Conventional Appendectomy Research Articles

Case Report of Appendiceal Mucocele

Appendiceal mucocele is an appendicular dilation secondary to intraluminal accumulation of mucosal material. Appropriate preoperative diagnosis and surgical resection remain the standard treatment. Here we present the case of a female patient in her third decade who came to the emergency room due to abdominal pain, with a tomography suggestive of appendiceal mucocele, for which she underwent surgery and a conventional appendectomy was performed without complications. The histopathological examination demonstrated simple appendiceal mucocele. without neoplastic activity, at follow-up in one year without recurrences.

Neuroendocrine Tumor of The Appendix: Retrospective 7266 analysis of Appendectomy Patients in a single center

Objective: We aim to identify appendiceal neuroendocrine tumors (NETs) seen after acute appendicitis and investigate their incidence in patients with laparoscopic or open appendectomy surgery. Here we have shaped the characteristic features of the tumor according to the 2010 classification rating of The World Health Organization (WHO) (surgical margin, invasion, grading, TNM stages) and also explored the disease-free survival in these patients. Material and Methods: This is the medical record of the patient with 7266 appendectomy retrospectively evaluated, and with these examples in histopathological analysis, a total of 43 patients were diagnosed with appendicitis NETs and included in the study. Age, gender, prediction of the surgical team during the operation, location of the tumor, WHO grade, depth of invasion, positive surgical margin, tumor size, TNM stage, and postoperative survival of these patients were analyzed retrospectively. Results: In this study, the incidence of appendiceal (NETs) was found to be 0.59% among 7,266 patients. Out of the 42 patients with appendiceal NETs, 27 were female and 16 were male. The mean age of the patients was 33.65 years (range: 11–78). The diagnosis was aided by clinical examination, ultrasound, and abdominal computerized tomography (CT) imaging. Most patients were initially diagnosed with appendicitis, and surgical interventions, including laparoscopic and conventional appendectomy, were performed. The pathological analysis confirmed appendicitis with NETs, classified according to the WHO 2010 recommendation. The majority of patients had well-differentiated NETs (G1 or G2). Surgical resection achieved negative radial margins, and no pathological signs were detected during follow-up colonoscopies. At a median follow-up of 70.2 months, all patients remained disease-free and alive. Conclusion: Appendiceal neuroendocrine tumors are rare but distinct entities that require a multidisciplinary approach for diagnosis and management. Surgical resection is the primary treatment, with systemic therapies reserved for advanced cases. The prognosis is generally favorable, with better outcomes seen in well-differentiated tumors. Long-term follow-up is crucial. Further research is needed to improve understanding and optimize treatment strategies for these tumors.

Soluciones antisépticas en la prevención de infección de herida quirúrgica en pacientes operados por apendicitis aguda complicada

Surgical wound infection secondary to complicated acute appendicitis is frequent. The objective was to compare the Dakin and the Superoxidative solutions to prevent surgical wound infections in complicated acute appendicitis. It was a comparative, cross-sectional study, in 104 patients with complicated acute appendicitis (medium age 36.29 years, 69(66.43%) men). Group 1: 52 patients with surgical wound lavage with Dakin modified solution. Group 2: 52 patients with superoxidative solution (Microdacyn®). All patients received ceftriaxone 1 g before surgery; conventional appendectomy was performed and the wall closure with Vicryl 1 and Nylon 2/0. Surgical wound was evaluated 7 days after surgery, looking for pus, edema, erythema, local heat. X2 and Student's t were used. Surgical wound infection was present in 11 (10.6%) patients, 3(5.8%) patients from group 1 and 8(15.4%) from group 2 (p=0.1). Both solutions are useful to prevent surgical wound infections in patients operated by complicated acute appendicitis.

