Laparoscopic Appendectomy For Perforated Appendicitis Research Articles

The utility of intraperitoneal drain placement after laparoscopic appendectomy for perforated appendicitis in postoperative intraperitoneal abscess prevention.

Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis. This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage. A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835). Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.

Laparoscopic Treatment of Perforated Appendicitis

The most frequent general surgical emergency worldwide is acute appendicitis. Because to its potentially fatal complications, including perforation, it could put patients at danger of death. An appendix that has ruptured frequently results in serious infectious complications as abdominal sepsis, pelvic abscess, and others. Laparoscopic appendectomy for perforated appendicitis raises several questions. In many nations today, laparoscopic treatment of perforated appendicitis is the preferred surgical technique. Aim: This prospective study's objective was to assess the efficacy of laparoscopy in the treatment of complicated appendicitis (perforation). Methods: The study was conducted prospectively during the period from September 2020 to August 2022. The study included 50 individuals who underwent peritoneal lavage after laparoscopic appendicectomy of perforated appendix in the department of Surgery, Lady Reading Hospital, Peshawar. The traditional method, three ports technique was used. Sometimes a fourth port is needed. Telescopic ports are 10 mm in size. The other two ports are 3/5 mm and 5/10 mm, respectively. Unipolar diathermy is a source of energy. Hemostasis and ligation of the appendicular stump are achieved via intra-corporeal knotting, endo-loop, and hemo-clip. Results: The study's age range is 5-70 years, with a mean age of 19 with male predominance. The duration of surgery varies from 30 to 120 minutes, with a mean duration of 65 minutes. Hospital stays range from 48 to 96 hours on average. There were 12 patients with complications, including paralytic ileus was seen in 1(2%), diarrhea in 2(4%), multiple or single (4% and 8%) port infections, and port TB in (4%). Open conversion was seen in 1 (2%) patient due to appendicitis burst haemorrhage. Every complication was treated carefully. Conclusion: Laparoscopy is an excellent method for treating perforated appendicitis. Thus, it is practical, achievable and may be carried out by skilled hands in any centre. That is now regarded as regular operating procedure. Keywords: Laparoscopic appendicectomy, Perforation (burst)

Single-port laparoscopic appendectomy for perforated appendicitis using ArtiSential® wristed articulated instrument.

Single-port laparoscopic appendectomy (SPLA) was firstly introduced in 1998 and has been suggested potential advantages including better cosmetic outcome, less post-operative pain and avoidance of possible haemorrhagic complications from injuring epigastric vessels. However, single-port laparoscopic approach using conventional straight instruments may lead to internal and external conflicts and ergonomic discomfort, and new laparoscopic articulating instruments were developed to overcome these limitations of straight instruments. The ArtiSential® (LIVSMED Inc., Republic of Korea) is an 8-mm diameter pistol-handle instrument that has complete articulating function like human wrist and intuitive controllability. We present a technical report of SPLA for perforated appendicitis using ArtiSential® wristed articulated instrument. A 78-year-old female with a body mass index of 23.5 was referred to our emergency room with right lower quadrant abdominal pain. Abdominal computed tomography scan showed a distended tubular structure in the right lower quadrant (1.2 cm in diameter) with periappendiceal fluid collection. The patient's clinical presentation was highly indicative of perforated acute appendicitis. We performed SPLA with ArtiSential® grasper with the left hand, and this instrument helped us to allow greater manoeuvrability and dexterity with double triangulation technique. The total operation time was 40 min, and the patient was discharged without complications on the 1st day after surgery.

Laparoscopic appendectomy for perforated appendicitis; a comparison with open appendectomy

Background: Perforated appendicitis is one of the common surgical emergencies which need immediate surgical intervention.For many years, the classic open appendectomy still seems to be the routine treatment of perforated appendicitis. The improvement of technology and an increase in laparoscopic experience have been central to the development of laparoscopic surgery.The aim of this study is to compare outcome of laparoscopic versus open surgery for surgical management of perforated appendicitis in our locality. Patients and Methods: This is a prospective study that included 40 patients with perforated appendicitis admitted at general surgery department in Qena university hospital “between April 2018 to April 2019”, 20 patients underwent open appendectomy and 20 had laparoscopic surgery. All patients subjected to: full clinical evaluation, diagnostic modalities as: laboratory investigation, plain X-ray erect and abdominal sonography. Results:All cases were completed successfully.A20 patient underwent open conventional surgery their mean age 29.80±7.32 years. While those underwent laparoscopic surgery were 20 patients and their mean of age 28.80±7.37 years. There were statistically significant differences between studied groups regarding operative time,time to return to a normal diet, length of hospital stayand postoperative complications. Conclusion: Laparoscopicsurgery for perforated appendicitisis safe and carries many advantages of minimallyinvasivetechniques. So, it should beused selectively, reservingthe traditionalopen approach.

