Management Of Uncomplicated Acute Appendicitis Research Articles

Direct visualization endoscopic retrograde appendicitis therapy for treatment of acute uncomplicated appendicitis.

To investigate the diagnostic and therapeutic value of direct visualization (single-use eyeMax subscope) endoscopic management of acute uncomplicated appendicitis. Thirty-six patients diagnosed with acute uncomplicated appendicitis, confirmed by computed tomography or ultrasonography, from Jan 2023 to Feb 2024 were enrolled in this study. We collected demographics, colonoscopy findings, subscope findings, clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT), and adverse events associated with ERAT. Appendiceal intubation was successful for all 36 patients. Thirty-five patients (97.2%) were definitely confirmed as having acute uncomplicated appendicitis. One patient with negative appendicitis was diagnosed as having cecal diverticulitis with fecalith incarceration. The mean procedure time was 13.1 ± 13.6 min. One patient presented with worsening abdominal pain, and a computed tomography scan suggested a perforated appendix. The mean length of hospitalizations was 1.78 ± 2 days. The mean follow-up was 158 days; during this period, two patients (5.6%) experienced recurrent abdominal pain after 23 and 88 days and subsequently underwent laparoscopic appendectomy. Direct visualization ERAT may be effective for diagnosing and treating acute uncomplicated appendicitis and seems to have a low complication rate.

Prediction of the outcome of nonoperative management of uncomplicated acute appendicitis in adults

Prediction of the outcome of nonoperative management of uncomplicated acute appendicitis in adults

To Determine the Effectiveness of Conservative Treatment Versus Appendectomy in the Management of Acute Uncomplicated Appendicitis.

Background: The vermiform appendix is considered to be a vestigial organ by the most. Its importance in surgery results only from its tendency for inflammation that results in a clinical syndrome known as acute appendicitis. It is the most common indication for emergency abdominal surgery in patients with acute abdomen with a crude annual incidence of 26 per 10,000 populations.Objectives: To determine the effectiveness of Conservative Treatment Versus appendectomy in the management of AcuteUncomplicated Appendicitis.Material and Methods: This randomized control trial was conducted in Department of General Surgery Saidu Group of Teaching Hospital Saidu sharif, from 1st January 2022 to 31st December 2022. A total of 96 cases were enrolled, that were divided into two groups. Informed written consent was taken from each patient. Patients in Group A were subjected to non-operative management with antibiotics while patients in Group B were subjected to appendectomy. Patients in both groups were evaluated for various parameters such as age, gender, pre- and post-operative duration of pain (group B), Alvarado score. Post stratification chi-square test was applied keeping P Value < 0.05 as significant. Results: Mean and SD for Age, Duration of Stay, Pre & Post Treatment Abdominal Score and Pre and Post Treatment Alvarado Score in Group A was recorded as 35±10.60, 3.0±0.24, 7.0±0.49, 3.0±0.20, 9.0±0.41 and 3.0±1.62 respectively. In the same manner, Mean and SD for Group B was 35±12.53, 5.0±0.41, 7.0±0.35, 3.0±0.35, 3.0±0.20, 9.0±0.41, and 2.5±1.5, respectively. Success rate in Group A was 26 (52%) whereas in Group B it was 36 (72%) patients. Conclusion: Conservative treatment can be applied safely in the majority of cases of the first attack of uncomplicated acute appendicitis, therefore, avoiding appendectomy and its associated morbidity and mortality. Keywords: Acute appendicitis, Alvarado Score, Antibiotic treatment, Acute uncomplicated appendicitis, Success rate.

Evaluation of Factors Predicting Successful Outcome in Patients Undergoing Expectant Management of Uncomplicated Acute Appendicitis.

