Emergency Appendectomy Research Articles

Laparoscopic delayed and interval appendectomy in the workstyle reform era.

Excessive working hours have been reported to contribute to burnout among surgeons. In Japan, work-style reform is a problem that needs immediate attention. Acute appendectomy, which often occurs at nighttime, is one of the most common emergency surgeries. The feasibility of delayed and interval appendectomy remains to be investigated. Two hundred forty-five consecutive patients who underwent laparoscopic appendectomy in our hospital were enrolled. They were divided into three groups: emergency appendectomy (immediate surgery, soon after the diagnosis [EA group], n = 153), delayed appendectomy (surgery during daytime the following day [DA group], n = 38) and interval appendectomy (antibiotics treatment followed by selective surgery three to four months later [IA group], n = 54). The clinical background and surgical outcomes were compared. Next, the residents' excess working time per month was calculated. The surgical outcomes (operation time, blood loss, length of hospital stay, postoperative complications) were similar between the EA and DA groups. However, no DA was performed during nighttime hours whereas 15.7% of EA was performed during nighttime hours (p = 0.0007). The surgical outcomes of the IA group were also comparable. The residents' excess working time declined following the introduction of DA and workstyle reform. Delayed and interval laparoscopic appendectomy are feasible, and can be performed to promote workstyle reform without impairing patient safety.

Patient backgrounds and short-term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis.

BackgroundAppendicitis is classified as either complicated (CA) or uncomplicated (UA). Some authors have shown that the epidemiologic trends of CA and UA may differ. The aim of this study was to clarify differences in backgrounds and surgical outcomes between CA and UA patients.MethodsThis study was a cohort study. We extracted case data from the Japanese Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. Patients were classified into three groups, depending on whether they underwent emergency appendectomy for CA (CA group), emergency appendectomy for UA (UA group), or elective appendectomy (EA group). We evaluated patient characteristics and surgical outcomes for each group.ResultsWe included 89,355 adult patients in the study, comprising 29,331 CA, 48,691 UA, and 11,333 EA patients. Old age, larger body mass index, smoking, and medication with antidiabetic drugs, oral corticosteroids, oral antiplatelet drugs, and oral anticoagulant drugs were independent risk factors for CA. The percentage of CA increased with age. In‐hospital mortality (0.15%, 0.02%, and 0.00%) and 30‐d mortality (0.09%, 0.01%, and 0.00%), respectively, of CA patients were significantly higher than those of the UA and EA groups. The duration of postoperative antibiotic administration, duration of fasting, and time before removal of a prophylactic drain were significantly longer in the CA group than in the UA and EA groups.ConclusionBackgrounds and treatment outcomes of CA and UA patients after emergency surgery are entirely different. Thus, the treatment strategy of CA and UA patients should differ accordingly.

EP.FRI.692 Gender differences in the age and outcomes of appendicectomy patients

Abstract Aims Appendicectomy is one of the commonest emergency General Surgical operations performed. However, there exists minimal published literature exploring whether there are differences between males and females undergoing appendicectomy. This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy. Methods A multicentre retrospective cohort study of all patients who had an emergency appendicectomy within four UK hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised by gender and the results compared. Results 559 emergency appendicectomies (315 (56.4%) male and 244 (43.6%) female patients) were included. Males undergoing appendicectomy were younger (median age: 33 vs 41 years, p < 0.001). American Society of Anaesthesiologists classification was equally matched. Whilst no difference in mean white cell or neutrophil count was identified, C-reactive protein was lower (mean 108 vs 137, p = 0.001) and bilirubin higher (mean 21 vs 15, p < 0.001) in male patients pre-operatively. Pre-operative imaging was performed more often in females: ultrasound (16.0 vs 1.3%, p < 0.001) and CT scan (69.3 vs 60.3%, p = 0.029). Male patients underwent more open surgery (13.7 vs 8.2%, p = 0.043). The intra-operative severity of appendicitis was equally matched. No differences in overall hospital length of stay (median 3 vs 3 days, p = 0.183), post-operative complication rates or 30-day readmission rates were identified. Conclusions This study demonstrates that differences exist between males and females who have emergency appendicectomy in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.