ОПЫТ ОРГАНИЗАЦИИ И РЕЗУЛЬТАТЫ ОКАЗАНИЯ НЕОТЛОЖНОЙ ХИРУРГИЧЕСКОЙ ПОМОЩИ В Г. СИМФЕРОПОЛЬ В ПЕРИОД ПАНДЕМИИ COVID-19

Despite of numerous publications, concerning problems of herniology, those that are dedicated to the treatment of hernia after conventional appendectomy are few. Reports about interparietal hernias can be reputed as casuistry. The aim of our study was a research of features of clinical course of interparietal hernias after appendectomy, their structure and optimization of surgical treatment. 11 patients with interparietal hernia were included among them 3 had subaponeurotic hernia, 8 – double-level. Men were 4 patients, women – 7, middle-sized hernia occurred in 5, large in 4, giant in 2 cases. According to EHS classification hernias were L1-2- 3W1L1R0 – 2, L2-3W2L1R0 – 1, L2-3W2L2R0 – 6, L3W1L1R0 – 2. The examination was routine, and in doubtful cases included ultrasound. During the examination the features of clinical picture were revealed: - 6 patients didn`t have complaints on tumor like mass, palpation didn`t show exact size of hernia and a hernia ring. Ultrasound gave information about size of hernia ring and reducibility. The type of surgery depended on the size of hernia ring, if they didn`t exceeded 5 cm there was used autoplasty, if so – alloplasty. It was shown: that features of clinical picture were lack of complaints on tumor like mass, inability to determine the size of hernia and it`s ring. Feature of structure of such hernia is that the size of intermuscular hernia sac is much bigger than the subcutaneous one. It can confuse during surgery and lead to clothing of hernia defect only in external oblique aponeurosis, leaving a problem uncorrected.

Microbiota Assessment of Pediatric Simple and Complex Acute Appendicitis.

Background and Objectives. The aim of this study is to determine the prevailing microbiota in samples from pediatric patients with acute appendicitis, as well as evaluate the antibacterial sensitivity of the isolated microorganisms, comparing the data obtained with the clinic’s antibacterial therapy guidelines. Materials and Methods. The study group consisted of 93 patients between the ages of 7 and 18. All patients underwent a laparoscopic or conventional appendectomy. The children were hospitalized with signs and symptoms suggestive of acute appendicitis. Microbiological cultures from the appendix and abdominal cavity were collected intraoperatively. Results. E. coli was identified in most cases irrespective of the clinical presentation of acute appendicitis. Most strains were susceptible to ampicillin and amoxicillin/clavulanic acid. Five strains of E. coli produced extended spectrum beta-lactamase (ESBL). Pseudomonas aeruginosa (P. aeruginosa) was the second most commonly isolated causative agent. Furthermore, it was common in cases of acute complex appendicitis. Most strains of P. aeruginosa were resistant to amoxicillin/clavulanic acid, ertapenem, ampicillin and cefotaxime, yet were susceptible to ceftazidime. Regardless of the clinical presentation, the samples yielded mixed isolates. Conclusion. E. coli is the main causative agent of acute appendicitis in the pediatric population displaying susceptibility to various antibiotics. P. aeruginosa was more prevalent in cases of acute complex appendicitis. P. aeruginosa isolates were susceptible to ceftazidime; however, they were resistant to cefotaxime, which should, therefore, be removed from guidelines for empirical antibacterial treatment of acute appendicitis due to phenotypic resistance of P. aeruginosa. We recommend antibiotics with distinct implementation to avoid antibiotic resistance.

Comparison of Outcomes of Laparoscopic and Open Appendectomy in Management of Appendicitis

