Recurrent Appendicitis Research Articles

Visual Endoscopic Retrograde Appendicitis Therapy versus Antibiotic Therapy for Treatment of Uncomplicated Acute Appendicitis.

Visual endoscopic retrograde appendicitis therapy (V-ERAT) involves a Single-use Video Scope, allowing real-time visualization of the appendiceal lumen during the procedure to treat uncomplicated acute appendicitis (AA). This study aims to compare V-ERAT to antibiotic therapy in treating uncomplicated AA. This multicenter, retrospective cohort study was conducted at nine hospitals in China from August 2021 to July 2023. Propensity score matching was performed to minimize selection bias. A total of 692 uncomplicated AA patients were included, with 188 undergoing V-ERAT and 504 receiving antibiotic therapy. The primary outcome was treatment success rate. The secondary outcomes included recurrent appendicitis rate, the appendectomy rate during the initial hospitalization, length of initial hospitalization, time to disease recurrence, and overall adverse events. The treatment success rate did not differ between the V-ERAT and antibiotic groups (93.6%; 95% confidence interval [CI] 89.1% to 96.7% vs. 90.5%; 95% CI, 87.6% to 92.9%) ( P = 0.225). However, V-ERAT demonstrated a significantly lower risk of appendicitis recurrence compared to antibiotic therapy during the follow-up (log-rank P < 0.001), with a hazard ratio of 0.14 (95% CI 0.07-0.29, P < 0.001). V-ERAT was associated with a lower appendectomy rate during the initial hospitalization (4.3%; 95% CI, 1.9% to 8.2% vs. 9.5%; 95% CI, 7.1 to 12.4%) (P = 0.027), a shorter length of initial hospitalization (3 [IQR, 3-4] vs. 4 [IQR, 4-6] days, P < 0.001), and a longer time to recurrence (269 [IQR, 210-318] vs. 70 [IQR, 21-103] days, P < 0.001). The overall adverse event rates did not differ between the two groups (log-rank P = 0.064). V-ERAT appears to be a safe and effective alternative to antibiotic therapy in treating uncomplicated AA, significantly reducing the risk of appendicitis recurrence.

Predictors of appendicectomy one year after antibiotic treatment for acute appendicitis: Insights from a prospective, multicentre, observational study.

Surgeons are sometimes reluctant to manage uncomplicated appendicitis non-operatively. Reasons cited include the risk of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long-term efficacy of antibiotic versus operative management of appendicitis. One-year follow-up of patients enrolled in the multicentre, COVID:HAREM cohort study during March-June 2020 was performed. Initial operative or non-operative management was determined on a case-by-case basis by the responsible surgeon. Outcomes were appendicectomy rate at 1-year, histology of removed appendix and predictors of unsuccessful antibiotic treatment. A total of 625 patients who had non-operative management were included. Emergency appendicectomy had been performed by 1-year in 24% (149/625), with a median time to appendicectomy of 12days [IQR 1-77] from presentation. Thirty-one patients had elective appendicectomy. Normal histology was reported in 6% of emergency procedures and 58% of elective ones. There were 7 malignancies and 3 neuroendocrine tumors identified at histology. All patients with malignant histology had ≥1 risk factors for malignancy at initial presentation. Faecolithiasis (hazard ratios (HR) 2.3, 95% confidence intervals (CI) 1.51-3.49) and a high Adult Appendicitis Score (AAS >16; HR 2.44, 95% CI 1.52-3.92) were independent risk factors for unsuccessful non-operative management. At 1year, 71% of patients managed non-operatively did not undergo an appendicectomy. Recurrence of appendicitis was associated with faecolithiasis and a high AAS. Patients at higher risk for appendiceal malignancy should have targeted follow-up. These factors should be considered when counseling patients on non-operative management.

