was (35.5 ± 2.8) min and (38.1 ± 3.4) in LA and OA groups,respectively.The hospital stay was (7.2 ± 2.5) days in OA group while it was (3.1 ± 1.5) days in LA group.The complication was 0.04％ and 0.13％ in OA group and LA group,respectively.Conclusion LA is superior to OA in operation time,postoperative recovery and complication.The laparoscopic appendectomy is a safe and efficient approach to treat acute appendicitis. Key words: Laparoscopic appendectomy (LA); Acute appendicitis

Female appendicectomy – Later and longer?

Female appendicectomy – Later and longer?