Objective: To compare the outcomes in relations to postoperative pain and complications, and hospital stay of laparoscopic versus open appendectomy in management of appendicitis.
 Study Design: Cross sectional study.
 Place and Duration of Study: This study was conducted in department of surgery Unit III of PUMHS Nawabshah and Suleman Roshan Medical College Tando Adam, Sindh Pakistan, from January 2020 to December 2021.
 Methodology: This study consisted of 136 consecutive cases of either gender, aged between 13 to 60 years, that were enrolled during study period and matching with the inclusion and exclusion criteria. After the permission of ethical committee, a detailed history was taken from all the patients with special regard to the pain in RIF, Pain starting around umbilicus, nausea, vomiting, fever and altered bowel habits. All the cases were randomly divided into Group A comprising of 68 cases which were operated by conventional open appendectomy (OA) and other group B also comprising of 68 cases which were operated by laparoscopically appendectomy (LA). All the clinical and demographic data was collected on a proforma designed for the study, and analyzed by using Statistical Package for Social Science (SPSS) software version 22. Effect modifier like age, gender was controlled by stratification and chi-square test was applied to see the effect of these on both open versus laparoscopic appendectomy outcome variable. P <0.05 was taken as significant.
 Results: In open appendectomy group male:female ratio of 1.2:1 and in laparoscopically appendectomy group male:female ratio of 1.5:1. The mean age was 31.28±4.30 years for OA group and 35.47±3.23 years for LA group (p 0.02).Alvarado score was showed <4 Score 0% in both groups, where as 4-7 Score in 9(13.23%) patients of OA group and 8(11.76%) patients of LA group, and > 7 Score was seen in 59(86.76%) patients of OA group and 60(83.23%) patients of LA group. The mean time in OA group was 45.21±12.1 minutes and LA group was 43.44±9.4 minutes (p 0.026).Mild pain was felt in 7(10.29%) patients of OA group and 39(57.35%) patients of LA group, Moderate pain was seen in 31(45.58%) patients of OA group and 26(38.23%) patients of LA group, severe pain was described by 30 (44.11%) patients in OA group and 3(4.41%) patients in LA group (p 0.005).The common complications seen in this study Ileus was 29(42.64%) patients in OA and 18(26.47%) patients in LA group) followed by wound infection 10(14.70%) patients in OA and 1(1.47%) patients in LA group. The duration of hospital stay was longer about 3-4 days in 58(85.29%) of OA patients as compared to LA cases where majority 65(95.58%) were discharged within 2 to 3 days. 
 Conclusion: We conclude that laparoscopic appendectomy procedure has a low rate of complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period than open appendectomy procedure.

The Epidemiological Profile of Acute Appendicitis, about 124 Cases, in the General Surgery Department of the Amissa Bongo Regional Hospital Center in Franceville, Gabon

Acute appendicitis is an acute inflammation of the appendix. It is a surgical emergency. It was a prospective, descriptive and analytical study, between September 2015 and October 2021, focusing on acute appendicitis. It is seen mainly in young subjects and in children, but not exclusively. Its diagnosis is essentially clinical. These were 124 patients operated on for acute appendicitis, with a male predominance: 78 men (62.90%) against 46 women (37.10%). The majority of patients came from Franceville (n = 66) 53.22%. The average age was 29.4 years (extremes 4 years and 54 years). The average admission time was +5.16 or -5.58 hours. Abdominal pain was the main reason for consultation. Physical signs were dominated by MAC Burney sign positivity in 91.1% of cases. Faced with certain doubtful cases, we requested an abdominal ultrasound. Phlegmonous appendicitis was the most frequent (n = 47) 45.96%. The ileocecal localization represented (n = 82) 66.12%, and other particularities in particular: Claudius AMIAND (n = 6), an appendicular duplication, appendicitis and pregnancy a case of crural appendicitis. Conventional appendectomy with burial by Mac Burney was the most used technique (n = 119) 95.42%. Anatomy pathology was rarely performed. The postoperative course was simple in 95.4% of cases. The average stay in inpatient surgery was 4.8 days. Isolated or combined antibiotic therapy was the rule. Postoperative follow-up at 1 month was systematic. Parietal suppuration was the main complication.