Expectant management, or non-operative management (NOM), with standalone intravenous antibiotic therapy, has emerged as an effective alternative to appendectomy for the treatment of uncomplicated acute appendicitis. Various clinical, biochemical, and radiological factors have been implicated in predicting the success or failure of outcomes. Therefore, it is important to identify patients at the onset who are likely to have successful outcomes for conservative management of uncomplicated acute appendicitis. We prospectively enrolled 85 surgical patients diagnosed with uncomplicated acute appendicitis in our study. On admission, clinical features such as duration of symptoms, pulse rate (PR), history of fever within 24 hours of admission, modified Alvarado score and adult appendicitis score, biochemical parameters such as C-reactive protein (CRP), and hematological parameters such as total leukocyte count (TLC) were recorded. Radiological imaging of patients, namely ultrasonography and contrast-enhanced CT abdomen to evaluate appendix diameter and mural enhancement, was also undertaken. The outcome of expectant management for these patients (success or failure) was recorded, and the above-mentioned factors were evaluated to find a possible correlation with successful expectant management. We found that among 85 patients, 77.6% had a successful NOM of appendicitis, whereas 22.4% had a failed NOM of appendicitis. The duration of symptoms, pulse rate, fever within 24 hours of admission, TLC, percentage of neutrophils, CRP level, appendix diameter, modified Alvarado score, and adult appendicitis scorewere found to be statistically significant predictors of successful NOM of appendicitis according to univariate analysis. According to multivariable analysis, pulse rate and appendix diameter value were found to be statistically significant predictors of successful NOM of appendicitis. With each beat per minute (bpm) increase in pulse rate, there was a 0.30% decrease in the probability of a successful NOM of appendicitis. With each mm increase in appendix diameter, there was an 82% decrease in the probability of a successful NOM of appendicitis. From our study, it can be concluded that patients who met the following criteria, i.e., duration of symptoms before presenting to surgical emergency less than two days, presence of fever within 24 hours of presenting to surgical emergency, pulse rate >90 bpm, TLC >12000 cells/dL, CRP >20 mg/L, appendix diameter >10 mm, modified Alvarado score ≥ 9, and adult appendicitis score ≥ 18, have a higher probability of failure of NOM and hence should be excluded from expectant management.

Outpatient Non-operative Management of Uncomplicated Acute Appendicitis: A Non-inferiority Study

IntroductionNon-operative management (NOM) of uncomplicated acute appendicitis is a well-established alternative to upfront surgery. The administration of intravenous broad-spectrum antibiotics is usually performed in hospital, and only one study described outpatient NOM. The aim of this multicentre retrospective non-inferiority study was to evaluate both safety and non-inferiority of outpatient compared to inpatient NOM in uncomplicated acute appendicitis.MethodsThe study included 668 consecutive patients with uncomplicated acute appendicitis. Patients were treated according to the surgeon’s preference: 364 upfront appendectomy, 157 inpatient NOM (inNOM), and 147 outpatient NOM (outNOM). The primary endpoint was the 30-day appendectomy rate, with a non-inferiority limit of 5%. Secondary endpoints were negative appendectomy rate, 30-day unplanned emergency department (ED) visits, and length of stay.Results30-day appendectomies were 16 (10.9%) in the outNOM group and 23 (14.6%) in the inNOM group (p = 0.327). OutNOM was non-inferior to inNOM with a risk difference of—3.80% 97.5% CI (− 12.57; 4.97). No difference was found between inNOM and outNOM groups for the number of complicated appendicitis (3 vs. 5) and negative appendectomy (1 vs. 0). Twenty-six (17.7%) outNOM patients required an unplanned ED visit after a median of 1 (1–4) days. In the outNOM group, the mean cumulative in-hospital stay was 0.89 (1.94) days compared with 3.94 (2.17) days in the inNOM group (p < 0.001).ConclusionsOutpatient NOM was non-inferior to inpatient NOM with regard to the 30-day appendectomy rate, while a shorter hospital stay was found in the outNOM group. Further, studies are required to confirm these findings.

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy

Objective: This manuscript is a mini review of the outpatient management of non-complicated acute appendicitis. We reviewed the literature supporting the safety and efficacy of outpatient management of laparoscopic appendectomy in adult patients with uncomplicated acute appendicitis. Background Data: Outpatient laparoscopic appendectomy is feasible and safe in selected patients in observational studies. Benefits include reduced length of stay (LOS) and postoperative complications. Data reported in 17 studies (mainly retrospective) suggested that outpatient appendectomy might be feasible. Several observational studies have shown that outpatient surgery is not associated with increased readmissions, increased morbidity rates, or reoperation. Until 2022, international guidelines supported the clinical efficacy and safety of outpatient appendectomy. However, the strength of the evidence is weak and recommendations cannot be given. In November 2022, the first randomized controlled trial (RCT) of outpatient treatment according to the ERAS protocol was published. In this study, the length of stay was significantly shorter. There were no differences in readmission rates. No further emergency consultations or complications were observed. The outpatient management had presented an economic saving. Conclusion: Outpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.