WP5.14 - Cost of conservative management of acute appendicitis: a cohort study

Abstract Aims Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy &amp; lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management. Methods Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography &amp; outcomes were evaluated for non surgical management. Appendicectomy (acute &amp; interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services. Results Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 &amp;lt;0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&amp;E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 &amp;lt;0.0001 CRP(mg/L) 76.3 66.3 3.4 &amp;lt;0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 &amp;lt;0.0001 Complicated 74 332 3 &amp;lt;0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 &amp;lt;0.0001 IP AB(days) 2 2 0 &amp;lt;0.0001 Post-op AB(days) 7 0 0 &amp;lt;0.0001 App HPA(mm) Length 66.6 55.7 &amp;lt;0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 &amp;lt;0.0001 Conclusions Appendicitis grading clinically &amp; radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs &amp; workload.

Therapeutic effectiveness of modified endoscopic retrograde appendicitis therapy for acute appendicitis of different severities in children

Objective: To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis. Methods: This study was a case-control study. A total of 586 children with acute appendicitis, who were admitted to the Pediatric Department of Second Affiliated Hospital of Air Force Medical University between January 2019 and November 2023, were selected as the research subjects. According to the severity of the disease, the patients were divided into simple appendicitis group, suppurative appendicitis group and perforated appendicitis group. The baseline data, hospitalization treatment and costs, outcomes, and recurrence in each group were analyzed, and the difference in the effectiveness of mERAT between the groups were compared by Kruskal-Wallis H test and χ2 test. Results: Among 586 children, there were 338 males and 248 females. The age at onset was 7.0 (4.6, 9.4) years. There were 475 cases of simple appendicitis, 78 cases of suppurative appendicitis, and 33 cases of perforated appendicitis. There were no significant differences in age and gender among the three groups (F=0.59, χ2=3.31, both P>0.05). However, there were statistically significant differences in body temperature, white blood cell counts, neutrophil percentage, lymphocyte percentage, nausea or vomiting, right lower abdominal pain, umbilical pain, right lower abdominal tenderness, and right lower abdominal rebound pain (H=7.56, 161.52, 169.11, and 169.61, χ2=12.05, 13.82, 12.05, 7.74, 20.35, and 94.61, all P<0.05). Also, the treatment time, postoperative hospital stay, total hospital stay, and cost showed statistically significant differences (H=4.70, 33.66, 34.99, 30.37, all P<0.05). There was no significant difference in the initial treatment success rate (98.1% (466/475) vs. 98.7% (77/78) vs. 90.9% (30/33), P=0.057). During the 30 (23, 36) months of follow-up, the recurrence rate was 7.9% (35/433) in the simple appendicitis group, 20.8% (15/72) in the suppurative appendicitis group, and 30.0% (9/30) in the perforated appendicitis group, with a statistically significant difference (χ2=23.56, P<0.001). Among the children with recurrent appendicitis, 15 cases still chose mERAT, of them 11 cases (31.2%) had simple appendicitis, 2 cases (2/15) had suppurative appendicitis, and 2 cases (2/9) had perforated appendicitis.The latest time to recurrence in the 3 groups was 32, 35 and 10 months, respectively. Conclusion: Treatment with mERAT has a good effect in pediatric simple appendicitis, but has a higher recurrence rate despite a better initial treatment success rate in suppurative appendicitis and perforated appendicitis.

Balancing Costs and Care: Nonoperative Appendicitis Treatment Outcomes in Pakistan.

