Non-complicated Appendicitis Research Articles

Role of Conservative Management in the Treatment of Acute Non-Complicated Appendicitis

Objective: The purpose of this study was to assess the efficiency of non-operative management of acute non-complicated appendicitis in terms of cost effectiveness, as well as related morbidity and mortality. Study Design: A prospective observational research. Place and duration: In the Surgical Unit of Islam Medical College and Teaching Hospital Sialkot for one-year duration from January 2021 to December 2021. Methodology: The study included 110 patients with early acute non-complicated appendicitis who were identified by clinical history, physical, and laboratory testing. 110 patients were given intravenous antibiotics for two days, followed by oral antibiotics for seven days. A proforma was used to collect the data. Several morbidities were recognized and tracked in patients. Results: There were 72 men and 38 women, with an average age of 20 years. Right iliac fossa pain, nausea, vomiting, and anorexia were the most frequent symptoms, whereas fever, tachycardia, and rebound tenderness in the right iliac fossa were the most common signs. Patients were randomly assigned to one of two groups. After an uneventful stay of 2 to 4 days. Patients in Group 1 (36.4 percent) who were treated conservatively had no problems and were discharged after a hospital stay of 2 to 4 days. Within four months, 5 patients (12.5%) and three patients (3%) experienced recurrence within six months. They had appendicectomies done in the traditional way. Wound infection was the sole postoperative complication in one patient (5%). Their hospital stay lasted anywhere from three to six days. Two (2.9%) patients with perforated/gangrenous appendix with appendicolith was found in Group-2 patients who had standard appendicectomy. Wound infection occurred in 4 individuals (5.7 percent), pelvic collection in 3 (4.3 percent), and subsequently small intestinal obstruction (adhesive) in two patients (2.8 percent). Their hospital stay lasted anywhere from four to nine days. Conclusion: Patients who were treated conservatively with antibiotics had minor discomfort and required fewer analgesics. Although surgery-related morbidity, death, and costs were averted, the recurrence rate was not insignificant. Keywords: Acute appendicitis, Conservative management, Recurrence

Complicated or non-complicated appendicitis? That is the question.

Acute appendicitis (AA) is a common disease that includes all age groups and both genders in societies and is one of the most common causes of acute abdomen. It is important to distinguish between complicated and non-complicated appendicitis before surgery. This study aims to determine laboratory parameters that can be used to determine whether the disease is complicated or non-complicated in patients admitted to the emergency department with AA. Female and male patients admitted to the Emergency General Surgery Department between May 2019 and November 2020 and diagnosed with appendicitis were included in the study. Demographic data (age, gender, and protocol numbers), complete blood counts (Delta neutrophil index [DNI], hemoglobin, monocyte, neutrophil, eosinophil, basophil, platelet, platelet distribution width, mean platelet volume, reticulocyte distribution width), biochemical parameters (amylase, direct bilirubin, indirect bilirubin, albumin, calcium, and lactate dehydrogenase), and examination information were obtained from the hospital automation system and recorded via SPSS software. Parameters of patients were divided into two groups as complicated and non-complicated appendicitis groups were compared. White blood cell (WBC), monocyte, neutrophil, DNI, total bilirubin, and direct bilirubin values were found to be statisti-cally significantly higher in the complicated appendicitis group compared to the non-complicated appendicitis group (p-values; <0.001, 0.003, <0.001, <0.001 and 0.008, respectively). DNI, bilirubin values, WBC, monocyte, neutrophil, and eosinophil can be used as laboratory parameters to distin-guish between complicated and non-complicated AA.

Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?