Standardized Discharge Antibiotics May Reduce Readmissions in Pediatric Perforated Appendicitis

BackgroundBased on limited evidence, the American Pediatric Surgical Association recommends 5-7 d of postoperative antibiotics in perforated appendicitis for preventing intra-abdominal abscess (IAA). In 2015, our institutional clinical practice guideline was modified to standardize prescription for 7 additional days of oral antibiotics after discharge. We hypothesized that prescribing oral antibiotics after discharge would be associated with fewer complications in perforated appendicitis. Materials and methodsA retrospective cohort study was conducted of pediatric (younger than 18 y) patients who underwent laparoscopic appendectomy for perforated appendicitis (August 1, 2012-April 30, 2019). Patients diagnosed with IAA before discharge or with a postoperative length of stay ≥8 d were excluded. Patient outcomes were compared prestandardization and poststandardization of discharge antibiotics. ResultsOf 617 patients, 212 (34.5%) were admitted prestandardization and 404 (65.5%) poststandardization. Overall, 409 patients (66.3%) received discharge antibiotics. The median total postoperative antibiotic duration was 4 d (interquartile range, 3-5) prestandardization versus 11 d (interquartile range, 10-12) poststandardization (P < 0.001). Prestandardization patients had a higher rate of IAA (8.9% versus 4.5%, P = 0.03) and were readmitted more frequently (13.1% versus 6.4%, P = 0.005). On adjusted analysis, admission poststandardization was associated with reduced odds of IAA (odds ratio, 0.51; 95% confidence interval, 0.25-1.06), but the relationship was imprecise. Admission poststandardization was significantly associated with reduced adjusted odds of readmission (odds ratio, 0.46; 95% confidence interval, 0.25-0.85). ConclusionsPrescription for seven additional days of oral antibiotics after discharge was associated with reduced odds of readmission in pediatric perforated appendicitis. This population may benefit from a longer postoperative antibiotic course than currently recommended.

Evaluation of some cellular biomarker proteins, oxidative stress and clinical indices as results of laparoscopic appendectomy for perforated appendicitis in children

Laparoscopic appendectomy for perforated appendicitis in children has the advantages of quick recovery, little influence of inflammatory and oxidative stress and low infection rate. Altogether 115 children with perforated appendicitis treated in our hospital from June 2018 to August 2019 were selected and divided into two groups according to different treatment methods. Laparoscopic appendectomy was used as the research group (RG) (67 cases) and open appendectomy (48 cases) as the control group (CG). The clinical indexes (operation time, intraoperative blood loss, ambulation time, incision length, postoperative exhaust time and length of stay) of the two groups were observed. The levels of C- reactive protein (CRP), procalcitonin (PCT), interleukin -6 (IL-6) and tumor necrosis factor-α (TNF-α) before and after treatment were detected by enzyme-linked immunosorbent assay (ELISA). The levels of oxidative stress factors (superoxide dismutase (SOD), malondialdehyde (MDA)) and the incidence of postoperative incision infection were observed in the two groups. A visual analogue scale (VAS) score was used to evaluate the postoperative pain in children. Logistic regression analysis was used to analyze the risk factors of postoperative incision infection in children. The improvement degree of clinical indicators in RG was significantly better than that in CG. The expression levels of CRP, PCT, IL-6 and TNF-α in RG were significantly lower than those in CG. The expression levels of SOD and MDA in RG were significantly better than those in CG. The postoperative incision infection rate in RG was significantly lower than that in CG. The postoperative VAS score in RG was significantly lower than that in CG. Logistic regression analysis results showed that the risk of incision infection was increased in children with operation time over 1h, incision length &gt;3cm, high CRP, high PCT, high IL-6, high TNF-α, high SOD and low MDA. Laparoscopic appendectomy for perforated appendicitis in children can effectively reduce intraoperative hemorrhage, postoperative pain, and the damage to the body of children, and can also reduce oxidative stress and inflammatory reaction in children.