Pseudomixoma Peritonei as an Unusual Tumor in a Kidney Donor

Introduction: Pseudomixoma peritonei is a neoplasia originating from the appendix, with an incidence of 2-4 per million habitants. Clinical presentation is variable, from asymptomatic to appendicitis, intestinal obstruction, or perforation, and is usually diagnosed incidentally at image studies or by laparoscopy when performing a conventional appendectomy. Case presentation: 40-year-old male with history of successful left kidney donation developed a pseudomixoma peritonei. At image examination, a CT revealed hypermetabolic activity consistent with peritoneal carcinomatosis, treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was established with good results and has been followed up for 4 years with no evidence of recurrent disease and adequate kidney function. Conclusion: Association of appendiceal neoplasms in organ donors has been unusual when developed most common present as carcinomatosis, combined treatment with cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy has shown the best long-term survival for appendiceal neoplasms.

Acute Appendicitis in Situs Inversus Totalis: A Case Report and Review of Literature

Acute appendicitis is the most common surgical condition seen in the emergency unit. In most cases, the diagnosis is straightforward, but sometimes maybe not easy as it may be presented in an atypical manner like unusual pain in the left iliac fossa. A 10-years-old boy was presented with an acute abdomen started in the periumbilical area and thereafter, shifted to the left iliac fossa. Chest X-ray and abdominal CT scan was confirmed the diagnosis of acute appendicitis with situs inversus totalis (SIT). Conventional appendectomy was performed with a good outcome. In addition to the detailed history and proper examination, a high index of suspicion and radiological investigations are mandatory to diagnose acute appendicitis in subjects with SIT.

Ingesta de proyectil de aire comprimido asociado a apendicitis aguda perforada

We report the case of a 28-year-old male patient with a history of voluntary ingestion of a metallic pellet 20 days before who was transferred to our department with typical symptoms of acute appendicitis. Under that circumstances he underwent conventional appendectomy. The analysis of the preoperative imaging tests and the intraoperative findings help to identify the association between the foreign body and acute appendicitis. Ingestion of foreign bodies, either accidental or voluntary, is an extremely uncommon cause of acute appendicitis; thus, there are few reports in the international literature. This is the first case reported in Argentina.

Evaluation of emergency general surgery operations in COVID-19 patients in a pandemic hospital: a single center experience

Background: During the pandemic, the decision on delaying elective surgeries was implemented country-wide, and emergency surgeries were excluded from this scope. In this study, the patients diagnosed with COVID-19 and who underwent an emergency general surgery operation were evaluated regarding indications, demographic characteristics, and preoperative and postoperative clinical features.Methods: In the study, emergency surgeries performed by the department of general surgery between 1st June and 30th September, when our center cared only patients diagnosed with COVID-19, were reviewed retrospectively.Results: A total of 13 patients, 7 women and 6 men, were included in this study. The most common surgical diagnosis was acute appendicitis (9/13). For all of the patients with appendicitis, a conventional appendectomy procedure was performed. 2 patients were diagnosed with an incarcerated femoral hernia and then operated (2/13). One patient was operated on due to a sharp object injury, and one due to an acute abdomen caused by a perforation. Only 3 of the operated patients developed postoperative wound site complications (23%). No mortality was observed by the end of a 15-day follow-up.Conclusions: The most common cause of emergency surgeries during the pandemic, changelessly, remains to be acute appendicitis. Besides, cases of trauma, perforated peptic ulcer, and incarcerated hernia are also commonly encountered. While the pandemic continues full steam, these conditions that are associated with the pandemic but among causes of mortality and morbidity other than COVID-19 and that may require an emergency surgery should be considered. All emergency surgical procedures should continue to be performed punctually by using necessary protective types of equipment.