Background: To research the perioperative significance of the simple laboratory test values on differentiating complicated acute appendicitis. Methods: The medical records of 216 acute appendicitis patients were examined retrospectively. Patients were divided into two groups according to pathological results (non-complicated (n=157) and complicated (n=59)). The demographic and clinical data, laboratory findings, length of hospital stay, and pathological results were compared between the two groups. Receiver operating characteristics (ROC) curves were performed to analyze the optimal cutoff value of numerical variables which were significantly differed between the group comparisons. Results: The preoperative data were similar in two groups except for age. The length of hospital stay (LOHS) was longer and total/direct bilirubin levels higher in the complicated group (p=0.002, p=0.002, and p=0.002, respectively. The lymphocyte level and amylase level were lower in the complicated group (p=0.02 and p=0.004, respectively). ROC curve analysis showed a cutoff values as follows: total bilirubin ≥0.89 mg/dL, direct bilirubin ≥0.43 mg/dL, lymphocyte≤1.63%, and amylase ≤46.5 U/L. Conclusion: Preoperative higher total and direct bilirubin levels are able to predict complicated appendicitis. Preoperative higher serum amylase levels should not have a place in the differential diagnosis of complicated appendicitis. This means that if serum amylase is elevated in a patient with doubted acute appendicitis, it does not suggest acute complicated appendicitis.

Letter to the Editor regarding “Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?”

Letter to the Editor regarding “Which simple laboratory test is better to differentiate acute complicated and noncomplicated appendicitis?”

Have acute appendicitis complications increased in children as a result of SARS-CoV-2?

The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. A retrospective cohort study was carried out. It included acute appendicitis patients under 15years of age treated from January 1, 2019 to December31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed. A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05). The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.

The effect of climate and air pollution on the development of complicated appendicitis

&lt;b&gt;Aim:&lt;/b&gt; The aim of this study was to examine whether there is a relationship between complicated appendicitis and seasons, weekends, and air pollution. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Materials and methods:&lt;/b&gt; Patients who had undergone appendectomy in the last three years due to acute appendicitis were filtered from the database. Patients’ demographic features, date of the surgery, pathology reports, data on atmospheric temperatures, atmospheric pressure, relative humidity, and air pollution on the date of the surgery were collected and compared between complicated and non-complicated appendicitis groups. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Out of 360 patients, 238 were men. The median age was 39 years for women and 29 years for men. Complicated appendicitis was seen in 78 (21.7%) patients, and the incidence rates were similar between the sexes (p = 0.69); this rate increased with increasing age (p = 0.001). The day of the week in which the surgery was performed (p = 0.55) and weekdays versus weekends (p = 0.16) did not change the complicated appendicitis incidence rate. This rate was similar among seasons (p = 0.44), temperature (p = 0.81), humidity (p = 0.62), and atmospheric pressure (p = 0.95). There was no difference between the groups for all noxious gases or PM2.5 levels, but for PM10 levels there was a significant difference (p = 0.045). In multivariate analysis, age (p = 0.001) and PM10 air pollution (p = 0.045) significantly affected the development of complicated appendicitis. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Air pollution of PM10 may have a real effect on the incidence of complicated appendicitis.

Comparison of Antibiotic treatment and Appendectomy for non-complicated Acute Appendicitis during Covid-19 pandemic

Aim: To evaluate the efficacy of antibiotic treatment as the primary option for non-complicated acute appendicitis in pandemic situation. Study Design: Prospective interventional study. Setting &amp; Duration of Study: CMH Lahore, a 700 bedded tertiary care hospital, for 4 months from 15th April 2020 to 15th august 2020. Methodology: A total of 110 cases meeting inclusion criteria, aged 13-65 years of both genders with suspicion of non-complicated appendicitis were included in the study, using probability sampling. They were divided in two groups on randomization basis. Group A for antibiotic therapy and Group B for appendectomy. Group A patients admitted in the ward 48 hours for IV antibiotics, were re-evaluated after 24 hours. If condition improves, the patient was discharged on oral antibiotics for next 10 days &amp; if condition does not improve, antibiotics were prolonged for 48 hours. If deteriorating or patient. .chooses to change group, they underwent appendectomy. If condition improved, they were discharged on oral antibiotics for next 10 days. Group B patient were discharged after 2 post-operative doses of I/V antibiotics. Post-operative I/V antibiotics for 48 hours &amp; 3 days oral antibiotics were given when appendix was gangrenous or perforated. Results: In a population of 110 patients, we studied the comparison of the groups having antibiotics and appendectomy as treatment for acute appendicitis. There is no significant difference in outcomes on basis of mean pain score and mean duration of hospital stay. Both ways of treatment can be adapted accordingly. Conclusion: Non-complicated acute appendicitis can be managed non-operatively in crisis situations like COVID-19 pandemic causing overburdening of hospitals. Keywords: Acute appendicitis, antibiotic therapy, appendectomy, pandemic.