Dear Respected Editor, In Pakistan, approximately 110,000 cases of appendicitis are reported annually [1], highlighting the condition's prevalence and significance. Traditional management predominantly revolves around widely practiced surgical intervention, such as appendectomy. [2]. Immediate appendectomy has become the standard treatment due to the significant morbidity and mortality difference between perforated and non-perforated acute appendicitis. However, the country's healthcare landscape presents a complex challenge due to varying regional access to medical resources. This variation in healthcare infrastructure exacerbates the difficulty of effectively managing appendicitis and underscores the need for solutions that strike a balance between clinical outcomes and economic considerations. While appendectomy remains a standard surgical procedure, it comes with inherent disadvantages, chief among them being the cost burden it places on patients and healthcare systems [3]. For patients in a low- to middle-income nation like Pakistan, the financial strain associated with surgery—which includes preoperative evaluations, surgical costs, hospital stays, and postoperative care—can be challenging [4]. Furthermore, the ripple effects affect the whole healthcare system, diverting resources that may otherwise be used for other urgent medical needs. A study by Siddiqui et al. emphasizes the need for a comprehensive analysis of economic factors in appendicitis management, particularly in low- and middle-income countries like Pakistan. The challenges in countries such as Pakistan require the exploration of alternative approaches that can optimize clinical outcomes while effectively managing healthcare costs without compromising patient care. [2] The recent study by Lee et al. introduces a promising alternative to conventional appendicitis management [5]. The research focuses on nonoperative treatment approaches, such as antibiotic therapy and observation, which have gained traction for their potential benefits Further, the study shows that the majority of the patients who had nonoperative treatment did not encounter a recurrence of appendicitis and were able to avoid surgical intervention for a period of around 20 years. Furthermore, there is a lack of data indicating any long-term dangers associated with nonoperative care. One of the prominent advantages lies in the reduction of immediate healthcare expenses, which can alleviate the financial burden on both patients and healthcare systems. By presenting evidence on the effectiveness and safety of nonoperative approaches, this study opens avenues for a paradigm shift in appendicitis management in Pakistan. The potential to achieve comparable clinical outcomes while minimizing the economic burden is a compelling proposition that warrants further exploration and consideration within Pakistan's healthcare challenges.

Predictive factors for recurrent acute appendicitis after conservative treatment

Introduction Conservative treatment of acute appendicitis is gaining popularity, and identifying patients with a higher risk of recurrence is becoming increasingly important. Previous studies have suggested that older age, male sex, diabetes, appendicolith and abscess formation may be contributing factors, however, results from the adult population are inconsistent. Aim This study aims to identify predictive factors for recurrent appendicitis after conservative treatment. Methods This retrospective study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and follow-up data were retrieved from medical charts and radiologic images. Uni -and multivariable logistic regression analysis were performed using Stata Statistical Software. Results In total, 379 patients with conservatively treated acute appendicitis were identified, of which 78 (20.6%) had recurrence. All patients were followed-up for a minimum of 41 months after the first diagnosis of acute appendicitis unless appendectomy after successful conservative treatment or death occurred during follow-up. The median time to recurrence was 6.5 (1–17.8) months. After multivariable logistic regression analysis, external appendix diameter >10 mm [OR 2.4 (CI 1.37–4.21), p = .002] and intra-abdominal abscess [OR 2.05 (CI 1.18–3.56), p = .011] on computed tomography were significant independent risk factors for recurrent appendicitis. Appendicolith was not associated with an increased risk of recurrence. Conclusion This study suggests abscess formation and appendix distension of >10 mm to be potential risk factors for recurrent acute appendicitis after initial successful conservative treatment.

ВРОЖДЕННАЯ АНОМАЛИЯ ЧЕРВЕОБРАЗНОГО ОТРОСТКА, ОСЛОЖНИВШАЯСЯ АППЕНДИЦИТОМ

Congenital malformations of the appendix are an extremely rare pathology, do not have a specific clinical picture and are usually detected at the time of surgery or pathohistological examination of the removed appendix. The purpose of the study. To present a description of a rare pathology – a case of incomplete doubling of the appendix and its atypical location, which contributed to the development of chronic recurrent appendicitis and periappendicitis. Results. The patient, aged 19, was operated on with a diagnosis of acute appendicitis. Laparoscopy has revealed that the appendix is partially retracted into the inguinal hernia and purulent fibrinous periappendicitis occurs. The vermiform appendix was removed. During its examination by both the surgeon and the pathologist, no developmental abnormality was detected. Pathohistological examination revealed incomplete doubling of the appendix. The additional process was located in the thickened mesentery of the main appendix. The complete absence of the outer layer in the muscle membrane and the serous membrane of the accessory process was revealed. This abnormality has provoked the development of chronic recurrent appendicitis and periappendicitis with the formation of an appendicular infiltrate. Conclusion. This article describes a rare clinical case of not only abnormal development of the appendix with the formation of chronic recurrent appendicitis, the formation of periappendicular infiltrate, but also its atypical location – it was partially involved in an inguinal hernia.

