Surgical Management Of Appendicitis Research Articles

Surgical Management of Appendicitis During Pregnancy.

Surgical Management of Appendicitis During Pregnancy.

Surgical management of appendicitis in patients with human immunodeficiency virus (HIV) positivity: a propensity score-matched analysis in a base hospital for HIV treatment in Japan.

To investigate the impact of human immunodeficiency virus (HIV) infection on surgical outcomes after appendectomy. Data on patients who underwent appendectomy for acute appendicitis between 2010 and 2020 at our hospital were investigated retrospectively. The patients were classified into HIV-positive and HIV-negative groups using propensity score-matching (PSM) analysis, adjusting for the five reported risk factors for postoperative complications: age, sex, Blumberg's sign, C-reactive protein level, and white blood cell count. We compared the postoperative outcomes of the two groups. HIV infection parameters, including the number and proportion of CD4 + lymphocytes and the HIV-RNA levels were also compared before and after appendectomy in the HIV-positive patients. Among 636 patients enrolled, 42 were HIV-positive and 594 were HIV-negative. Postoperative complications occurred in five HIV-positive patients and eight HIV-negative patients, with no significant difference in the incidence (p = 0.405) or severity of any complication (p = 0.655) between the groups. HIV infection was well-controlled preoperatively using antiretroviral therapy (83.3%). There was no deterioration in parameters and no changes in the postoperative treatment in any of the HIV-positive patients. Advances in antiviral drugs have made appendectomy a safe and feasible procedure for HIV-positive patients, with similar postoperative complication risks to HIV-negative patients.

Laparoscopic versus open appendicectomy in pregnancy: experience from a single institution and meta-analysis.

Acute appendicitis remains an uncommon cause of non-obstetric abdominal pain during pregnancy, with surgery being the preferred management option. We examined our experience with the surgical management of appendicitis during pregnancy, particularly the risk of foetal loss during the 1st and 2nd trimester and performed a meta-analysis of the available literature. We performed a retrospective analysis of all patients who had an appendicectomy during pregnancy (January 2010 to December 2019) and a meta-analysis comparing foetal death in open appendicectomy versus laparoscopic appendicectomy during the 1st and 2nd trimester. Seventy pregnant patients were included in our study (57 laparoscopic, 13 open). There were 4 foetal deaths during the study period (7%), all of which occurred after the laparoscopic approach (P-value=0.578). Open appendicectomies were associated with an increased risk of pre-term delivery (P-value=0.038). The meta-analysis of 9 studies, which included 311 patients, showed that there was no significant difference between OA and LA in foetal deaths during the 1st and 2nd trimesters (1st trimester foetal deaths: 9/143 laparoscopic versus 4/57 open, M-H risk difference-0.02, 95% CI, -0.14 to 0.10): 2nd trimester foetal deaths: 7/159 laparoscopic versus 2/154 Open, M-H risk difference 0.03, 95% CI, -0.02 to 0.09). Our findings suggest there is no increased risk of foetal loss in pregnant patients undergoing a laparoscopic appendicectomy.

Top 12 ‘Quickfire’ Best Poster Presentations

Purpose: Acute appendicitis is the most common cause of an acute abdomen. The COVID-19 pandemic has affected the management of acute appendicitis. Initial guidelines advised the use of laparoscopy only if benefits substantially exceeded the risk of potential viral transmission. The main aim of this study was to evaluate the trends in surgical management of appendicitis in the first year of COVID-19 in a tertiary referral centre in Ireland. Methods: A retrospective review of all appendicectomies in a tertiary hospital from January to December 2020 was performed. Basic demographic data was collected along with information on operative approach, conversion to open, laboratory and radiological investigations and histopathology. Results: 452 appendicectomies were identified. More males were affected, at 52.5%. The mean age was 25 years (range: 3-85 years). Laparoscopic appendicectomy was performed in 97% of cases (n = 438). All appendicectomies in January and February were laparoscopic. 66.6% of all open appendicectomies performed were in March and April (n = 4). Regarding these 4 open appendicectomies, none were perforated and 3 were paediatric patients. Open appendicectomies outside of these months (n = 2) were for complicated appendicitis. A combination of laparoscopic and open technique was required in 9 cases. Conclusion: The first phase of Covid-19 in Ireland resulted in a significant increase in the number of open appendicectomies, when concerns surrounded the potential aerosolisation of the virus during laparoscopic procedures. It was not a result of case complexity. This was not mirrored in Phase 2 of the pandemic in September and October.