The lymphocyte-to-monocyte ratio may distinguish complicated from non-complicated pediatric appendicitis: A retrospective study and literature review

To date, no parameter with satisfactory accuracy exists for the diagnosis of appendicitis. This retrospective study describes the discriminatory value of preoperative hematologic factors associated with complicated and non-complicated pediatric appendicitis. Clinical and laboratory data were obtained from 294 children diagnosed with appendicitis on admission and treated at our tertiary-level pediatric hospital from 2015 to 2017; they were divided into three groups: control group (n=118), histologically proven complicated (n=120), and non-complicated (n=56) appendicitis. Complicated appendicitis was associated with male preponderance and elevated neutrophil and monocyte levels (all p<0.001). Non-complicated appendicitis was associated with elevated eosinophil levels (p=0.023), and unaltered lymphocyte levels (p=0.30). Compared to non-complicated disease, the lymphocyte-to-monocyte ratio (LMR) was decreased in complicated appendicitis (p=0.003) but unaltered in the control group (p=0.38). In the discrimination analysis, LMR had high accuracy (AUC 0.73±0.05; p<0.001; odds ratio (OR) (95% confidence interval (CI)) 6.0 (2.4-15.3)) and was the only parameter independently associated with complicated appendicitis on regression analysis (OR (95% CI), 0.544 (0.359-0.825); p=0.004). We identified LMR as a novel potential marker for the differentiation of complicated from non-complicated pediatric appendicitis. This has implications on the treatment approach, either surgical in complicated disease or conservative in non-complicated disease.

Quality of Life in Pediatric Minimally Invasive Surgery: Cost-Utility Analysis of Laparoscopic Versus Open Appendectomy.

Background: Economic evaluation in health care is becoming increasingly important. Laparoscopic appendectomy (LAp) is one of the most frequent minimally invasive procedures in the pediatric population. The increased costs of this approach in any indication could be justified by proving its cost-utility in terms of health-related quality of life (HRQoL). We aim to perform a cost-utility analysis between open and LAp (open appendectomy [OAp] and LAp). Materials and Methods: We included the data of children operated for acute noncomplicated appendicitis, who agreed to answer a validated quality of life (QoL) questionnaire. Costs were calculated for each patient. We established a threshold for cost-effectiveness (λ) of 20,000 to 30,000€ per quality adjusted life year (QALY) according to previous research. Results: A total of 53 patients were included. Overall mean costs in the OAp were 758.98€ and in the LAp 1525.50€. The incremental cost-effectiveness ratio was 18,000€/QALY, under the threshold of cost-effectiveness, therefore favoring the laparoscopic approach as it improves HRQoL despite the costs. Conclusions: Economic evaluation studies in Pediatric Surgery are scarce and rarely measure outcomes in terms of QoL. This information is important in the decision-making process for institutions and health-care professionals. Our results encourage the use of laparoscopy in pediatric appendectomy to improve HRQoL in our patients.

The predictors of complicated acute appendicitis: large unstained cells, gamma-glutamyl transferase, monocyte to platelet ratio, age and gender

Aim: In this study, we sought to investigate possible biomarkers markers that can preoperatively distinguish complicated and non-complicated acute appendicitis.&#x0D; Material and Method: Patients who underwent appendectomy between February and December 2019 were screened retrospectively. Patients with pathology findings other than appendicitis were excluded. Patients with a confirmed diagnosis of acute appendicitis were categorized as complicated and non-complicated appendicitis for analysis of sociodemographic characteristics, comorbidities and preoperative laboratory parameters.&#x0D; Results: A total of 575 patients were included in the study. Among these, 432 (75.1%) were diagnosed with non-complicated appendicitis and 143 (24.9%) were diagnosed with complicated appendicitis. The mean (SD) age was 34.2±14.2 years. Hypertension, diabetes mellitus and hypothyroidism were the most frequent comorbidities. Age (OR, 1.026; p=0.010), male gender (OR, 1.837; p=0.044), LUC (OR: 19.868; p=0.034) and GGT (OR: 1.013; p=0.013) were associated with a higher risk of complicated appendicitis. An increase in monocyte to platelet ratio (MPR) (OR: 0.920; p=0.047) was associated with a lower risk of complicated appendicitis.&#x0D; Conclusion: In patients with acute appendicitis, parameters including age, gender, as well as LUC, GGT and MPR, which are easily available and relatively cheap biomarkers, can be useful to distinguish non-complicated and complicated cases preoperatively.