Three-Year Outcomes of Oral Antibiotics vs Intravenous and Oral Antibiotics for Uncomplicated Acute Appendicitis

Current short-term evidence has shown that uncomplicated acute appendicitis can be treated successfully with oral antibiotics alone, but longer-term results are lacking. To assess the treatment effectiveness of oral antibiotic monotherapy compared with combined intravenous (IV) and oral antibiotics in computed tomography-confirmed uncomplicated acute appendicitis at a longer-term follow-up. This secondary analysis of a predefined year 3 follow-up of the Appendicitis Acuta II (APPAC II) noninferiority, multicenter randomized clinical trial compared oral moxifloxacin with combined IV ertapenem plus oral levofloxacin and metronidazole for the treatment of uncomplicated acute appendicitis. The trial was conducted at 9 university and central hospitals in Finland from April 2017 to November 2018, with the last follow-up in November 2022. Participants included patients aged 18 to 60 years, who were randomized to receive either oral antibiotics monotherapy (n = 301) or combined IV and oral antibiotics (n = 298). Antibiotics monotherapy consisted of oral moxifloxacin, 400 mg/d, for 7 days. Combined IV and oral antibiotics consisted of IV ertapenem sodium, 1 g/d, for 2 days plus oral levofloxacin, 500 mg/d, and metronidazole, 500 mg 3 times/d, for 5 days. The primary end point was treatment success, defined as the resolution of acute appendicitis and discharge from hospital without the need for surgical intervention and no appendicitis recurrence at the year 3 follow-up evaluated using a noninferiority design. The secondary end points included late (after 1 year) appendicitis recurrence as well as treatment-related adverse events, quality of life, length of hospital stay, and length of sick leave, which were evaluated using a superiority design. After exclusions, 599 patients (mean [SD] age, 36 [12] years; 336 males [56.1%]) were randomized; after withdrawal and loss to follow-up, 582 patients (99.8%) were available for the year 3 follow-up. The treatment success at year 3 was 63.4% (1-sided 95% CI, 58.8% to ∞) in the oral antibiotic monotherapy group and 65.2% (1-sided 95% CI, 60.5% to ∞) in the combined IV and oral antibiotics group. The difference in treatment success rate between the groups at year 3 was -1.8 percentage points (1-sided 95% CI, -8.3 percentage points to ∞; P = .14 for noninferiority), with the CI limit exceeding the noninferiority margin. There were no significant differences between groups in treatment-related adverse events, quality of life, length of hospital stay, or length of sick leave. This secondary analysis of the APPAC II trial found a slightly higher appendectomy rate in patients who received oral antibiotic monotherapy; however, noninferiority of oral antibiotic monotherapy compared with combined IV and oral antibiotics could not be demonstrated. The results encourage future studies to assess oral antibiotic monotherapy as a viable treatment alternative for uncomplicated acute appendicitis. ClinicalTrials.gov Identifier: NCT03236961.

Suspected Simple Appendicitis in Children: Should We Use a Nonoperative, Antibiotic-Free Approach? An Observational Study.