Variation in anti-microbial prescription and complications post emergency appendicectomy in Australia: do we follow recommended guidelines?

This study aims to establish compliance levels to prescription guidelines among Australian surgeons in the use of antibiotics in the surgical management of appendicitis. The secondary outcomes are predictors of post-operative infective complications; surgical site infection (SSI) and intra-abdominal abscess (IAA) at 30 days. A multi-centre, prospective, observational study was conducted over a period of 2 months with a 30-day follow-up. Patients were eligible for recruitment if they underwent appendicectomy for suspected appendicitis. Antibiotics prescription practices were recorded and compared to national guidelines. A total of 1189 patients were recruited across 27 centres; 1081 (92.1%) patients were given prophylactic antibiotics at the time of appendicectomy. Patients with gangrenous appendicitis were more likely to receive prophylactic antibiotics (98.9%); lower rates of use were seen in the non-appendicitis group (85.7%). A total of 619 (53.3%) patients received antibiotics in the post-operative period. Despite recommendations, 300 (44.3%) patients with simple appendicitis received post-operative antibiotics. Only six (2.9%) patients with complicated appendicitis did not receive antibiotics. Overall, SSI and IAA rates were 1.9% and 2.7%, respectively. Aboriginal and Torres Strait Islanders (P = 0.02) and patients with converted operations (P = 0.001) were more likely to have a SSI. Patients with complicated appendicitis and those operated on by a consultant were more likely to increase the odds of IAA (odds ratio 3.8 and 5.1, respectively). This broad-based study shows mixed compliance with antibiotic guidelines in the surgical management of appendicitis in Australia. The use of post-operative antibiotics in patients with simple appendicitis should be a target for antimicrobial stewardship programmes to prevent antibiotic over-utilization.

The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate

IntroductionNegative appendectomy rate (NAR) is a quality metric used in the surgical management of appendicitis. The rates of negative appendectomy (NA) in children range anywhere from 1% to 40% in the literature. Many reports do not provide clear pathological definitions for either appendicitis or NA on which they base their calculation of NAR. We reviewed our experience with pediatric appendectomy and the pathological spectrum encompassed within our definition of a NA and examined how the pathologic definition impacts our hospital's NAR. MethodsA retrospective review from 2012 to 2016 in a single institution identified 1676 children that underwent appendectomy. Average age was 11.4 (2–18 years). Patient demographics, clinical outcomes and pathological findings were collected. At our institution, appendicitis is defined as the presence of transmural acute inflammation in the appendix and those patients without this finding have been considered to have had a negative appendectomy. Results1435 patients underwent appendectomy for presumed appendicitis. The rate of pathologically diagnosed appendicitis was 91.1% (1307/1435) and as such, the NAR was 8.9% (128/1435). Review of the pathology of the NA cohort identified 67/128 (52.3%) patients with completely normal pathology. The remaining 61 patients displayed some sort of pathological abnormality including malignancy (n = 2), fecaliths (n = 9), pinworms (n = 3), granuloma (n = 2), fibrous obliteration (n = 4), isolated periappendiceal inflammation (n = 1), and acute inflammation confined to the mucosa (n = 40). Exclusion of these patients with abnormal pathology decreased the NAR to 4.6%. Patients with pathological abnormalities of the appendix other than transmural inflammation had a higher rate of 30-day readmission than patients with acute appendicitis (8.2% versus 4.5% p < 0.01). ConclusionPediatric NAR is dependent upon the pathological definition of appendicitis and negative appendectomy. Institutional variation in definition may explain discrepancies in the literature. By example, including only those that show “the absence of inflammation or other appendiceal pathology” would decrease our NAR by 50%. This study calls into question the interpretation of interhospital NAR and the use of NAR as a quality metric in the management of appendicitis.Retrospective comparative study: Level III evidence.