Is a single dose of prophylactic antibiotics sufficient in patients with acute noncomplicated appendicitis

Background Antibiotics prescription before surgery is considered to be effective in reducing the infectious complications of appendectomy. As a result, most surgeons prescribe antibiotics before surgery for patients diagnosed with appendicitis. Objective The aim of study was to evaluate the effect of a single antibiotic dose compared with the concurrent regimen on the outcome of appendectomy, especially infective complications. Patients and methods A total of 60 cases diagnosed with appendicitis were included, and they were divided into two groups: group A (single dose of cefotaxime 1 g and metronidazole 500 mg before surgery) and group B (the same regimen was received, and it was repeated twice daily for 4 days). All cases were subjected to history taking, physical examination, and routine investigations. At follow-up, all cases were clinically assessed. Results There were no significant statistical differences between groups in age, sex, and BMI variables. No significant statistical differences were observed during the surgery and hospitalization period between two groups. Wound infection occurred in 10 and 6.67% of cases in both groups, respectively (P > 0.05). However, the cost was significantly higher in group B. Conclusion A single dose preoperative antibiotics appears to be as efficacious as concurrent regimen in preventing wound infections after appendectomy. Continuing antibiotic prophylaxis in the postoperative period was not necessary, and it added additional unnecessary financial costs.

PREOPERATIVE EVALUATION OF THE SCORING SYSTEM DEVELOPED BY ATEMA TO DISTINGUISH COMPLICATED FROM UNCOMPLICATED ACUTE APPENDICITIS

Background: The diagnosis of acute appendicitis is purely based on history, clinical examination and some laboratory investigations (e.g. WBC count). Certain diagnosis can only be obtained at surgery and after pathological examination of surgical specimen. The Atema scoring system can distinguish complicated from non-complicated appendicitis preoperatively. Objective: To evaluate the validity and diagnostic accuracy of the Atema scoring system in differentiating complicated from non- complicated appendicitis before surgery. Patients and Methods: A prospective study was carried out on 60 patients complaining of acute abdominal pain, diagnosed as acute appendicitis using the Alvarado score and undergoing open appendectomy operation in the Emergency Department, Faculty of Medicine, Al-Azhar University from December 2019 to July 2020. Routine clinical and laboratory work up were done, the Atema Score was calculated to every patient in the study preoperatively. The decision to operate was made by a senior surgeon (consultant). The intraoperative finding whether the acute appendicitis was complicated or not was recorded. Post operatively, the histo-pathological examination results were recorded for each patient. The ROC curve was done, the cut-off point of the Atema scoring system was detected based on the ROC curve. The area under the ROC curve and the p-value were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the Atema scoring system above the level of the cut-off point were calculated. Results: In total of 60 patients, 37 patients (61.7%) had complicated appendicitis and 23 patients (38.3%) had non-complicated appendicitis. The sensitivity of the Atema score has a diagnostic accuracy of 0.944 (Area under the curve) with sensitivity 86.96% and specificity 89.19% with positive predictive value 83.3% and negative predictive value 91.7%. Conclusion: The Atema score can significantly differentiate between complicated and non-complicated acute appendicitis. A higher score denotes increased probability of the presence of complications as perforation and gangrene.

Acute Appendicitis in Children During the COVID-19 Pandemic: Neither Delayed Diagnosis Nor Worse Outcomes.