EP.WE.48Emergency appendicectomy during COVID-19 pandemic – A single UK centre experience

Abstract Background In December 2019 following an outbreak of Novel coronavirus infection (COVID-19) in Wuhan, China, it spread rapidly overwhelming the healthcare systems globally. With little knowledge of COVID-19 virus, very few published reports on surgical outcomes; hospitals stopped elective surgery, whilst emergency surgery was offered only after exhausting all conservative treatment modalities. This study presents our experience of outcomes of emergency appendectomies performed during the pandemic. Methods Prospectively we collected data on 132 patients in peak pandemic period from 1st March to 5th June 2020 and data compared with 206 patients operated in similar period in2019. Patient demographics, presenting symptoms, pre-operative events, investigations, surgical management, postoperative outcomes and complications were analysed. Results Demographics and ASA grades of both cohorts were comparable. In study cohort 84.4% and 96.7% in control cohort had laparoscopic appendicectomy. Whilst the study cohort had 13.6% primary open operations, control cohort had 5.3%. Mean length of stay and early post-operative complications (<30 days) were similar in both cohorts apart from surgical site infections (p = 0.02) and one mortality in study cohort. Conclusion In these overwhelming pandemic times, although conservative treatment of acute appendicitis is an option, a proportion of patients will need surgery. Our study shows that with careful planning and strict theatre protocols, emergency appendicectomy can be safely offered with minimal risk of spreading COVID-19 infection. These observations warrant further prospective randomised studies.

TP9.2.24Is preoperative ABO blood typing required in emergency appendicectomies?

Abstract Aims Intra-operative bleeding is very rarely a complication of laparoscopic appendicectomy. Despite this, it is often mandatory for any patient undergoing an emergency appendicectomy to have pre-operative ABO blood type sampling. This could be an unnecessary expense and may lead to patients being delayed for theatre. The aim of this study was to see how many patients who underwent an appendicectomy required a blood transfusion intra-operatively or within 30 days of their operation. Methods Data were collected retrospectively for patients of all ages who underwent an appendicectomy for suspected appendicitis at a single centre from March 2018 to May 2020. The primary outcome measure was intra-operative and post-operative blood transfusion up until 30 days after the operation. Results Over 26 months, 698 appendicectomies were performed. Preoperative ABO blood typing was performed in 95% (n = 663) of patients. Collectively, 1,305 blood samples were obtained at a combined total cost of £13,703 to the hospital. None of the patients required blood transfusion intra- or post-operatively. Pre-operative blood transfusion was performed in only three patients, all due to chronic anaemia. 21 (3%) patients were delayed in going to theatre whilst awaiting two valid ABO blood typing results. Conclusions Emergency appendicectomies very rarely experience complications associated with bleeding or requiring blood transfusion. Clinical guidelines should reflect this by avoiding recommendation of such tests in emergency appendicectomies, reducing delays to surgery and resulting in a more efficient allocation of financial and staff resources.

TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis

Abstract Aims Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations. Methods Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019. Results A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p < 0.001) or guarding(p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815). Conclusion Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.

TP9.2.22A six year retrospective study of appendicular neoplasms and review of literature