Comparison of Open Appendectomy and Laparoscopic Appendectomy in Perforated Appendicitis.

IntroductionLaparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes. This study compares laparoscopic appendectomy and open appendectomy in cases of a perforated appendix by assessing surgical site infection, mean operating time, and length of hospital stay.Materials and methodsThis study was a prospective randomized study conducted at the Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan, from January 2016 to January 2017, by randomly allotting the laparoscopic or the open appendectomy technique to 130 patients by the lottery method. Patients having a perforated appendix were included after they provided informed consent. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, US).ResultsThe frequency of wound site infection was significantly higher in open appendectomy (27.69%) than in the laparoscopic approach (10.77%; p=0.01). Mean hospital stay was slightly longer in the laparoscopic approach (4.38 ± 1.09 days) than in open appendectomy (4.18 ± 0.77 days; p=0.23). Mean operating time for laparoscopic appendectomy and open appendectomy was 46.98 ± 2.99 minutes and 53.02 ± 2.88 minutes, respectively (p<0.000).ConclusionLaparoscopic appendectomy was associated with fewer surgical site infections and shorter mean operating time than an open appendectomy.

Does laparoscopic appendectomy increase the risk of intra-abdominal abscess in children who have perforated appendicitis?

Objective: The aim of this study is to compare the rates of intraabdominal abscesses (IAAs), in laparoscopic appendectomy (LA) and open appendectomy (OA) for perforated appendicitis in children. Methods: A retrospective database search of consecutive cases of children with a diagnosis of perforated appendicitis who underwent OA or LA by the first author or were operated under his supervision diagnosed with appendicitis between 2011 and 2014 and who underwent surgery as treatment was conducted.Results: Seventy-eight patients were included in our study. Forty-two and 36 patients underwent LA and OA, respectively. One case was converted from LA to OA. There was no statistically significant difference at superficial incisional surgical-site infections and IAA between groups but drain placement ratio and length of hospital stay was higher in OA group. Conclusions: The lack of difference in postoperative incidence of IAA supports the idea that LA does not increase the risk of IAA in perforated appendicitis. Although LA for perforated appendicitis in children has been intensely debated, our findings indicate that laparoscopic procedures performed by experienced pediatric surgeons will decrease the risk of complication and conversion to OA. Laparoscopy in children is a safe procedure for perforated, complicated appendicitis.

Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?

Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported. From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups. Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay. The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.

Does Intravenous Acetaminophen Improve Postoperative Pain Control after Laparoscopic Appendectomy for Perforated Appendicitis? A Prospective Randomized Trial

The recent increased awareness of the dangers of opioids in the United States has highlighted the need to minimize narcotics and identify nonopioid options for pain control after surgery. With evidence suggesting that intravenous acetaminophen (IVA) can be an opioid sparing option, we conducted a prospective, randomized trial that evaluated the effect of IVA on the postoperative pain course of children with perforated appendicitis. After IRB approval, children with perforated appendicitis were randomized to receive postoperative IVA with the standard patient/nurse-controlled analgesia (PCA) or to receive the PCA alone. All patients were treated according to an evidence-based treatment protocol. The primary outcome was duration of time on PCA. Eighty-two patients were analyzed from 7/14 to 11/15. There was no statistically significant difference in the time to transition from the PCA to oral pain medications for children given IVA compared with children not receiving IVA (76.4 ± 32.5 versus 86.7 ± 49.3 hours; p = 0.73). Children in the IVA group had no statistically significant difference in intravenous narcotics delivered and pain scores compared with the non-IVA group. There was no significant difference in the amount of oral narcotics between both groups (2.8 ± 2.4 versus 2.9 ± 2.5; p = 0.88). Patients who received IVA had higher medication charges ($3752.7 ± 1618.3 vs. $1198.19 ± 521.51; p < 0.01), but not total hospital charges ($53842.0 ± 19409.2 vs. $50501.03 ± 16223.32; p = 0.76). Children given IVA showed no difference in the transition time off the PCA and to oral pain medications after laparoscopic appendectomy for perforated appendicitis.