The aim of this study was to describe the incidence of complicated appendicitis during the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic lockdown. This was a retrospective study of pediatric patients diagnosed with acute appendicitis in a single pediatric institution that assumed care responsibility for most of the pediatric emergencies during the lockdown period in Madrid (Spain). A control group was made up of the same number of patients diagnosed the previous year. One hundred fifty-one patients diagnosed with acute appendicitis were included (77 during self-quarantine and 74 during the previous year). The incidence of complicated appendicitis was 38.9% versus 28.3%, showing no significant differences. The 2 groups were homogeneous, with no differences in time elapsed between symptom onset and first emergency department visit, laboratory test results, median length of stay, intensive care admissions, or patients correctly diagnosed on their first visit. COVID-19 (coronavirus disease 2019) self-quarantine has not increased the incidence of complicated appendicitis, and children who developed complicated appendicitis did not have worse clinical outcomes. Parents did not delay presenting for medical attention, and emergency department pediatricians did not fail to diagnose this condition. Reorganization of hospital resources, fast-track treatment protocols for noncomplicated appendicitis, and extended use of home-stay hospitalization for complicated appendicitis could have contributed to these favorable outcomes.

Complicated or Non-complicated Appendicitis? That is the Question

Complicated or Non-complicated Appendicitis? That is the Question

The Effect of Environmental Factors on the Incidence of Complicated Appendicitis in Mongolian Paediatric Population

Introduction: Acute appendicitis (AA) in children is the primary cause of urgent surgery in pediatric patients. Diagnosis of AA continues to be a challenge, especially in the youngest children, who often present with abdominal pain accompanied by nonspecific signs. As epidemiological data on the relationship between acute appendicitis and environmental factors are relatively few and the issue is still controversial, we conducted this study which compared two groups of patients with complicated and noncomplicated appendicitis in a sample of patients admitted to a MNCMCH. The aim of this study was to determine the risk factors for complications in acute appendicitis in the paediatric population. Methods: Our study was performed on 1003 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between January 2019 and December 2019. The diagnosis was based on the results of pathological examination. The two groups of complicated (gangrenous and perforated) and noncomplicated (catarrhal and phlegmonous) acute appendicitis were compared. Results: 1003 pediatric patients (≤18 years old) were suspected of having acute appendicitis and subsequently underwent surgery. From a total of 967 patients, 56% (n = 542) were male, 44% (n = 425) were female (gender ratio was 1.3:1). The histological examination noted that 33.1% were uncomplicated, 66.9% were complicated. While the incidence of acute appendicitis was higher during winter, the highest incidence of complicated appendicitis was observed equally in winter and autumn without significant association (p = 0.541). The months of December and March were marked by the highest incidence of AA. The highest incidence of complicated appendicitis was observed during the month of December (45%) with statistically significant difference (p < 0.001). Our study of the incidence of family history, allergy and family members was noted in complicated and noncomplicated group with statistically significant difference (p < 0.001). Conclusions: Pediatric acute appendicitis incidence is increased in winter months in Mongolia. Preventive measures to decrease morbidity and mortality associated with this disease can be taken during the winter seasons from December to March. However, further large-scale studies are needed to support this conclusion.

Is a Single Portion of Prophylactic Antibiotics Sufficient in Patients with Acute Non-Complicated Appendicitis?

Intense a ruptured appendix is perhaps the most well-known intense careful sicknesses and one in each 100,000 individuals is tainted with intense a ruptured appendix. Around two third (2/3) of patients are men and two third (2/3) of patients age from 15-44 years of age. In any case, anybody can be contaminated subverting the age.

Acute Appendicitis Pathways: A Systemic Review

Background: Clinical pathways are effective in reducing healthcare cost and standardizing management protocol for diseases and conditions. However, there are no standardized pathways for appendicitis. This study aims to determine whether implementation of a standardized clinical pathway for managing appendicitis may lead to improved patient care. Materials and Methods: We searched for articles published in PubMed, MEDLINE, and Cochrane library between 1974 and 2015. Thirty-seven papers published in English that met inclusion criteria were included and analyzed in this review. A total of 37 studies met inclusion criteria and were analyzed for the purpose of this study. Results: A clear definition for appendicitis pathway was observed in 30 articles. Appendicitis was diagnosed based on clinical and laboratory findings; however, 34% of the studies included radiological investigations. Sixteen studies provided clear definitions for discharge criteria. Time of follow-up (5 - 28 days) was reported in 10 studies. Operative time was the most commonly used outcome measure. The mean length of stay for non-complicated appendicitis was 1.3 days, and 6.26 days for complicated appendicitis. Most of the studies concluded that the accuracy of a clinical pathway for appendicitis diagnosis can be achieved by assessing the incidence of a normal appendix. The mean cost for patient care was $4874.14 (SAR 18,278.03). Conclusion: There was no standardized definition for appendicitis clinical pathway components. Studies suggested that establishing a clinical pathway for appendicitis improves the outcome and minimizes the cost.