Abstract Aims The aim of this study was to evaluate the incidence of appendiceal neoplasm, identify possible association of pre and intra-operative factors associated with it, and to determine its clinical significance. Methods Using pathological reports from surgical specimens of appendix from January 2015 to September 2020, a single centre retrospective analysis was performed. Medical records of patients, pre-operative investigations, intra operative findings, histological reports and post operative management were evaluated. Results The incidence of appendiceal neoplasms was 2.33% (65/2791). They consisted of Neuroendocrine tumor (NET) in 35(53.85%), followed by Low grade mucinous neoplasm (LAMN) in 23(35.38%), Goblet cell carcinoid in three (4.62%), mucinous cystadenoma 2(3.08%), one (1.54%) adenocarcinoma and one (1.54%) metastasis. Appendicitis was the most common indication for surgery. 46(70.77%) patients had emergency surgery. 89.13% emergency surgeries was appendicectomy, NET being the most common tumor in 60.87%. 19(29.23%) patients had elective surgery, all had pre operative radiological investigation, LAMN being most common. Only five (7.69%) patients had intra operative suspicion of tumor. Ten patients required second procedure in the form of right hemicolectomy in nine, and cytoreducetive surgery in one. All patients were followed up as per national guidelines. Conclusions The incidence of appendiceal neoplasms though low, has been steadily rising. Its diagnosis is rarely evident on pre operative radiological investigations. Surgeons should be aware of these neoplasms and its frequent association with emergency appendicectomies done for suspected acute appendicitis.

EP.WE.410Appendicectomy during the COVID-19 pandemic: an assessment of the change in practice within the West of Scotland

AimsThe Covid-19 pandemic has significantly impacted emergency and elective surgical activities. Multiple surgical professional bodies initially recommended appendicitis be managed conservatively or with judicious open surgery to mitigate potential risks with Covid-19 transmission. This study compares the investigation, operative findings and outcomes of patients who underwent appendicectomy before and after the National lockdown.MethodsA multicentre retrospective cohort study of patients who had emergency appendicectomy in four West of Scotland hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK National lockdown of 23rd March 2020 compared to those presenting post-lockdown.ResultsA total of 559 appendicectomies were performed (280 pre-lockdown and 279 post-lockdown) in four hospitals and included in the analyses. More males than females had appendicectomy in the post-lockdown period (60.6% vs 52.1%, p 0.044). Pre-operative CT scanning was performed more often post-lockdown (71.7% vs 56.8%, p < 0.001) and an open approach was adopted more frequently post-lockdown (19.0% vs 3.6%, p < 0.001). The proportion of operations for complicated appendicitis increased post-lockdown (31.9% vs 22.1%, p = 0.009). Median hospital stay was equal in both groups (3 vs 3 days, p = 0.787). Post-operative complication rates were similar in both groups apart from a higher 30-day re-admission rate post-lockdown (7.9% vs 3.6%, p = 0.028).ConclusionCovid-19 has resulted in significant modifications to the pre-operative work-up and surgical approach to patients undergoing emergency appendicectomy. Whilst the proportion of patients with complicated appendicitis has increased post-lockdown, overall clinical outcomes remain similar.

EP.FRI.580 Negative appendectomy rates at a district regional hospital

Abstract Aim Emergency appendectomy is one of the most common emergency procedures done. Negative appendectomy rates vary and the aim was to identify the rate of it at a DGH. Method Appendectomy cases at a small regional hospital were during a 2-year period (2017-2018) were included. Elective and interval appendectomies were excluded. Histopathology findings were noted. Results 78 patient had an emergency appendectomy, of which 87% (n = 68) had it done laparoscopically. Normal appendix on pathology was found in 13.8% (n = 12) of the removed appendices. They were all removed laprascopically. The majority were females (n = 11) compared to males (n = 1). 58% of the normal appendix (n = 7) were identified as a macroscopically normal appendix. 36% of the females were mid-cycle (n = 4). The mean WBC on admission was 9.5 (4.8-13.6 x109/L) . All of the females had a transabdominal USS as initial investigation but was inconclusive. Conclusion Negative appendectomy rates are still high in female patients, whether doing further scans such as TVUSS or CTAP might reduce the risks of getting a negative appendectomy, needs to be discussed and tailored to each case, as the majority are young patients in the reproductive age group.

SP4.1.2 Appendicitis during the COVID pandemic – Are we seeing more complicated presentations?