Management of uncomplicated acute appendicitis during the COVID-19 pandemic: Appendectomy or non-surgical treatment?

This study aims to compare medical treatment and appendectomy in patients diagnosed with uncomplicated acute appendicitis during the COVID-19 pandemic. Retrospectively analyzed were the data of 80 patients who received medical or surgical treatment for uncomplicated acute appendicitis between March 15, 2020, and August 31, 2020. The demographic characteristics of the patients, length of hospital stay, physical examination and radiology findings, laboratory results, and any complications were recorded. Patients were divided into two groups depending on the mode of treatment, as surgical and non-surgical. Forty patients were given medical treatment and 40 patients were directly operated on for appendicitis. Of the 40 patients who received medical treatment, 8 (20%) ended up requiring an operation due to recurrence. The mean duration of hospitalization was 2 days (range: 1-3), and the mean follow-up duration was 285.35±65.66 days (range: 101-379). The white blood cell count was significantly higher in the surgical group (p=0.004), and the length of hospital stay was longer in the non-surgical group (p<0.001). The prevalence of post-operative complications was similar for patients who underwent appendectomy directly on admission or after recurrence (p=1.000). Among the patients who received medical treatment, the most important predictors of requiring surgery were the red cell distribution width and increased appendix diameter in computed tomography (p<0.05). Medical treatment is an effective alternative in patients with uncomplicated appendicitis. Even in the case of a recurrence in follow-up, surgery due to a potential recurrence is not associated with an increased rate of complication compared to direct surgery.

Comparison of conservative and operative treatment of uncomplicated appendicitis in the pediatric population

Introduction/Objective. Studies about possibilities of conservative, i.e., non-operative management of acute uncomplicated appendicitis in adult and pediatric population have been published lately, considering benefits of preserving appendix and potential complications related to appendectomy. Methods. In this retrospective study, medical data of 76 patients treated at the Institute for Child and Youth Health Care of Vojvodina in Novi Sad for acute uncomplicated appendicitis in 2015 and 2016 have been analyzed, comparing length of stay, antibiotic therapy use, complications occurrence, as well as the financial burden depending of the type of therapy applied. Results. During this period, 76 patients (55 operated on and 21 treated conservatively) were treated for acute uncomplicated appendicitis. Conservatively treated children spent statistically significantly shorter period of time at the hospital compared to the ones operated on (4.24 vs. 5.76 days; p &lt; 0.001). Early surgical complications occurred in 10.91% of those operated on and in 9.52% conservatively treated children, which was not a statistically significant difference (p = 0.863). The total cost of hospital stay was significantly lower in those who underwent non-operative management (10,340 RSD vs. 54,281 RSD; p &lt; 0.001). The difference was significant even when analyzing costs related to rehospitalization and operative treatment of children initially treated conservatively (p &lt; 0.001). Conclusion. Non-operative, i.e., conservative treatment of acute uncomplicated appendicitis in the pediatric population is safe and effective compared to the operative one, and it is not associated with more frequent occurrence of early surgical complications. Total costs for the non-operative treatment are significantly lower, even considering costs related to re-hospitalization of children initially treated conservatively.

The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study.

Background Acute appendicitis remains the most common cause of lower abdominal pain leading to emergency visits. Even though the standard treatment of acute appendicitis remains appendectomy, in recent times, multiple randomized control trials and meta-analyses have deduced conservative treatment as a successful alternative treatment.During the coronavirus disease (COVID) pandemic, with a shortage of staff and resources, treatment with conservative management of uncomplicated acute appendicitis became very beneficial under certain circumstances and conditions. This study aimed to assess whether it is effective to manage patients with uncomplicated acute appendicitis with antibiotic therapy. Methodology This was a single hospital based retrospective, cross-sectional study from Jan 2015 to May 2020. Patients with clinical and radiological features of uncomplicated acute appendicitis with Alvarado's score >6 were included in the study. Patients were kept on antibiotics, intravenous fluids, and analgesia as part of a conservative regime. Those who failed to respond to conservative therapy were managed surgically. The follow-up period was six months. Results One hundred eighty-two cases of uncomplicated acute appendicitis were included and managed conservatively, of which 52.2% were males while 47.8% were females. The median age of the patients was 26 years. Conservative treatment was successful in 26.2% of the patients, with a recurrence of 5.5% in the six-month follow-up period. The mean number of days of hospital stay was three days in patients treated with conservativeor surgical treatment. Conclusion Conservative management is gaining popularity, and many centers are inclined towards non-operative management; however, appendectomy remains the gold standard treatment for appendicitis.