Simple appendicitis may be self-limiting or require antibiotic treatment or appendectomy. The aim of this study was to assess the feasibility and safety of a nonoperative, antibiotic-free approach for suspected simple appendicitis in children. This single-center, retrospective study included patients (0-17 years old) who were hospitalized at the pediatric surgery department due to suspected appendicitis between 2011 and 2012. Data from patients who primarily underwent appendectomy were used as controls. The follow-up of nonoperatively managed patients was conducted in 2014. The main outcome of interest was appendicitis recurrence. A total of 365 patients were included: 226 were treated conservatively and 139 underwent appendectomy. Fourteen (6.2% of 226) of the primarily nonoperatively treated patients required secondary appendectomy during follow-up, and histology confirmed simple, uncomplicated appendicitis in 10 (4.4% of 226) patients. Among a subset of 53 patients managed nonoperatively with available Alvarado and/or Pediatric Appendicitis Scores and sonographic appendix diameters in clinical reports, 29 met the criteria for a high probability of appendicitis. Three of these patients (10.3% of 29) underwent secondary appendectomy. No complications were reported during follow-up. A conservative, antibiotic-free approach may be considered for pediatric patients with suspected uncomplicated appendicitis in a hospital setting. Only between 6 and 10% of these patients required secondary appendectomy. Nevertheless, the cohort of patients treated nonoperatively was likely to have also included individuals with further abdominal conditions other than appendicitis. Active observation and clinical support during the disease course may help patients avoid unnecessary procedures and contribute to spontaneous resolution of appendicitis or other pediatric conditions as the cause of abdominal pain. However, further studies are needed to define validated diagnostic and management criteria.

Author response: Factors associated with recurrent appendicitis after successful treatment with antibiotics.

Author response: Factors associated with recurrent appendicitis after successful treatment with antibiotics.

Amyand&amp;apos;s hernia unveiled: a case report on perforated appendix within the inguinal hernia sac

Background: Acute appendicitis (AA) is still a common cause of lower abdominal pain, which frequently leads to emergency room (ER) visits. A case of perforated appendix within the inguinal hernia sac was presented. Case presentation: The clinical journey of a 30-year-old male patient with acute right iliac fossa pain suggestive of recurrent appendicitis was detailed in this case report. The patient\&amp;apos;s complicated medical history, which included dostinex-treated hyperprolactinemia and a previous episode of conservatively managed appendicitis in 2017, sets the stage for complex diagnostic challenges. The patient complained of acute localized tenderness and pain in the right iliac fossa, but no gastrointestinal symptoms, fever, or diarrhea were present. The admission laboratory results showed elevated white blood cells (WBC) (15.2), hemoglobin (Hb) (15.8), and platelet (PLT) (191) levels. Computed tomography scans exposed a perforated appendix within the right inguinal hernial sac surrounded by inflammatory changes. Laparoscopic appendectomy revealed a perforated appendix within the inguinal hernial sac, necessitating omental dissection and drainage. The postoperative course was uneventful, with a 7-day hospital stay and subsequent OPD follow-up. Microscopic examination confirmed acute suppurative appendicitis with periappendicitis aligning with clinical and radiological assessments. Conclusions: Amyand\&amp;apos;s hernia is a rare type of hernia that involves the appendix. A perforated appendix within a groin hernia is unusual and necessitates immediate source control to manage infection and prevent sepsis.