AimsStudies have suggested a decrease in emergency presentations of appendicitis during the COVID-pandemic along with a nationwide fall in non-COVID related presentations to A&E. We therefore hypothesised that those treated for appendicitis had later presentations resulting in increasing incidence of ‘complicated appendicitis’ and post-operative complications.MethodsWe retrospectively analysed all patients ≥16years, undergoing emergency appendicectomy during 3-month period of UK national lockdown (pandemic cohort). Data was compared to the same period one year previously (pre-pandemic cohort). Primary endpoint was nature of appendicitis (uncomplicated or complicated). Secondary endpoints were operative approach, LOS and post-operative complications. Statistical analysis was performed using Fisher’s Exact Test.ResultsA total of 31 patients (median age 35years) underwent emergency appendicectomy in the pre-pandemic cohort and 30 patients in the pandemic group (median age 37). 9/31 (29%) and 18/30 (60%) were found to have complicated appendicitis in each group respectively (p = 0.021). Open procedures took place in 2/31 pre-pandemic, and 12/29 (4 of which were converted from laparoscopic procedures) in the pandemic cohort (p = 0.002). Median LOS was 2 in each group, though the pandemic cohort had a much wider range (0-7 vs 0-25 days). Post-operative complications occurred in 1/31 and 5/30 patients respectively (p = 0.104) with 1 mortality within 30 days.ConclusionsDespite overall volume and demographics of patients remaining the same, the COVID-19 pandemic has resulted in a statistically significant increase in complicated presentations of appendicitis to our hospital. Subsequently this has resulted in increasing incidence of open operations and post-operative complications.

TP9.2.1Evaluating the incidence, the predictors and the outcomes of patients with negative appendicectomy

Abstract Introduction Negative appendicectomy (NA) is still a major issue following appendicectomy. We evaluated the rate and predictors of negative appendicectomy in a cohort. Patients and Methods Data of patients who underwent emergency appendicectomies over a year was collected and analysed. The absence of inflammation and/or other significant pathology in the appendix was considered negative by standard definition. A stricter definition of NA was the absence of inflammatory cells in the appendix. Negative appendicectomy rate (NAR) was calculated using the standard criteria (NAR-SDC) and the strict criteria (NAR-STC). Results 372 patients were included, 179 males and 193 females with a median age of 27 (5-94) years. Median duration of symptoms and waiting time to surgery were 2 days and 1 day respectively. The mean admission WBC and CRP were 12,600 (3000-38000)/mm3 and 66.9 (1-323) mg/L respectively. Laparoscopic appendicectomy was performed in 93.5% of patients with a conversion rate of 4.6%. NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was significantly higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower mean total WBC (p-value 0.014) and CRP (p-value 0.0001) on admission. Independent predictors of negative appendicectomy are female gender, duration of symptoms more than 3 days, and lower total WBC. Conclusion NA is still a major problem in the management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms duration more than 3 days, lower WBC are independent predictors of NA.

EP.FRI.960 USS appraisal in females of child bearing age presented with possible appendicitis

Abstract Aims Appendicitis remains the most common acute surgical condition. No standard guidelines for the use of imaging studies, and there is a discrepancy between the published data regarding accuracy of these modalities and our practical findings. Yet the growing number of USS reported as “appendix not visualized” has led us to rethink about the value of USS in acute appendicitis. Methods A retrospective single centre study for all females (15-45 years) underwent emergency appendectomy for suspected acute appendicitis. Analysis of preoperative clinical, radiographic and postoperative histopathological data was done. Results 632 cases analysed over 18months, out of those 238 (37%) were females (15-45 years). USS was done in 129(54%) cases. 25(10.5) cases had both USS and CTAP. 32(13%) cases had only CTAP. The mean rate of appendix visualization in the USS was 30%(71cases) two thirds reported by radiologist versus one third by sonographers. Our negative appendectomy rate dropped from 25 to 15% after a positive scan. Conclusions Traditional preference for ultrasound in the UK compared to CTAP in young population is mostly due to the potential hazards of irradiation, but USS commonly does not visualise the appendix in our practice (70%), and has low sensitivity and specificity for appendicitis. However, following a positive USS, NAR dropped to 15%. Radiologists had a higher visualization rate of appendix compared to sonographers. Commitment to improve the performance of ultrasonography by allocating adequately timed sessions to the most experienced radiologists and increasing the use of low dose CT scans are possible solutions.