Outpatient management of acute uncomplicated appendicitis after laparoscopic appendectomy: a randomized controlled trial

ObjectiveTo confirm the safety and efficacy of outpatient management of laparoscopic appendectomy, with an enhanced recovery after surgery (ERAS) protocol, in adult patients with uncomplicated acute appendicitis.Summary background dataOutpatient laparoscopic appendectomy is feasible and secure in selected patients in observational studies. The benefits include reduced length of stay (LOS) and postoperative complications. This is the first randomized controlled trial of outpatient management following ERAS protocol.MethodsPatients admitted from the emergency department with acute appendicitis were randomized into one of two groups: standard care within the hospital (HG) or the outpatient group (OG). An ERAS protocol was followed for both groups. Patients in the HG were admitted to the surgical ward. Patients in the OG were referred to the day-surgery unit. The primary endpoint was the length of stay.ResultsNinety-seven patients were included: 49 in the OG and 48 in the HG. LOS was significantly shorter in the OG (mean 8.82 h) than in the HG (mean 43.53 h), p < 0.001. There was no difference in readmission rates (p = 0.320); we observed only one readmission in the OG. No further emergency consultations or complications were observed. The cost saving was $516.52/patient as a result of the intervention.ConclusionOutpatient management of appendectomy is safe and feasible procedure in selected patients. This approach could become the standard of care for patients with uncomplicated appendicitis, showing fewer complications, lower LOS and cost.Trial registration: Registration: www.clinicaltrials.gov (NCT05401188) Clinical Trial ID: NCT05401188

Endoscopic retrograde appendicitis therapy (ERAT) vs appendectomy for acute uncomplicated appendicitis: A prospective multicenter randomized clinical trial.

To compare the efficacy and feasibility of endoscopic retrograde appendicitis therapy (ERAT) with appendectomy for treating acute uncomplicated appendicitis. This was a prospective multicenter randomized trial in which consecutive patients were randomized at a ratio of 1:1 to receive either ERAT or appendectomy. The outcomes included technical success rate, procedure time, postoperative pain relief, postoperative analgesic use, time to soft diet intake, length of postoperative hospital stay, postoperative complications, and recurrence rate. From August 2013 to December 2015, 110 patients with acute uncomplicated appendicitis were randomized to ERAT or appendectomy. The technical success rate was 94.55% for ERAT compared with 100% for appendectomy. Recurrence of appendicitis within 3-year follow-up occurred in 8 patients following ERAT. Postoperative abdominal pain was less frequent with ERAT than with appendectomy (21.15% [11/52] vs 87.27% [48/55], P<0.001). Soft diet intakebegun earlier after ERAT than appendectomy (6h vs 48 h, P < 0.001), and post-procedure hospital stay was shorter (3 days vs 5 days, P<0.001), as was the use of analgesics postoperatively (9.09% vs 49.09%, P < 0.001). ERAT is a feasible, safe, and effective alternative approach for the management of acute uncomplicated appendicitis. Compared with appendectomy, advantages of ERAT include no skin wound, organ preservation, reduced postoperative pain, early food intake, quick recovery, fewer postoperative complications, and shorter post-procedure hospitalization. The unsolved problem related to ERAT is the recurrence of appendicitis.

Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis

Appendectomy remains the standard of care for uncomplicated acute appendicitis despite several randomized clinical trials pointing to the safety and efficacy of nonoperative management of this disease. A meta-analysis of randomized clinical trials may contribute to the body of evidence and help surgeons select which patients may benefit from surgical and nonsurgical treatment. To assess the efficacy and safety of nonoperative management vs appendectomy for acute uncomplicated appendicitis. A systematic review was conducted using indexed sources (Embase and PubMed) to search for published randomized clinical trials in English comparing nonoperative management with appendectomy in adult patients presenting with uncomplicated acute appendicitis. To increase sensitivity, no limits were set for outcomes reported, sex, or year of publication. All nonrandomized or quasi-randomized trials were excluded, and validated primers were used. Among 1504 studies imported for screening, 805 were duplicates, and 595 were excluded for irrelevancy. A further 96 were excluded after full-text review, mainly owing to wrong study design or inclusion of pediatric populations. Eight studies met the inclusion criteria and were selected for the meta-analysis. Meta-extraction was conducted with independent extraction by multiple reviewers using the Covidence platform for systematic reviews and in accordance with PRISMA guidelines. Data were pooled by a random-effects model. Treatment success and major adverse effects at 30 days' follow-up. The main outcome (treatment success proportion at 30 days of follow-up) was not significantly different in the operative and nonoperative management cohorts (risk ratio [RR], 0.85; 95% CI, 0.66-1.11). Likewise, the percentage of major adverse effects was similar in both cohorts (RR, 0.72; 95% CI, 0.29-1.79). However, in the nonoperative management group, length of stay was significantly longer (RR, 1.48; 95% CI, 1.26-1.70), and a median cumulative incidence of 18% of recurrent appendicitis was observed. These results point to the general safety and efficacy of nonoperative management of uncomplicated acute appendicitis. However, this strategy may be associated with an increase in duration of hospital stay and a higher rate of recurrent appendicitis. This meta-analysis may help inform decision-making in nonoperative management of uncomplicated acute appendicitis.

Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children.&#x0D; Study design: Prospective comparative study.&#x0D; Settings: Pediatric surgery Department, Ghulam Muhammad Mahar Medical College Sukkur.&#x0D; Study duration: 1st February 2020 to 31st May 2021.&#x0D; Materials and Methods: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were managed with surgical management immediately. Follow-ups were carried out after discharge on the 7th day, 1 month, and six months. Patients reporting a recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with the open technique. Patients were observed for post-operative complications.&#x0D; Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368.&#x0D; Conclusion: It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management.

Conservative Management in Acute Appendicitis is it Superior to Surgery? A Retrospective Study

To see the merits of the surgical treatment and hence to reaffirm the superiority of surgery in acute appendicitis. Background: Surgery was the treatment of choice for acute Appendicitis which was practised over centuries. During the last decade, there were some publications about the conservative management of uncomplicated acute Appendicitis in adults and its advantages over the surgery. And all that studies also states that there was recurrence of about 20-30 %. Methods: The data of patients that came to the surgical department with acute appendicitis and recurrent appendicitis during the period November 2020 to December 2021 were analysed. The patients treated with surgery alone were included in the study. Detailed history, laboratory investigations and radiological investigation including Ultrasonogram (USG) were analysed to differentiate acute and recurrent cases. From the data we could identify the number of both acute and recurrent cases. Hospital admissions, number of episodes for the recurrent treatment, loss of working days and other relevant data were collected from the patients. Results: There were 61 patients who were operated for appendicitis including both acute and recurrent cases in the period of 1 year in the COVID era. Among these 34 were acute appendicitis and 27 recurrent appendicitis. Male: Female ratio was 39:22. Our study shows that majority are male patients and the most numbers are in the age group 10-30 years comparable to the standard statistics. Our study shows that 44.26% (27) of the total cases (61) operated was recurrent appendicitis. The number of recurrent episodes varied from the period of 1 week to 2 years after conservative treatment". In them treatment also varied from outpatient to inpatient in different individuals. The advantage of less hospital stays and decreased morbidity of conservative treatment is lost with subsequent investigation and surgical treatment in those. All the patients who got operated on follow up had an uneventful post operative period. Conclusion: So conservatively managed patients had lost many working days and had economic loss compared to patients operated for acute appendicitis early. Early surgery in acute appendicitis actually decreased the cost and morbidity. Keywords: Acute appendicitis; Recurrent Appendicitis; Appendicectomy; Conservative treatment; Appendicular perforation.

Antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis (APPAC III): randomized double-blind superiority trial.