APPENDICITIS INFLAMMATORY RESPONSE SCORE FOR DIAGNOSIS OF ACUTE APPENDICITIS AS COMPARED TO ALVARADO SCORE

Background: Acute appendicitis was first described by Reginald. H. Fitz in 1886. It is the most frequent cause of acute abdominal pain requiring surgical intervention. Annually appendectomy is the most common abdominal operation performed on emergency basis. Lifetime risk for developing acute appendicitis is 8.6% in men and 6.7% in women. Acute Appendicitis inciting event in most instances is obstruction of the appendix lumen. Acute Appendicitis is classified as catarrhal phlegmonus, gangrenous and perforated. This classification describes the evolutionary stage of disease. Acute appendicitis is more of a clinical diagnosis present as pain abdomen with classical migration from peri-umbilical region to right iliac fossa in 75% of patient nausea and anorexia. Clinical signs are mostly pyrexia, localized tenderness in the right iliac fossa, muscle guarding and rebound tenderness. Laboratory and radiological investigation are also important tool for the diagnosis. Scoring system have been designed to aid in the clinical assessment of patient with acute appendicitis. The most used scoring is the Alvarado score is best performing in validation studies. Alvarado score doesnt incorporate C reactive protein as a variable, many studies shows the importance of C reactive protein in assessment of patient with appendicitis. Objective: Appendicitis Inflammatory Response score as a diagnostic tool for acute appendicitis in our hospital setting. Study design: A Prospective Study. Study period: October 2016 – September 2018. Study setting: Department of General Surgery, Justice K. S. Hegde charitable hospital. Study population: Patients admitted with signs and symptoms of acute appendicitis at Justice K.S. Hegde charitable Hospital, Mangalore. Sample size: 123 patients using epiinfo software for diagnostic test with PPV 64% with article reference (12) confidence interval of 95% and power of study at 80%. Study group: Patients clinically diagnosed with acute appendicitis and giving consent for the study. Methodology: The present study was conducted in the Department of General surgery, Justice K.S. Hegde charitable Hospital Mangalore, in 123 patients, of any age, who were admitted with complaint of acute appendicitis. Patients included in the study were finally correlate with the histopathological report. Result: The maximum patients were in the age group of 11-20 year compromising around 30.9%. Most of the patients were female around 56.1%. Histopathological report showed around 82.1% as Acute appendicitis, 6.5% acute on chronic, recurrent appendicitis 8.9%, chronic appendicitis, granulomatous appendicitis &amp; lymphoid hyperplasia of appendix were .8% each. AIR classified around 46.3% in low probability, 48% indeterminate and 5.7% in high probability group. Alvarado classified around 3.3% in unlikely, 51.2% in possible diagnosis, 37.4% acute and 8.1% in definite group. On spearman correlation coefficient there was found to be a strong positive correlation between both the scoring system and statistically significant p value of 0.0001. AIR score showed a sensitivity of 56.44% and specificity of 59.09% at score &gt;4. Alvarado had a sensitivity of 98.02 % and specificity of 9.09% at score &gt;4. Alvarado and AIR showed 9.90% and 6.93% at score &gt;8 respectively. The specificity of Alvarado and AIR was 100% respectively. The AIR at a low and higher score had a high PPV and NPV, that may help in correctly diagnosing the patient with acute appendicitis and ruling out from non- appendicitis patient. Conclusion: 1. Alvarado score is better diagnostic tool for acute appendicitis as compared to the AIR score. 2. Alvarado score has higher sensitivity in score of &gt;4 as compared to AIR. 3. AIR score with low sensitivity has low discriminatory power in ruling out patient with acute appendicitis.

“Healed” Appendix is not actually “Healed” from the surgeon’s perspective: Is it a histopathologic misnomer?

The study aims to present a refute for the use of histopathologic diagnostic nomenclature of the word “Healed” in the perspective of the appendix after appendectomy. Appendectomy is being done worldwide for the acute inflammation of the appendix in golden hours or as an interval appendectomy after the subsidence of the features of inflammation for recurrent appendicitis. The word “Healed” presents a negative psychological impact on the patients as they think that their already “Healed” appendix is unnecessarily removed by the surgeon whereas the pathologist friends use this nomenclature only by the presence of features of any healing wound like fibrosis, eosinophils etc. We also present gross examination findings, histopathologic microscopic features along with photomicrographs of the few appendectomy specimens which were laparoscopically operated for the recurrent appendicitis.