Influence of Covid -19 on the management of Appendicitis

Objective: Acute Appendicitis encounters as the frequent problem in surgical pediatric patients leading to Appendectomy, being one of the most common procedures performed in surgical Emergency. During COVID-19 pandemic, the trends in the management of acute appendicitis have changed. Conservative management of appendicitis with antibiotics is being proposed as an alternative to conventional appendectomy. So, this study is conducted to compare the presentation and outcome of Appendicitis managed during pre and post pandemic period in our settings. Methodology: After approval of Ethical Review Committee, a total of 267 patients of age 1-12 years were selected for the study. It was a retrospective Cohort Study. Patients were divided into group A (n=145) which was pre pandemic group. Data was collected retrospectively from charts regarding demographics, presentation, duration of stay operative findings and complications from May-Oct 2019 and Group B (n=122) during covid-19 was collected from the patients presented with appendicitis over a period of six months from May-Oct 2020 . Similar months of the year were selected to remove seasonal variation in the presentation of Appendicitis. All information was collected on a predesigned Performa. Data was compared and analyzed on SPSS 20. Results: Out of 267 patients, 151 (56.56%) were male. Group A patients presented during pre-pandemic period (n=145) were undergone appendectomy for appendicitis in 129 patients (88.96%) with 59 patients (40.68%) having acutely inflamed appendix and 70 patients (48.27%) had complicated appendicitis such as gangrenous, perforated with generalized peritonitis. In Group A only 16 patients (11.03%) were managed conservatively for appendicular mass. In contrast to group B (n=122) presented during pandemic, only 43 patients (35.24%) were operated with findings of acutely inflamed appendicitis while gangrenous/perforated appendicitis with pelvic abscess and/or generalized peritonitis was found in most of the patients with a number of 69 (56.55%), only 10 (8.19%) patient presented as Appendicular mass hence managed conservatively. Conclusion: Delay in presentation and early conservative management during pandemic crisis has resulted in an increase in the complications of Appendicitis. Early referral to specialized centers with vigilant selection for conservative treatment can save patients from developing complications. Keywords: Appendicitis, covid-19, Appendectomy, complications, Pandemic

Conventional versus small incision appendectomy: a retrospective randomized controlled trial study

Background: Open appendectomy is practiced for more than a century and in the recent times small incision appendectomy is also practiced frequently. The efficacy of conventional appendectomy and small incision appendectomy in terms of pain, operating time and duration of hospital stay and have produced conflicting results. Hence this study was conducted to assess the same. Methods: A hospital based randomized controlled trial study was conducted among the patients with appendicitis undergoing surgical intervention for the same in department of general surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, during the study period from January 2017 to December 2019. A total of eighty cases with acute appendicitis were included in the study. Group A (n=40) includes conventional open appendectomy cases and group B (n=40) includes small incision open appendectomy cases. Data entry was done using Microsoft excel and data was analyzed using SPSS version 17. Results: Blood loss, post-operative pain scores on day 1 and day 2, duration of hospital stay were found to be reduced in Small incision open appendectomy group compared to conventional open appendectomy group. Duration taken to resuming the normal activities and the complications were found to be similar in both conventional and small incision appendectomy group and small incision open appendectomy group. Conclusions: Small incision open appendectomy is superior to conventional open appendectomy in terms of length of hospital stay, return to normal activity, blood loss and postoperative pain scores, which are considered the major advantages of minimally invasive surgery.

NEEDLESCOPIC APPENDECTOMY IN PEDIATRIC PATIENTS

Background: Acute Appendicitis (AA) is one of the most common surgical emergencies in children. Its spectrum ranges from simple inflammation to gross perforation. Objective: To evaluate the feasibility, safety, efficacy and merits of using approach by using instruments have diameter ≤ 2 mm. as suture grasper devices Patients and Methods: Needlescopic appendectomy (NA) accomplished for 40 patients with uncomplicated appendicitis, and attended to the Pediatric Surgery Department of Al-Azhar University Hospitals, in Cairo, Egypt, and Mataria Teaching Hospital during the period from May 2019 to February 2020. We used 18-G epidural needle (EN), Veress needle and a thin homemade insulated long diathermy probe (LDP) without any conventional laparoscopic instruments. Results: NA was attempted in 40 patients equally divided between males and females. Under general anesthesia, the operations were completed without conversion to open appendectomy. Twenty-eight cases were compeleted intra corporeally and 12 cases were completed extra corporeally. Mean operative time was 30.2+4 minutes for intracorporeal and 22.5+ 6 minutes for extra corporeal. Conclusion: NA was safe, easy and minimally invasive with cosmetic advantages over conventional appendectomy.