Prolonged operative time in laparoscopic appendectomy: Predictive factors and outcomes

IntroductionTo our knowledge, this study is the first to identify the predictive factors and outcomes of prolonged operative time associated with laparoscopic appendectomy. We aimed to identify preoperative factors that influence operation time and to determine how operative time affects laparoscopic appendectomy outcomes. MethodsThe medical records of 3049 patients who had undergone laparoscopic appendectomy between January 2008 and December 2014 were retrospectively reviewed. Prolonged operative time was defined in the top 10% according to distribution (>90 min). A multivariate regression model was generated to assess potential predictive factors and outcomes of prolonged operative time. ResultsIn laparoscopic appendectomy for non-perforated appendicitis, independent factors that predict a prolonged operative time as identified through multivariate analysis were elevated C-reactive protein levels, symptom duration of more than 3 days, and computed tomography findings indicating an appendiceal diameter of more than 10 mm. In laparoscopic appendectomy for perforated appendicitis, overweight, elevated C-reactive protein, symptom duration of more than 3 days, and computed tomography findings of abscess were independent predictive factors for prolonged operative time. Prolonged surgery increases the risk of complications, prolonged hospital stay, and readmission. ConclusionsOverweight, elevated C-reactive protein, symptom duration of more than 3 days, appendiceal diameter of more than 10 mm, and abscess were independent predictive factors of prolonged operative time. Furthermore, prolonged operative time was associated with adverse postoperative outcomes after laparoscopic appendectomy.

Fast track pathway for perforated appendicitis

BackgroundPerforated appendicitis is associated with an increased morbidity and length of stay. “Fast track” protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. MethodsIn 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. ResultsThirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). ConclusionA fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns.

Irrigation versus suction alone during laparoscopic appendectomy; A randomized controlled equivalence trial

IntroductionThe objective of this study was to compare operative peritoneal irrigation versus suction alone during laparoscopic appendectomy in adult patients; our hypothesis was that the two methods are equivalent in terms of rate of post-operative intra-abdominal abscess. There has been only one prospective, randomized, superiority trial in children, that showed non-significant difference in the rate of intra-abdominal abscess comparing irrigation to suction alone during laparoscopic appendectomy for perforated appendicitis. Non-significant difference in a superiority trial does not imply equivalence. MethodsThis was a single-institution, prospective, randomized controlled equivalence study based on a null-hypothesis of non-equivalence between irrigation and suction alone. Adult patients with intra-operative findings of an acutely inflamed appendix, with suppuration or perforation localized to the right iliac fossa, paracolic gutter or pelvis were randomized to irrigation or suction alone. The primary endpoint was the rate of intra-abdominal abscess. An unconditional exact test of equivalence was used to test the null-hypothesis. ResultsEighty-one patients were included for analysis. Two (5%) of 40 patients in the irrigation group and two (4.9%) of 41 in the suction-only group developed postoperative intra-abdominal abscess. The 95% confidence interval for the difference between the two groups was −0.1200 to 0.1244, captured within the pre-defined δ limits (−0.15, 0.15). With reference to the rate of intra-abdominal abscess, equivalence was demonstrated between irrigation and suction-only techniques. ConclusionsIn patients with suppurative or perforated appendicitis, the rate of intra-abdominal abscess is equivalent between groups treated with peritoneal irrigation and suction alone.

Laparoscopic appendectomy for perforated appendicitis in children: Is intraperitoneal drainage necessary?

Objective: In this study, our aim is to evaluate the necessity of intraperitoneal drainage in perforated appendicitis. Methods: 510 pediatric patients [246 laparoscopic (LA) and 264 open (OA)] underwent appendectomy between 2007 and 2014. 275 of them were perforated appendicitis (106 LA, 169 OA). The patients were retrospectively evaluated in terms of age, sex, symptoms, length of hospital stay (LOHS), antibiotherapy, postoperative nasogastric tube placement and intraperitoneal drainage, follow-up period, intraoperative and postoperative complications. Results: Statistically significant differences were observed between laparoscopic perforated appendicitis (71 male, 35 female; median 9.5 years) and open perforated appendicitis (108 male, 61 female; median 9 years) groups in terms of placement of nasogastric tube (102/106 vs.169/169) (p=0.021), length of hospital stay (1.67± 0.11 days vs. 2.34± 0.09 days) (p<0.001), intraperitoneal drainage (32/106 vs. 138/169), (p<0.001), duration of intraperitoneal drainage (1.66± 0.28 vs. 4.21± 0.2 days) and LOHS (5.82± 0.3 vs. 4.23± 0.6 days) respectively (p <0.001). There was no significant difference between the two groups in terms of development of intra-abdominal abscess (10/106 vs. 9/169), (p=0.144), surgical site infection (2/106 vs. 8/169), (p=0.187) and development of adhesive intestinal obstruction (1/106 vs. 9/169) (p=0.053). Conclusion: Laparoscopic access reduces the necessity for drainage and shortens duration of nasogastric tube and length of hospital stay. J Clin Exp Invest 2015; 6 (3): 224-227 Key words: Laparoscopic appendectomy, perforated appendicitis, intraperitoneal drainage