Non-operative management of uncomplicated acute appendicitis is an option, but omission of antibiotics from the regimen has not been tested. A double-blind, placebo-controlled, superiority RCT in adults with CT-confirmed uncomplicated acute appendicitis was designed to compare placebo with antibiotics (intravenous ertapenem followed by oral levofloxacin and metronidazole). The primary endpoint was treatment success (resolution resulting in discharge without appendicectomy within 10 days); secondary outcomes included pain scores, complications, hospital stay, and return to work. From May 2017 to September 2020, 72 patients with a mean(s.d.) age of 37.5 (11.1) years were recruited at five hospitals. Six were excluded after randomization (5 early consent withdrawals, 1 randomization protocol violation), 35 were assigned to receive antibiotics, and 31 to receive placebo. Enrolment challenges (including hospital pharmacy resources in an acute-care surgery setting) meant that only the lowest sample size of three predefined scenarios was achieved. The 10-day treatment success rate was 87 (95 per cent c.i. 75 to 99) per cent for placebo and 97 (92 to 100) per cent for antibiotics. This clinical difference of 10 (90 per cent c.i. -0.9 to 21) per cent was not statistically different for the primary outcome (1-sided P = 0.142), and secondary outcomes were similar. The lack of antibiotic superiority statistically suggests that a non-inferiority trial against placebo is warranted in adults with CT-confirmed mild appendicitis. Registration number: EudraCT 2015-003634-26 (https://eudract.ema.europa.eu/eudract-web/index.faces), NCT03234296 (http://www.clinicaltrials.gov).

Efficacy and Safety of Non-Operative Management of Uncomplicated Acute Appendicitis Compared to Appendectomy: An Umbrella Review of Systematic Reviews and Meta-Analyses.

BackgroundNon-operative management (NOM) of uncomplicated acute appendicitis (AA) has been introduced as an alternative to appendectomy. This umbrella review aimed to provide an overview of the efficacy and safety of NOM of uncomplicated AA in the published systematic reviews.MethodsThis umbrella review has been reported in line with the PRISMA guidelines and umbrella review approach. Systematic reviews with and without meta-analyses on the efficacy of NOM of AA were analyzed. The quality of the reviews was assessed with the AMSTAR 2 tool. The main outcomes measures were the treatment failure and complication rates of NOM and hospital stay as compared to appendectomy.ResultsEighteen systematic reviews were included to this umbrella review. Eight reviews documented higher odds of failure with NOM, whereas two reviews revealed similar odds of failure. Six reviews reported lower odds of complications with NOM, six reported similar odds, and one reported lower odds of complications with surgery. Eight reviews reported similar hospital stay between NOM and appendectomy, one reported longer stay with NOM and another reported shorter stay with NOM. Pooled analyses showed that NOM was associated with higher treatment failure overall, in children-only, adults only, and RCTs-only meta-analyses. NOM was associated with lower complications overall, yet children-only and RCTs-only analyses revealed similar complications to surgery. NOM was associated with shorter stay in the overall and adult-only analysis, but not in the children-only analysis.ConclusionsNOM of AA is associated with higher treatment failure, marginally lower rate of complications and shorter stay than appendectomy.

Digital single-operator cholangioscope for endoscopic retrograde appendicitis therapy.

This study aimed to investigate the diagnostic and therapeutic value of a digital single-operator cholangioscope (SOC) system for endoscopic management of acute appendicitis. 14 patients with acute uncomplicated simple or supportive appendicitis were evaluated between November 2018 and September 2020. The diagnosis of acute appendicitis was confirmed by direct colonoscopy imaging and cholangioscope. The success rate of digital SOC-assisted endoscopic retrograde appendicitis therapy (ERAT), the procedure time, postoperative length of hospital stay, complications, and recurrence rate were recorded. Technical success rate was 100 %, with high quality imaging of the appendiceal cavity achieved using SOC in all 14 patients. The mean procedure time was 37.8 (standard deviation [SD] 22) minutes. All patients experienced immediate relief from abdominal pain after the procedure. Mean postoperative hospitalization was 1.9 (SD 0.7) days. No recurrence occurred during 2-24 months of follow-up. Digital SOC-assisted ERAT provided a feasible, safe, and effective alternative approach for diagnosis and management of acute uncomplicated appendicitis without the need for X-ray or ultrasonic guidance.

904 Can Patients with Acute Appendicitis be Ambulated Safely?

IntroductionDuring the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis.MethodData was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded.Results190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy.ConclusionsPatients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.

Early impact of COVID-19 pandemic on paediatric surgical practice in Nigeria: a national survey of paediatric surgeons

IntroductionThe novel coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known and mortality is increasing. We assessed its...

Impact of the COVID-19 pandemic on surgical services: early experiences at a nominated COVID-19 centre.

Impact of the COVID-19 pandemic on surgical services: early experiences at a nominated COVID-19 centre.