Factors Associated with the Rate of Acute Perforated Appendicitis Among Patients Who Underwent Emergency Appendectomy From January to December 2018: A Retrospective Cohort Study

Factors Associated with the Rate of Acute Perforated Appendicitis Among Patients Who Underwent Emergency Appendectomy From January to December 2018: A Retrospective Cohort Study

68 Outcomes of Emergency Appendicectomy At Torbay Hospital During Peak SARS-COV-2 Pandemic

Abstract Introduction SARS-COV-2 has created unprecedented challenges for healthcare systems. As a result, new intercollegiate guidelines have been published in the UK to manage emergency surgeries commencing 25th March 2020. Devon has one of the lowest incidences of Covid-19 in UK. In this study, we report outcomes of emergency appendicectomy at Torbay Hospital during peak COVID-19 pandemic, from 25th March till 26th May 2020. Method This is a single centre retrospective review at Torbay Hospital, Devon. It includes all patients who underwent emergency appendicectomy. Primary outcomes were intra-operative findings, change of operation choice due to revised guidelines, and length of admission. The secondary outcome was 14 days post-operative mortality and morbidity. Results A total of 29 patients, median age 33.1, underwent emergency appendicectomy. 79.3% (n = 23) had a pre-operative SARS-COV-2 nasal swab test, all of which were negative. All appendicectomies were conducted in a non-COVID theatre. Level 3 PPE and precautions were used intra-operatively. The choice of operation was changed in 37.9% (n = 10), from laparoscopic to open as per COVID-19 guidelines. Most patients (86.2%) were discharged from hospital within 5 days of operation. None of the patients or surgeons contracted COVID-19 related infection in 14 days following the operation. Conclusions This study is a snapshot into safety of operative management of acute appendicitis in patients not suspected of COVID-19 infection during first wave of pandemic. However, it will be interesting to see long-term multi-centre comparative studies analysing the effect of surgical management of appendicitis during all three waves of pandemic.

699 Does Pre-Operative Imaging Improve Negative Appendicectomy Rate?

Abstract Aim Appendicectomy is one of the most commonly performed emergency operations. There is no set guideline for an acceptable negative appendectomy rate (NAR) in the UK. Based on previous studies, a NAR of 15-30% is typically accepted. We sought to define our local practice NAR in our initial audit, introduced an appendicitis pathway based on this initial data, and then re-audited to assess whether there had been an improvement in the NAR. Method All emergency appendicectomies carried out over a 1-year period from April 2018 – April 2019 were initially analysed. The subsequent audit analysed data from August 2020 - November 2020, after the pathway had been introduced. Histological analysis was used to determine positive or negative appendicectomy. Results A total of 207 patients had an appendicectomy over the initial 1-year time frame. In our re-audit, 38 patients had an appendicectomy. Demographics were similar in both groups. The NAR increased from 17% to 18%. Conclusions On first glance, the NAR does not seem to have improved. On a closer look, all patients over the age of 18 in our re-audit had a pre-operative CT, and there were no negative appendicectomies in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have shown both its sensitivity and specificity for appendicitis is below 50%. We may have to explore alternative imaging modalities in the paediatric population or accept the higher NAR.