Safety of a new protocol decreasing antibiotic utilization after laparoscopic appendectomy for perforated appendicitis in children: A prospective observational study

IntroductionIn a previous randomized trial, we found children with perforated appendicitis could be safely discharged prior to completion of a 5day intravenous antibiotics course. To progress the protocol further, patients who met discharge criteria early were discharged without oral antibiotics if leukocyte counts were normal. MethodsChildren undergoing laparoscopic appendectomy for perforated appendicitis were prospectively observed after institution of a new antibiotic regimen consisting of daily intravenous dosing ceftriaxone/metronidazole while an inpatient. Patients discharged prior to 5days were discharged home without oral amoxicillin-clavulanate if no leukocytosis at discharge. Outcomes were compared to the previous protocol of daily intravenous ceftriaxone/metronidazole with completion of a 7-day antibiotic course with amoxicillin-clavulanate of all patients discharged prior to 5days. Results540 patients (270 new protocol, 270 old protocol) were identified. There was no significant difference in patient demographics, admission leukocyte count, time to regular diet, or length of stay. Postoperative abscess occurred in 21.8% in the new protocol compared to 19.3% of the previous (P=0.5). There was a significant decrease in the number of patients discharged home on oral antibiotic therapy (P<0.001). ConclusionsPatients meeting discharge criteria with normal leukocyte count prior to completion of 5days IV antibiotic therapy can be safely discharged home without oral antibiotics after laparoscopic appendectomy for perforated appendicitis.

Postoperative Monotherapy with Piperacillin-Tazobactam versus Multidrug Therapy with Cefotaxime and Metronidazole for Perforated Appendicitis in Children: A Case-Control Study

Purpose: Recent data suggest that monotherapy with a broad-spectrum antibiotic may be as efficacious as, and potentially less costly than, standard multi-drug therapy. We compared mono-therapy with intravenous piperacillin-tazobactam (PT) with multi-drug therapy with cefotaxime and metronidazole (CM) in aspect of postoperative complications and hospital stay. Methods: We reviewed the hospital records and medical costs of the pediatric patients who were managed for perforated appendicitis between April 2013 and May 2014 retrospectively. Results: Forty-six patients with laparoscopic appendectomy for perforated appendicitis were included in our study. PT group was 20 and CM group was 26 patients. On admission, there were no significance in sex distribution, duration of symptoms, leukocyte count, and CRP levels. At postoperative third, fifth, and seventh day of each regimen, PT group have no statistical difference with CM group in leukocyte count, percentage of neutrophil, and CRP. There was no difference in abscess formation rate, wound infections, and hospital stay between two groups. There was only one patient who was readmitted with elevation of CRP and leukocyte count in CM group. Conclusion: Daily dosing with the mono-therapy of PT offers as efficient as multi-drug therapy of CM. To evaluate the efficacy of broad-spectrum antibiotics monotherapy in perforated appendicitis children, the cohort included more patients should be needed.

Ceftriaxone-induced pseudolithiasis in children treated for perforated appendicitis

Ceftriaxone has been associated with development of pseudolithiasis. In our institution, it is used for treatment of perforated appendicitis in children. This study evaluated the occurrence of ceftriaxone-related pseudolithiasis in this population. After obtaining IRB approval, we performed a retrospective chart review over 51 months. We included patients undergoing laparoscopic appendectomy for perforated appendicitis. All patients were treated with ceftriaxone post-operatively. Patients without initial or post-treatment gallbladder imaging available for review were excluded. There were 71 patients who met inclusion criteria with a mean (±SD) age of 10.8 ± 3.8 years. Of these, 14 % (n = 10) developed stones or sludge in the gallbladder. The mean duration of ceftriaxone therapy was 8.7 ± 3.8 days. The average time to post-antibiotic imaging was 11.5 ± 10.3 days from initiation of antibiotics. There was no significant difference in duration of ceftriaxone therapy in the children that developed pseudolithiasis or sludge (10.0 ± 4.9 days) compared to those that did not (8.5 ± 3.6, p = 0.26). One child (10 %) with pseudolithiasis went on to become symptomatic, requiring a laparoscopic cholecystectomy. In our experience, ceftriaxone use for perforated appendicitis is associated with a significant incidence of biliary pseudolithiasis, and is unrelated to duration of ceftriaxone therapy.