Laboratory markers used in the prediction of perforation in acute appendicitis.

In this study, we aimed to evaluate the laboratory markers used in the diagnosis of acute appendicitis (AA) and present the parameters that can be used to predict acute perforated appendicitis. The cases who underwent an appendectomy in our clinic between September 2018 and March 2020 were evaluated retrospectively. A total of 530 patients who met the study criteria were included in the study. Patients were divided into two groups according to the presence of an intraoperative perforation. Non-complicated appendicitis patients formed Group-1, and perforated appendicitis patients formed Group-2. The demographic, clinical, and laboratory characteristics of the patients were compared. The number of non-complicated patients in Group 1 was 443, while there were 87 (16.4%) patients in Group 2 who had perforated appendicitis. The mean age of the patients in the normal appendicitis group was 29.90±10.51 years, and the mean age of the patients in the perforated appendicitis group was 36.32±14.58 years. In the normal appendicitis group, 257 (58%) of the patients were male, 186 (42%) were female, while in the perforated appendicitis group, 38 (43.7%) were male, 49 (56.3%) were female. In the perfo-rated appendicitis group, white blood cell (WBC) value was 16.19±4.71 (p<0.001), C-reactive protein (CRP) value was 146.28±113.59 (p<0.001), total bilirubin value was 0.71±0.36 (p<0.001), and neutrophil-lymphocyte ratio (NLR) was 10.85±6.25 (p<0.001). We believe that the WBC, total bilirubin, CRP, and NLR values obtained within this study, which is tested in the rapid and easily accessible blood tests in routine examinations that can contribute to the prediction of perforation.

YAŞLI HASTALARDA LAPAROSKOPİK VE AÇIK APENDEKTOMİNİN KARŞILAŞTIRILMASI: TEK MERKEZ DENEYİMİ

Objective: Acute appendicitis rates are gradually increasing in the elderly people population with prolonged life expectancy. This study aims to compare applicability of laparoscopic and open surgical methods in patients treated surgically for acute appendicitis over 65 years of age. Materials and Methods: Patients over 65 years old who underwent surgical treatment for acute appendicitis at the Sakarya University Hospital between 2011-2018 were included in the study. The patients were clas-sified according to the surgical method applied as laparoscopic or open appendectomy and complicated or non-complicated appendicitis. All groups were evaluated in terms of mean age, gender, white blood cell (WBC) levels, presence of comorbid disease, ASA score, operation time, the onset of oral intake, duration of hospital stay, postoperative intensive care require-ment, presence of complications and mortality. Results: Of the 161 patients who underwent appendectomy over 65, 98 were male (% 60,80) and 63 were female (% 39,20). It was determined that open appendectomy was per-formed in 109 (% 67,70) of the cases, and laparoscopic appendectomy in 52 (% 32,29). It was determined that 61 (% 55,91) of 109 cases undergoing open surgery and 22 (% 42,32) of 52 cases undergoing laparoscopic appendectomy were compli-cated acute appendicitis. Complications were observed in 24 (% 14,94) of one hun-dred and fifty patients. In terms of complications, no significant difference was found between laparoscopically operated groups and open appendectomy groups (P=0,873). Conclusion: Laparoscopic appendectomy is considered as a safely feasible method in the popu-lation of elderly and high comorbid patients.

Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study

BackgroundThe aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population. MethodsPediatric patients (n = 184) with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery.Patients were further divided in two groups, those with non-perforated (n = 148; 79%) and perforated appendicitis (n = 38; 21%). ResultsThe mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, p < 0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963–1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2–99.3) and 88.5% (95% CI: 88.2–93.2) respectively (p < 0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, p = 0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, p < 0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, p < 0.001), body temperature >38.5 °C (47.4% vs. 11.0%, p < 0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, p < 0.001). ConclusionHyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning. Type of studyProspective comparative study Level of evidenceII