NEEDLESCOPIC APPENDECTOMY IN PEDIATRIC PATIENTS

Background: Acute Appendicitis (AA) is one of the most common surgical emergencies in children. Its spectrum ranges from simple inflammation to gross perforation. Objective: To evaluate the feasibility, safety, efficacy and merits of using "Needlescopic" approach by using instruments have diameter ≤ 2 mm. as suture grasper devices Patients and Methods: Needlescopic appendectomy (NA) accomplished for 40 patients with uncomplicated appendicitis, and attended to the Pediatric Surgery Department of Al-Azhar University Hospitals, in Cairo, Egypt, and Mataria Teaching Hospital during the period from May 2019 to February 2020. We used 18-G epidural needle (EN), Veress needle and a thin homemade insulated long diathermy probe (LDP) without any conventional laparoscopic instruments. Results: NA was attempted in 40 patients equally divided between males and females. Under general anesthesia, the operations were completed without conversion to open appendectomy. Twenty-eight cases were compeleted intra corporeally and 12 cases were completed extra corporeally. Mean operative time was 30.2+4 minutes for intracorporeal and 22.5+ 6 minutes for extra corporeal. Conclusion: NA was safe, easy and minimally invasive with cosmetic advantages over conventional appendectomy.

Laparoscopic appendectomy is an appropriate initial way in acute appendicitis surgery

Aim and design Appendectomy is the treatment of acute appendicitis and still has no standard surgical technique. The purpose of this study is to compare conventional open appendectomy (OA) and laparoscopic appendectomy (LA) techniques, in terms of different parameters. Patients and methods A total of 169 patients were retrospectively analyzed. The patients were divided into the OA (n=85) and the LA (n=84) groups. Groups were compared in terms of age, sex, BMI, Charlson comorbidity index, leukocyte levels, C-reactive protein levels, and operative findings. Results There was a statistically significant difference between the two groups in terms of sex (P=0.006) and leukocytosis (P=0.009). The number of female patients was found to be higher in the LA group, and more leukocytosis was seen in the OA group. The operation time was shorter in the OA group (P=0.001). Considering the complication rates, there was a statistically significant difference against the OA group (P=0.042). Conclusions LA has higher recovery rates, has fewer complication rates, requires shorter hospital stay, and provides advantage in patients with high comorbidity. In acute appendicitis, first option in surgical intervention should be LA. Therefore, it is recommended that LA learning curve of the general surgery residents should be increased.

Laparoscopic or Open Appendectomy following Acute Appendicitis during Pregnancy: A Systematic Review

Objective: To evaluate the best surgical approach for the appendicitis during pregnancy in all trimesters. Methods: Systematic review conducted in MEDLINE® Cochrane, EMBASE and LILACS database up to February 16th, 2020. Articles were selected according to study type, type of intervention and outcomes. Articles were selected by more than one researcher based on title, abstract and full text. The SIGN checklist was used for bias assessment. Results: A total of 55 articles were retrieved from MEDLINE® via Pubmed, Cochrane, LILACS and EMBASE. Sixteen studies were elected for full text reading, and fifteen of them were selected for the concluding paper evaluation. Conclusion: Articles revealed higher effi cacy in the laparoscopic appendectomy when compared to conventional open appendectomy in all trimesters.

Apendicectomia convencional versus videolaparoscópica pelo SUS: estudo descritivo e transversal sobre as internações hospitalares no Brasil