Monotherapy versus triple therapy antibiotics for the management of perforated appendicitis in children

Introduction: Appendicitis is the most common surgical emergency in the pediatric population. Despite the widespread prevalence of the disease, there is little consensus regarding the diagnosis and management of appendicitis. The aim of the study is to compare the surgical outcome of laparoscopic appendectomy in children for perforated appendicitis using perioperative triple versus a single antibiotic based regimen. Patients and methods: A retrospective review was done for all the children who had a laparoscopic appendectomy for perforated appendicitis in a tertiary pediatric surgery center in UAE in the period from June 2009 to January 2014. A total of 56 children was included in the study Group A, monotherapygroup 'MG' (31 cases) who were managed with piperacillinl tazobactam and group B, triple therapy group 'TG' (25 cases) who were managed with Amoxicillin Clavulanate, Metronidazole and amikacin. Results: There were 52% males and 48% females, mean age were 8.3 ± 1.5 years. There were 26% cases versus 28% cases in MG and TG respectively who required more than 7 days antibiotics. Mean total length of hospital stay was statistically significant more in TG than MG. There was significant difference between both groups (13% versus 36% in MG and TG respectively) for the need to replace the IV cannula before 72 hours. Conclusion: Monotherapy antibiotic management of perforated appendix in children was equally effective as triple antibiotic therapy in the current study population for the infectious morbidities. Monotherapy antibiotic management showed significant less incidence of intravenous cannula morbidities and shorter total hospital stay

Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy

PurposeTo evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children with perforated appendicitis (PA). MethodsWe reviewed the medical files of 221 children who underwent LA (n=75), OA (n=122), and conversion (CO) (n=24), comparing duration of operation, re-admissions, re-operations, intra-abdominal abscesses (IAA), and wound infections. ResultsCompared to OA, LA resulted in fewer re-admissions (1.3% vs. 12.3%; P=.006), fewer re-operations (4% vs. 17.2%; P=.006), and fewer wound infections (0% vs. 11.5%; P=.001). No differences in the duration of operation (72.9±23.0min vs. 77.7±48.0min; P=.392) or IAA (4% vs. 11.5%; P=.114) were observed. Compared to LA, CO had more complications. ConclusionsWe report that LA is superior to OA with regard to incidence of re-admission, re-operation, and wound infection.

Laparoscopic versus Open Appendectomy: Outcomes Analysis

The advantages of laparoscopic appendectomy (LA) over open appendectomy (OA) are unclear. This study compares the outcomes of LA versus OA. A retrospective study from 1998 to 2008 of patients (18 years or older) with appendicitis was performed from 12 medical centers. Study outcomes included 30-day postoperative morbidity and length of hospitalization (LOH). Overall, 16,512 patients were included in this study (LA=10,075, OA=6437). Male patients (LA=52.9% vs OA=57.3%, P<0.0001) and patients with perforated appendicitis (LA=19.3% vs OA=32.8%, P<0.0001) were more likely to undergo OA. LA for nonperforated appendicitis was associated with a lower wound infection rate (LA=1.9% vs OA=3.1%, P<0.0001) and shorter LOH (LA=1.4±1.2 vs OA=1.7±1.2 days, P<0.0001). Similar results were seen with LA for perforated appendicitis (wound infection: LA=5.0% vs OA=9.1%, P<0.0001; LOH: LA=3.8±2.7 vs OA=5.2±3.0, P<0.0001). Postoperative abscess drainage and readmission rates were similar between LA and OA for both nonperforated and perforated appendicitis. Multivariable analysis demonstrated that LA was associated with lower wound infection (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.5 to 0.7), higher abscess drainage (OR, 1.3; 95% CI, 1.1 to 1.6), and shorter LOH. In conclusion, LA continues to be the preferred operation for appendicitis in adults.