Surgical Management of Appendicitis and Cholecystitis during Pregnancy: A National Analysis

Surgical Management of Appendicitis and Cholecystitis during Pregnancy: A National Analysis

Operative management of appendicitis

Appendectomy has been the standard of care for appendicitis since the late 1800s, and remains one of the most common operations performed in children. The advent of data-driven medicine has led to questions about every aspect of the operation—whether appendectomy is even necessary, when it should be performed (timing), how the procedure is done (laparoscopic variants versus open and irrigation versus no irrigation), length of hospital stay, and antibiotic duration. The goal of this analysis is to review the current status of, and available data regarding, the surgical management of appendicitis in children.

A cost and outcome analysis of pediatric single-incision appendectomy

BackgroundFor appendicitis, single-incision laparoscopic appendectomy (SIA) has been proposed as an alternative to 3-port appendectomy (3PA). However, there remains controversy regarding outcomes and cost of SIA. We sought to review our experience with these two techniques to identify differences in these factors. Materials and methodsThe charts of children (0-17 y) who underwent appendectomy at a tertiary pediatric hospital from 2011-2014 were retrospectively reviewed. Appendectomy was either performed through traditional 3PA or SIA (laparoscopically assisted via externalization through an umbilical incision). Demographic data including age, body mass index, comorbidities, and gender were examined. Information on perforation, operative time and cost, length of stay, and infectious complications for both SIA and 3PA was identified. Data were analyzed using student t tests and chi square analysis. ResultsA total of 337 patients underwent appendectomy (141 SIA and 197 3PA), 35.6% of whom (40 SIA, 80 3PA) had perforated appendicitis. For nonperforated appendicitis, SIA had significantly shorter operative times, decreased operative costs, and length of stay. However, these differences were not found for perforated appendicitis. Regardless of appendicitis severity, there was no difference in rates of wound infection, abscess, or readmission between the two techniques. ConclusionsOur study suggests that SIA is a faster, more cost effective alternative than 3PA for acute appendicitis. SIA did not result in increased infection rates for acute or perforated appendicitis and can be considered an equivalent alternative to 3PA in the surgical management of appendicitis.

Retroperitoneal, Abdominal, and Pelvic Abscess in Appendicitis: The Limitation of Diagnostic Modalities

Acute appendicitis is a common and well-recognized condition that can be easily managed. However, at times it can become significantly complicated and thus life-threatening. Acute appendicitis can present atypically with findings such as peritonitis and even abdominal abscesses. During laparotomy it is highly unusual to find signs of peritonitis that were not initially visualized by abdominal imaging studies consisting of retroperitoneal and pelvic abscesses. In this case report, we describe the diagnosis and management of a 62-year-old female discovered to have several retroperitoneal abdominal and pelvic abscesses complicated by peritonitis discovered during exploratory laparotomy at the time of appendectomy. The presentation of appendicitis has been associated with abdominal abscesses and peritonitis; however, these findings may at times not be seen using CT imaging. Furthermore, retroperitoneal abscess is a relatively uncommon finding associated with appendicitis. Through this report, we plan to illustrate the importance of not neglecting the possibility of particular intra-abdominal and extra-abdominal inflammatory conditions which may arise during the surgical management of appendicitis. J Med Cases. 2015;6(9):430-432 doi: http://dx.doi.org/10.14740/jmc2266w

Retroperitoneal, Abdominal, and Pelvic Abscess in Appendicitis: The Limitation of Diagnostic Modalities

Acute appendicitis is a common and well-recognized condition that can be easily managed. However, at times it can become significantly complicated and thus life-threatening. Acute appendicitis can present atypically with findings such as peritonitis and even abdominal abscesses. During laparotomy it is highly unusual to find signs of peritonitis that were not initially visualized by abdominal imaging studies consisting of retroperitoneal and pelvic abscesses. In this case report, we describe the diagnosis and management of a 62-year-old female discovered to have several retroperitoneal abdominal and pelvic abscesses complicated by peritonitis discovered during exploratory laparotomy at the time of appendectomy. The presentation of appendicitis has been associated with abdominal abscesses and peritonitis; however, these findings may at times not be seen using CT imaging. Furthermore, retroperitoneal abscess is a relatively uncommon finding associated with appendicitis. Through this report, we plan to illustrate the importance of not neglecting the possibility of particular intra-abdominal and extra-abdominal inflammatory conditions which may arise during the surgical management of appendicitis. J Med Cases. 2015;6(9):430-432 doi: http://dx.doi.org/10.14740/jmc2266w