A prospective study of relevance of interval appendicectomy in treatment of appendicular lump

Appendicitis is one of the most common diseases that a surgeon faces in practice. Sometimes patients may present a few days after the onset of acute appendicitis with a palpable mass a phlegmon is a type of inflammatory tumour that consists of an inflamed appendix, as well as the larger omentum and associated viscera.To evaluate the need for interval appendicectomy in patients with appendicular lump. The study included all patients with an appendicular mass and was put on conservative management. . Failures of resolution of mass with conservative management were taken up for appendicectomy. The patients were discharged on successful conservative management and followed up at regular intervals for 12 months. Any patient with features suggesting recurrence of acute appendicitis on follow up was admitted and taken up for appendicectomy. All of the above information was gathered and statistically evaluated.Out of 58 cases of appendicular mass, 3 (5.17%) were operated due to failure of resolution of mass. The remaining 55 (94.83%) cases were successfully treated conservatively and followed up regularly for 12 months. 4 (7.27%) patients were lost to follow up. 1 (1.81%) patient revealed carcinoma of caecum and underwent right hemicolectomy. The remaining 50 (86.2%) cases, from which 42 (84%) patients remained recurrence free. 8 patients (16%) had recurrent appendicitis, out of which 7 (14%) patients underwent emergency appendicectomy, 1(2%) patient developed appendicular lump and was treated non operatively. In our study recurrence rate of acute appendicitis following resolution of appendicular mass is low (16%). So interval appendicectomy have to no longer be the rule in all patients after resolution of mass and should be reserved for patients with recurrences or with increased risk factors for recurrence.

Comment on: factors associated with recurrent appendicitis after successful treatment with antibiotics.

Comment on: factors associated with recurrent appendicitis after successful treatment with antibiotics.

Endoscopic retrograde appendicitis therapy in adults with uncomplicated acute appendicitis: a systematic review and meta-analysis

Background and AimsEndoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally-invasive, endoscopic alternative to laparoscopic appendectomy in the treatment of acute appendicitis. This systematic review and meta-analysis aims to evaluate the efficacy and safety of ERAT in treating uncomplicated, acute appendicitis. MethodsA systematic review of studies in the PubMed/MEDLINE and Cochrane databases was performed through June 2023. The primary outcomes included clinical success rate (defined as resolution in signs and symptoms of appendicitis) and technical success rate (defined as successful placement of a drain or stent within the appendiceal orifice or irrigation to relieve appendiceal obstruction). Secondary outcomes included adverse event rates and rates of intestinal perforation, procedure time, hospital length of stay, duration of follow up, and rates of appendicitis recurrence after ERAT. ResultsA total of eight studies were considered eligible for analysis (326 patients; average age 36.4 years old, 55.4% male). The rate of technical success was 98% (95% CI; 97%, 100%; I2=2.2%), and the rate of clinical success was 99% (95% CI; 97%, 100%; I2=0%). The total pooled adverse event rate was 1.8% (95% CI; 0.4%, 3.2%, I2=0%) with a pooled intestinal perforation rate of 1.5% (95% CI; 0.02%, 2.8%, I2=0%). The average procedure time was 44.9 minutes. The average hospital length of stay following ERAT was 3.22 days. The aggregate rate of appendicitis recurrence following ERAT was 6% (95% CI; 3%, 9%; I2=16.5%) after being followed for an average of 17.7 months. ConclusionsERAT demonstrates excellent technical and clinical success rates with minimal adverse events. Additional randomized controlled studies are needed to refine inclusion criteria and to standardize the approach to appendiceal stent placement during ERAT to minimize rates of intestinal perforation.

Endoscopic transcecal appendectomy for recurrent appendicitis after previous endoscopic mucosal resection.

Endoscopic transcecal appendectomy for recurrent appendicitis after previous endoscopic mucosal resection.

Recurrent Appendicitis in Children: The Impact of a Poorly Known Disease

Recurrent Appendicitis in Children: The Impact of a Poorly Known Disease

Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study

BackgroundThe success rate of non-operative treatment (NOT) of acute uncomplicated appendicitis (AUA) in children varies from 65% to 95%. There are no recommendations on the appropriate antibiotic therapy.ObjectiveTo determine the...

Risk of appendiceal malignancy in conservatively treated acute appendicitis.

Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis. This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts. The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis (p = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis (p = 0.002). The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.