Por mais de um século, a apendicectomia convencional (aberta) foi o único tratamento padrão para apendicite. Entretanto, a abordagem videolaparoscópica (VLP), técnica contemporânea e mais sofisticada, revolucionou o manejo desta patologia. Objetivo: este estudo tem por objetivo realizar uma análise descritiva e transversal sobre as internações hospitalares por apendicectomia convencional e videolaparoscópica realizadas pelo SUS no Brasil. Métodos: trata-se de um estudo descritivo e transversal, realizado por meio da análise de dados secundários, oriundo do Sistema de Informações Hospitalares (SIH), sobre as apendicectomias (convencional e videolaparoscópica) ocorridas no Sistema Único de Saúde (SUS), no Brasil, no período de 2009 a 2018. Resultados: a cirurgia videolaparoscópia apresentou menor número de óbitos por procedimentos, menor taxa de mortalidade e maior custo por internação, em relação a cirurgia convencional. O tempo médio de dias de permanência hospitalar não teve diferença estatisticamente significamente entre as técnicas. Além disso, para ambas as técnicas (seja aberta ou VLP), os dados sugerem um crescente aumento no número total e valor médio de internação. Quanto à evolução temporal, para ambas as técnicas, os números sugerem uma taxa decrescente para o tempo médio de internação e a taxa de mortalidade. Considerações finais: a apendicectomia por vídeo no SUS apresentou mais vantagens assistenciais e financeiras, sugerindo-se que criem-se políticas de financiamento e estímulo para ampliação da realização deste método, frente ao método aberto.

Day Care Appendectomy Is Safe in Young Patients with Uncomplicated Early Presentation

We analyzed the surgical outcomes of uncomplicated appendicitis in patients treated with conventional or laparoscopic appendectomy on an ambulatory basis compared with those who stayed overnight. Demographics, clinical course, surgery type, length of stay, and surgical outcomes of patients who underwent conventional or laparoscopic appendectomy for uncomplicated appendicitis were measured. Comparisons were performed using Student t test and chi square analysis. A total of 197 patients were enroll in the study, 69 (35%) patients were discharged within 12 h after their surgery with a mean age of 26.1 years ± 10.23, and the rest of the patients (n = 128,65%) were hospitalized, with a mean age of 27.0 years ± 12.2 (p < 0.608). Open treatment was practice on 124 (62.9%) patients, laparoscopic approach was achieved on 73 (37%) patients, and three (1.5%) patients underwent conversion due to difficult dissection. There was a 14-h mean difference between groups, from the initial time of abdominal pain until arrival to the emergency room, with a mean time in the ambulatory group of 27.7 h ± 19.7 and hospitalized group of 42.4 h ± 39.7 (p < 0.001). Five (7.2%) patients on the ambulatory group presented post-surgical complications, with no significant difference from the patients of the inpatient group (n = 6, 4.7%) (p < 0.456). Overall, mortality rate was 0%, and all patients are well and alive with a mean follow-up of 8 months (range, 6–18 months). This study confirms suitability of conventional appendectomy as an outpatient procedure for uncomplicated appendicitis’ management.

Comparative analysis of the management of acute appendicitis between the normal period and COVID-19 pandemic.

Acute appendicitis is the most common abdominal surgical emergency. There is no adequate information to evaluate the effects of the COVID-19 pandemic on acute appendicitis and its surgical management. The present comparative study reports successful appendectomy and infection control in patients with appendicitis during the COVID-19 pandemic and last year covering the same period. This retrospective observational study was conducted in acute appendicitis-treated patients from 13.03.19 to 13.05.19 and from 13.03.20 to 13.05.20, respectively. This study included 150 patients (110 patients in 2019; 40 patients in 2020 (during COVID-19 pandemic)). The patients were named as Group A (Normal period) and Group B (Pandemic period), respectively. The groups were comparable as there was no significant difference between the mean age, mean BMI, and mean length of stay. There is a significant difference between the comorbidities of Group A and Group B (p=0.033). There was no significant difference between the laboratory and radiological findings of Group A and Group B. There was a significant difference between the perforation number of Group A and Group B (p=0.029). There was no significant difference between the needs of ICU and conversion from laparoscopic to conventional appendectomy of Group A and Group B. The findings obtained in this study suggest that late admission to the hospital caused complicated cases and made acute appendicitis management more difficult during the pandemic period, which was already a troubling period. During the COVID-19 pandemic, the principles applied to emergency surgery for infected patients should be applied to both suspected and confirmed cases.