Examining a Common Disease with Unknown Etiology: Trends in Epidemiology and Surgical Management of Appendicitis in California, 1995–2009

The study was designed to examine the epidemiology of appendicitis and risk factors of perforation and appendectomy. Retrospective analysis of the California Office of Statewide Health Planning and Development Patient Discharge Data was performed from 1995 to 2009. Patients with appendicitis were identified by ICD-9 diagnosis code. Population statistics from the RAND Corporation were used to calculate incidence rates. Risk factors of perforation and appendectomy were also calculated. A total of 608,116 patients with appendicitis (70% non-perforated) were included. The incidence increased at an average rate of 0.5 cases/100,000 population/year (p<0.001), with annual incidence peaking during the third quarter. Children age 10-14 had the highest rates of appendicitis (169.6 cases/100,000). The lifetime cumulative incidence rate is 9.0%. Appendicitis is most common in whites and Hispanics and less common in African Americans and Asians. Risks of perforation include Hispanic or Asian race, young or old age, and non-private insurance. The adjusted odds of appendectomy increased since 1995 in patients with non-perforated appendicitis (OR 1.5, 95% CI (1.3-1.7); p<0.001), but it decreased in patients with perforated appendicitis (OR 0.4, 95% CI (0.4-0.5); p<0.001). This is the largest epidemiological study of appendicitis to our knowledge in recent years. Incidence has increased over time and is higher in the summer months. Whites and Hispanics have higher rates of appendicitis, but Hispanics and Asians and patients with non-private insurance, have higher odds of perforation. Surgical management of perforated appendicitis has decreased over time. It is unknown why the incidence has increased, displays seasonality, and varies by race.

Acute Appendicitis in Patients with Acute Leukemia

The decision to operate for abdominal pain in patients with leukopenia can be exceedingly difficult. Surgical exploration may be the only effective way to differentiate acute appendicitis from other causes, but it involves considerable risk of infectious complications due to immunesuppression. Leukemic patients, who presented significant RLQ pain, had been indicated for operation, despite having advanced disease or having had received chemotherapy or steroids.Four adult leukemia patients, complicated by acute appendictis, were reviewed. Two patients were in induction chemotherapy, one receiving salvage chemotheapy due to relapse and the other was in conservative treatment. Two patients were acute myelocytic leukemia (AML), one had acute lymphocytic leukemia (ALL), and the other had aleukemic leukemia. All patients underwent appendectomy and recovered without complication. Our experience supports the theory that the surgical management of appendicitis in acute leukemia is the most effective way, in spite of leukopenia.

Primary appendectomy. The effect of prophylatic cephaloridine on postoperative wound infection

A prospective, randomized, double-blind study on the effect of cephaloridine prophylaxis in the surgical management of appendicitis was performed. Of the 139 patients studied, 70 received cephaloridine and 69 received placebo prophylaxis. Both groups of patients were well matched with regard to age, sex, operative findings, and bacteria isolated at operation. Postoperative wound infections were detected in 11.6% of placebo-treated patients and in 1.4% of cephaloridine-treated patients (P less than .02). Prophylactic treatment with cephaloridine of patients undergoing surgery for uncomplicated appendicitis resulted in a perceptible reduction in the rate of postoperative wound infection.

Primary Appendectomy

A prospective, randomized, double-blind study on the effect of cephaloridine prophylaxis in the surgical management of appendicitis was performed. Of the 139 patients studied, 70 received cephaloridine and 69 received placebo prophylaxis. Both groups of patients were well matched with regard to age, sex, operative findings, and bacteria isolated at operation. Postoperative wound infections were detected in 11.6% of placebo-treated patients and in 1.4% of cephaloridine-treated patients (P less than .02). Prophylactic treatment with cephaloridine of patients undergoing surgery for uncomplicated appendicitis resulted in a perceptible reduction in the rate of postoperative wound infection.