1320 Evaluation of Routine Group and Save Testing Prior To Appendicectomy

Abstract Introduction Group and save (G&amp;S) testing is often performed prior to emergency appendicectomy. However, there are no standard national guidelines regarding the routine use of preoperative G&amp;S. We performed a Trust Audit to review the need for G&amp;S prior to appendicectomy in order to recommend new guidelines. Method Retrospective review of all patients that underwent appendicectomy at Chelsea and Westminster Hospital between October 2019 and March 2020. We evaluated the existing literature on blood transfusion rate and the need for G&amp;S prior to appendicectomy. Results One hundred and seventy-three patients (female 56%, median age 26 years) underwent appendicectomy (94% laparoscopic, 6% open). One hundred and thirty-four (77%) patients had a valid G&amp;S and none of the patients received a blood transfusion perioperatively. The estimated total cost of G&amp;S sampling for laparoscopic appendicectomy over one year in the Trust is £6825 (excluding all other laparoscopic surgery). Conclusions Based on the audit findings and literature review, routine G&amp;S testing is not necessarily required for all patients undergoing laparoscopic appendicectomy. G&amp;S should be requested on a patient case-specific basis (for example, chronic anaemia or haematological conditions) with discussions between the anaesthetist and surgeon. This would reduce delays in emergency lists, have financial implications and there is no evidence to support that the routine use of G&amp;S benefits patient outcomes. These recommended guidelines have been presented at Surgery/Anaesthetics Clinical Governance and have been rolled out in the Trust with the aim to perform a re-audit in 3-6 months.

Clinical presentation of appendicitis in the paediatric age group

Misdiagnosis and complications result from the unusual clinical presentation of acute appendicitis in school children. The aim of this study was to see how age affected clinical presentation, intraoperative findings and post-operational complications in children suffering from acute appendicitis. From November 2016 until December 2018, 112 children under the age of 16 years who underwent both emergency and elective appendectomy in Basaveshwar teaching and general hospital, Kalburgi, were enlisted in this retrospective research study. Out of 112 cases, the majority of the cases, i.e., 60 (54%) were males, followed by 52 females (46%), and the ratio of male to female was 1.5:1. An acute inflamed appendix was the commonest intra-operative observation in this study, i.e., in 92 cases (82%), followed by a perforated appendix in 9 cases, gangrenous mass in 6 cases, appendicular mass in 3 cases and Meckel's diverticulitis in 2 cases respectively. Wound gaping was seen in 4 (4%) cases and postoperative ileus in 3 (3%) cases, respectively. There was no mortality. Appendicitis is a common surgical emergency in the paediatric age group. Early diagnosis & surgery are the key factors in the management of paediatric appendicitis. The younger ones having a more altered general state & a higher tachycardia degree, indicating that the disease has had more systemic repercussions. Hence, when treating a young child suffering from acute abdominal pain and systematically addressing the question of whether it may be acute appendicitis, extreme caution is needed.

The Histopathology of the Appendix in Children at Interval Appendectomy.

Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

Laparoscopic appendectomy with left lateral tilt in pregnant women in the second and third trimesters: A clinical case series in a single Vietnam centre

IntroductionThe presentation of acute appendicitis during pregnancy may cause diagnostic and therapeutic difficulty. Laparoscopic appendectomy (LA) is widely accepted as a minimally invasive procedure for acute appendicitis. However, LA during the second and third trimesters is associated with problems, including technical difficulty, a risk of foetal loss and preterm delivery. MethodClinical data were retrospectively collected and analysed between April 2016 and April 2021. A telephone questionnaire was administered in cases of missing data. The clinical information obtained included a detailed medical and obstetric history; preoperative, intraoperative, and postoperative data; complications; and pregnancy outcomes. ResultsThere were a total of eighteen patients in the 2nd and 3rd trimesters who had undergone emergent laparoscopic appendectomy with a left lateral tilt of 70–90°. The gestational age at the time of surgery ranged from 20 to 35 weeks. The time to complete the first trocar for the camera ranged from 3 to 6 min, the operation time ranged from 30 to 60 min, and the length of hospital stay was 2–8 days. There were 5 procedures performed in the 3rd trimester. None of the cases required conversion to an open procedure, and all were without postoperative complications. Only one miscarriage complication was reported among a total of 4 patients with peritonitis. ConclusionOur results demonstrated that urgent laparoscopic surgeries are feasible and can be safely performed with minimal risk for patients and foetuses in the second and third trimesters of pregnancy. Larger prospective studies are required to validate these findings.

MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 &amp; COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p&lt;0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery