Surgical Treatment Of Acute Appendicitis Research Articles

Efficacy and safety of different antibiotic treatment versus surgical treatment for acute appendicitis: A network meta-analysis.

This systematic review and network meta-analysis compared various antibiotic treatments with surgical treatment for acute appendicitis. We searched PubMed, Embase, Cochrane Library, and Wanfang databases for randomized controlled trials (RCTs) that met the prespecified inclusion criteria up to July 2023. The interventions included various antibiotics and surgery. The outcomes measured were initial treatment success, treatment success at 1-year follow-up, and treatment-related complications. Meta-analysis was conducted using R software with the gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the interventions. Thirteen RCTs involving nine treatments (cefotaxime [CTX] + tinidazole [TNZ], CTX + metronidazole [MTZ], ampicillin [AMP] + gentamicin [GEN] + MTZ, amoxicillin/clavulanate [AMC] + GEN, meropenem [MEM] + MTZ, AMC, ertapenem [ETP] + MTZ, ETP, and surgery) were included in this network meta-analysis. In head-to-head comparisons, no statistically significant difference was found between any two interventions for initial treatment success (p>0.05). The SUCRA indicated that surgery ranked first (SUCRA, 66.5%) for initial treatment success. Surgery was associated with an increased treatment success rate at 1-year follow-up compared to AMC (OR=0.01, 95% CrI=0.00-0.14, p<0.05), MEM+MTZ (OR=0.06, 95% CrI=0.00-0.42, p<0.05), and AMP+GEN+MTZ (OR=0.02, 95% CrI=0.00-0.23, p<0.05). No statistically significant differences were found between any two interventions regarding complications (p>0.05). Our network meta-analysis suggests that surgery ranks highest for initial treatment success and treatment success at 1-year follow-up. However, surgery may increase the complication rate.

Contrast-Enhanced Ultrasound-Guided Endoscopic Retrograde Appendicitis Treatment-A Pilot Study on the Diagnostic and Therapeutic Efficacy in Uncomplicated Appendicitis.

To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis. A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed. Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment. Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.

Understanding Techniques, Risks, and Recovery for Enhanced Patient Care of Laparoscopic Appendectomy

Introduction: Because laparoscopic appendectomy is a less intrusive procedure with good results, it has become the accepted surgical treatment for acute appendicitis. In order to improve patient care, this study sought to thoroughly examine the methods, related hazards, and recuperation times of laparoscopic appendectomy. Methodology: A retrospective cohort study comprising 87 patients who had laparoscopic appendectomy between June 2023 and May 2024 was carried out at District Headquarters (DHQ) Hospital Kohat. Patient demographics, surgery specifics, problems, and recovery results were all recorded. To assess the data, statistical analysis such as t-tests and chi-square tests were carried out. Results: The study population's mean age was 34.5 years, and its male to female ratio was slightly greater (57.5%). The average operating duration was 65.2 minutes, and in 13.8% and 39.1% of cases, respectively, differences in surgical technique—such as the use of SILS and advanced energy devices—were noted. The incidence of complications was minimal, with 2.3% of patients experiencing intraoperative injuries, 8.0% experiencing postoperative infections, and 4.6% developing abscesses. There were no discernible variations between male and female patients' recovery results or complication rates. Conclusion: This study demonstrates that laparoscopic appendectomy is safe, effective, and has a low risk of complications and good recovery results when treating acute appendicitis. The results validate laparoscopic procedures as the gold standard surgical method. To improve surgical methods and postoperative care guidelines and eventually improve patient outcomes, further research is necessary.

Acute Appendicitis in the Elderly: Current Update on Management: Review Article

Acute appendicitis in the elderly is a difficult condition to diagnose and treat due to its atypical clinical presentation, the co-morbidities that these patients have and the risk of developing complications like perforation. The diagnosis involves the use of imaging modalities like computerized tomography and the treatment is by performing an appendectomy. Laparoscopic appendectomy is slowly becoming the gold standard in the surgical treatment of acute appendicitis in the elderly. We have conducted this review article to look at the diagnosis and management of acute appendicitis in the elderly. The role of laparoscopic appendectomy in the surgical treatment of acute appendicitis in the elderly is also investigated.

Medical and surgical treatment of acute appendicitis: Past, present and future

Acute appendicitis (AA) remains the most common surgical emergency worldwide. Currently, the preferred treatment modality for AA in adults is laparoscopic appendectomy. However, alternative and efficient therapies have emerged in the last years. For instance, non-operative management, endoscopic appendectomy, and robotic appendectomy are now considered for patients with AA. The aim of this study was to analyze the evolution of medical and surgical management of AA in order to define current standards and future directions.

Evaluation of the results of laparoscopic surgical treatment for acute appendicitis in elderly patients

Objectives: The aim of this study was to evaluate the clinical and paraclinical characteristics and results of treatment of acute appendicitis in elderly patients. Methods: A prospective study was conducted on 189 patients, including 42 of them over the age of 60, diagnosed with acute appendicitis or peritonitis due to appendicitis based on clinical and paraclinical symptoms and treated with laparoscopic surgery from April 2022 to June 2023 at the Department of Digestive Surgery, Hue University of Medicine and Pharmacy Hospital. Results: Elderly patients with acute appendicitis admitted to the hospital had an average age of 69.3 years. The time from symptom onset to hospital admission in elderly patients was 30.1 hours compared to 19.1 hours in the non-elderly group. The elderly group had a rate of peritonitis of 40,5% compared to 13.6% in the non-elderly group (p &lt; 0.001). The mean time for passing initial gas in elderly patients was 18,1 hours compared to 13.3 hours in the non-elderly group (p = 0.004). Postoperative hospital stay in elderly patients was 4.7 days compared to 3.5 days in the non-elderly group (p &lt; 0.001). Postoperative complications in the elderly patient group were 2.4% compared to 0% in the non-elderly group (p = 0.222). There were no complications during surgery or 30-day mortality. Conclusions: Elderly patients with acute appendicitis were hospitalized later, had a higher rate of peritonitis and had a longer postoperative hospital stay than non-elderly patients. Laparoscopic surgery to treat acute appendicitis in the elderly is a safe method. Key words: acute appendicitis, elderly, laparoscopic appendectomy, appendicitis peritonitis.

Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review.

Recent studies have discussed the role of antibiotic treatment in the conservative management of acute appendicitis and whether antibiotics are a safe option to replace appendicectomy, which has been the gold standard treatment of acute appendicitis for many years. The bibliographic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Medline, and PubMed comparing conservative versus surgical treatment of acute appendicitis were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-one studies consisting of systematic reviews and meta-analyses involving 44,699 participants were identified. At least 17,865 participants were treated with antibiotics. Our studies compare antibiotic versus appendicectomy among acute appendicitis patients ranging from 7 to 94 years of age. In most studies, patients received parenteral antibiotics for a total of one to three days, and oral antibiotics such as oral cephalosporin plus metronidazole, oral amoxicillin/clavulanate, oral fluoroquinolones plus Tinidazole upon hospital discharge for a total of 7 to 10 days. The total course of antibiotics for both parenteral and oral regimes ranged from 2 to 16 days, with 10 days being the commonest duration. The recurrence rate following initial antibiotic treatment at one-year follow-up ranged from 13% to 38%, while the mean duration of recurrence ranged from three to eight months. The majority of the patients with recurrence underwent appendicectomy, while some patients were either given a repeat or different course of antibiotics due to the possible presence of antibiotic resistance; however, only 2.4% of the patients were successfully treated upon completion of the second course of antibiotics. Most of the studies concluded that appendicectomy remains the gold standard treatment for uncomplicated acute appendicitis, given its higher efficacy and lower complication rates. Although antibiotic treatment cannot be routinely recommended, it can be considered an appropriate alternative in selected patients with uncomplicated appendicitis who wish to avoid surgery and also acknowledge the risk of recurrence and the potential need for subsequent surgery at the same time.

Acute appendicitis in pregnancy - do we treat correctly, or do we delay unnecessarily?

Acute appendicitis is the most common non-gynaecological indication for surgical intervention during pregnancy. The aim of this study was to compare perioperative and postoperative results of surgical treatment of acute appendicitis in the early and late stage of pregnancy. This is a retrospective study focused on the evaluation of perioperative and postoperative results of appendectomy in pregnancy. The study included all pregnant patients who underwent laparoscopic or open appendectomy at the University Hospital Ostrava during the observed 10-year period (January 2012-December 2021). The patients were divided into two subgroups according to the stage of pregnancy in relation to the expected viability of the foetus (the viability limit was defined as the 23rd week of pregnancy). In the monitored 10-year period, a total of 25 pregnant patients underwent appendectomy. Comparing the two subgroups of patients, there were no statistically significant differences in any of the admission parameters. Laparoscopy was performed in 100% of the patients in the lower stage of pregnancy (< 23 g.w.) and in 61% of the subgroup of patients with more advanced pregnancy (> 23 g.w.); this difference was statistically significant (p = 0.039). Differences in subgroups regarding duration of surgery, risk of revision and 30-day postoperative morbidity were not statistically significant. In the subgroup of patients < 23 g.w., uncomplicated forms of appendicitis predominated (66%), whereas in the subgroup > 23 g.w., complicated forms predominated (69%); this difference was statistically significant (p = 0.026). When comparing the two subgroups of patients, there was a statistically significant difference in the length of hospitalization (p = 0.006). The mortality rate of the group was zero. The results of the study confirm the fact that advanced pregnancy may be related to complicated forms of appendicitis. Therefore, early appendectomy is still the method of choice. In accordance with the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommendations, laparoscopic approach is preferred in pregnant patients, even in advanced pregnancy.

Laparoscopic Surgery for Acute Appendicitis Complicated by Peritonitis

Introduction . Acute appendicitis (AA) is one of the most common acute abdominal surgical diseases. The current incidence, according to various authors, is 22.8 per 10,000 inhabitants. Annually, 50 to 70 thousand people die from AA and its complications around the world. Laparoscopy is generally accepted as the most effective method of differential diagnosis of AA. It is fundamentally significant to move from the diagnostic stage to the therapeutic one, i.e. to perform the elimination of the disease, including cases with other surgery-requiring pathology detected. Aim . To evaluate the role of video-endoscopic surgical methods in the surgical management of acute appendicitis complicated by peritonitis. Materials and methods . The analysis of recent publications and personal clinical experience revealed that diagnostic laparoscopy, unless contraindicated, should be performed as the initial step in suspected acute abdominal pathology. When the surgery is technically performable, laparoscopy also causes curative effect. Results and discussion. The use of laparoscopy in surgical treatment of acute appendicitis complicated by peritonitis has proven advantages for the patient over open surgery. An adequate appendectomy as a reliable method for elimination of the source of peritonitis is the key to successful treatment of patients. Laparoscopic lavage in the early postoperative period against the postoperative peritonitis with developing complications, is considered to be an alternative method to non-surgical treatment or delayed intervention and to have better ultimate results than percutaneous drainage or relaparotomy. Conclusion . The success of video-endoscopic technologies application depends not only on the technical aspects, but also on the correct choice of indications for such an intervention and their appropriate combination with open surgeries.

The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia

Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.

EFFECTIVENESS OF LYMPHOTROPIC THERAPY IN THE PATIENTS WITH ACUTE APPENDICITIS AND ITS COMPLICATED FORMS

Introduction. Despite using the latest generations of antibiotics and modern methods of their introduction in the surgical treatment of acute appendicitis, purulent-septic complications keep occurring, accounting for 45% of fatal outcomes in the patients operated on for this disease. Materials and methods. Patients were divided into two groups. The main group included patients who were administered antibiotics and pathogenetic drugs locally to the ileocecal zone by means of lymphotropic administration. The comparison group included patients who received standard antibiotic therapy. Results. On the 5th day of the postoperative period, the level of IgA in the main group was 1.16 ± 0.7 mg/ml, and in the comparison group – 1.54 ± 0.8 mg/ml. The level of elastase in the operated patients of the main group decreased to 111.797 ± 21.39 nmol/min × ml, i.e., by 2.4 times (p &lt;0.001), and in patients of the comparison group – to 179.605 ± 26.79 nmol/min × ml, i.e., by 1.5 times (p &lt;0.05). Under the influence of lymphotropic administration of the antibiotic, the volume of the spleen decreased by the 5-th day to 281.22 ± 18.8 cm³, i.e., 145.44 cm³, and with standard administration of antibiotics, the spleen decreased within the period to 344.71 ± 21.13 cm³, i.e., by 79.54 cm³, which is less by 66 cm³, or 1.8 times (p &lt;0.05) vs. main group. Conclusions. The proposed method of antibiotic therapy is a preventive measure against purulent-septic complications, especially in its destructive forms, improves the results of treatment of patients with acute appendicitis, and shortens their term of staying in the hospital, which has a positive impact on financial status.

Laparoscopic appendectomy for acute appendicitis in pregnancy

The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.

Апендикулярно-генітальний синдром у дітей

The importance of preserving the reproductive potential of the population of Ukraine is due to the increase in the number of women with infertility due to infectious and inflammatory diseases of the abdominal cavity and pelvic organs, which were suffered in childhood and adolescence. Purpose - to determine and systemize of the most significant factors of appendicular-genital syndrome depending on the primary pathological focus; to develop a practically significant classification signs and an algorithm for examination and treatment of girls with combined pathology to improve the results of treatment of this group of patients. Materials and methods. It was carried out an analysis of the medical records of inpatients, girls, for the period from October 2019 to May 2022, who were hospitalized for urgent indications and operated on for acute surgical pathology of the organs of the abdominal cavity and pelvis of an inflammatory nature. The age of the patients ranged from 4 to 17 years old (average age 11.0+0.5 years old). In the process of preliminary analysis, it was found that out of 203 patients who were to be treated surgically for the clinical picture of «acute abdomen», combined appendicular-genital pathology occurred in 13 girls. Results. It was determined that the key feature of appendicular-genital syndrome is the non-specificity of the clinical picture. In the appendicular form of the disease, the symptoms of acute appendicitis predominate in the pathological state, and in the genital form, the symptoms of acute adnexitis dominate. Connective appendicular-genital pathology in the catarrhal form of inflammation of the appendix was determined in 2 (15.39%) cases, in the phlegmonous form in 8 (61.54%) cases, in the gangrenous form in 2 (15.39%) cases, in periappendicular abscess - in 1 (7.68%) case. All patients in the study group underwent surgical treatment, the extent of which in each case was determined by the surgical findings and the prevalence of the pathological process. Most (61.58%) surgical interventions were performed laparoscopically, in compliance with the principles of maximally organ-preserving techniques (appendectomy, organ detorsion, stopping bleeding, excision of cysts, sanitation of the abdominal cavity, and, if necessary, drainage of the pelvic cavity). Only in 2 (15.38%) cases was the removal of the uterine appendages during their torsion, under the conditions of their obvious necrosis and the duration of the disease more than 72 hours. Conclusions. In order to improve the quality and speed of diagnosis of the combined inflammation of the appendix and uterine appendages, as structural elements of the syndrome «acute abdomen», the preoperative examination of patients should be multidisciplinary and necessarily include an examination by a pediatric surgeon, a pediatric gynecologist, and a pediatrician, with ultrasound of the abdominal cavity, pelvis, and retroperitoneal space. Frequency occurrence of appendicular-genital syndrome in girls is on average 6.4% of the total number of patients with the syndrome «acute abdomen». During the surgical remediation of the primary focus of inflammation relative to the appendages of the uterus, the tactics should be as organ-sparing as possible with extensive use of laparoscopic techniques for mandatory visual assessment of the organs of the abdominal cavity and pelvis. Patients who underwent surgical treatment for acute appendicitis in combination with diseases of the uterine appendages should form a separate dispensary group, in which preventive examinations are recommended once every 3 months during the first postoperative year, and thereafter once every 6 months until the moment of patient’s transfer to an adult medical and preventive institution. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Possibilities of endovideosurgery to bypass appendicular peritonitis. Literature review

An analysis of modern literature and our own clinical experience suggests that the use of laparoscopic methods in the surgical treatment of acute appendicitis complicated by peritonitis has proven advantages over open surgery. The key to successful treatment of patients is reliable elimination of the source of peritonitis — performing an adequate appendectomy. Early laparoscopic debridement for postoperative peritonitis can be an alternative to non-surgical treatment and delayed intervention. The success of the laparoscopic approach depends not only on technical aspects, but also on the correct determination of indications and contraindications for surgery.

Non-obstetric causes and presentations of acute abdominal pain among pregnant women

Objectives: Assess the patient characteristics and presentations of non-obstetric causes of acute abdominal pain among pregnant women.&#x0D; Methods: Sixty five pregnant patients of different gestational age groups were enrolled in this study who visited Sulaimani Emergency Hospital between 2nd January 2019 and 31 December 2019. &#x0D; Results: Acute appendicitis is the most common cause of non-obstetric abdominal pain in pregnant women (35.4%) followed by acute cholecystitis (18.5%) and renal stones (12.3%). Miscarriages are most commonly associated with acute pancreatitis with a rate of (50%). The majority of the patients were discharged home well within one month except for one patient (1.5%) who unfortunately died after surgical treatment for acute appendicitis.&#x0D; Conclusion: Acute appendicitis is the most common non-obstetric cause of acute abdominal pain in pregnant women. While 2nd and 3rd causes were, acute cholecystitis and renal colic consecutively in decreasing frequency.

Comparison of open and laparoscopic techniques in the surgical treatment of acute appendicitis.

Acute appendicitis (AA) is the most common cause of acute abdomen and appendectomy is one of the most common surgical procedures. In this study, we aimed to compare open appendectomy (OA) and laparoscopic (LA) surgical techniques in the treatment of AA. The data of 236 patients treated with the diagnosis of AA in 2019-2020 were analyzed. Of these patients, 85 patients who received OA and 84 patients who received LA were included in the study. Then, the two groups were compared in terms of demographic, laboratory, clinical, and surgical treatments. A total of 169 patients were included in the study. The mean age was 34.9 years (range 16-78), and the male-to-female ratio was 0.69. Statistical analysis revealed that the OA group had more leukocytosis, more female gender, and longer operation time than the LA group, but the LA group's complication rate was lower (p<0.05). LA offers less morbidity, a shorter duration of hospital stay, and a fast return to normal activities compared to OA. In the surgical treatment of AA, LA can be applied as a routine and first-line treatment.

The effect of COVID-19 pandemic period on acute appendicitis and its complications.

Acute appendicitis is the most common abdominal surgical emergency. This new type of coronavirus, also called SARS-CoV-2, causes severe acute respiratory syndrome, and this has turned into a pandemic. We aimed to determine the risk factors associated with appendectomy and complicated appendicitis during the COVID-19 pandemic period and to evaluate the effects on the surgical treatment of acute appendicitis and its outcomes. In the current comparative study, we analyzed its effects on appendectomy management and complicated appendicitis in patients with appendicitis during the COVID-19 pandemic and past year covering the same period. The patients in this study consisted of adult patients with acute appendicitis who applied to the Emergency Surgery Department of Kartal Dr. Lütfi Kırdar City Hospital General Surgery Clinic between March 1, and August 31, 2020 (COVID-19 pe-riod) (Group B) and the same period of 2019 (Group A). A comparative and retrospective study was planned. A total of 658 patients who presented with acute appendicitis were included in the study. Group A and Group B consist of 347 and 311 people, respectively. No significant difference was found in the demographic and clinical characteristics of the study population. There was no significant difference between Group A and B in terms of the duration of the application of patient complaints, the duration of the procedure, the time the patient was admitted to the hospital, the time of the patient being taken to the surgery, the findings during the operation, and the post-operative complications. There were similar features in general appendectomy pathologies, but in our study, a significant decrease in catarrhal appendicitis was observed in Group B, namely, during the COVID-19 pandemic period (p=0.04). During the COVID-19 pandemic, there was no significant increase in complicated appendicitis, but a significant reduction in negative appendectomies. This result shows that during the pandemic period, patients do not come to the emergency surgery unit unnecessarily and receive timely and appropriate surgical care.

Predictive Value of Red Blood Cell Distribution Width, Mean Platelet Volume and Platelet Distribution Width in Children with Acute Appendicitis.

Background and Objectives: Acute appendicitis in pediatric patients is one of the most common surgical emergencies, but the early diagnosis still remains challenging. The aim of this study was to determine the predictive value of Red blood cell distribution width (RDW), Mean platelet volume (MPV) and Platelet distribution width (PDW) in children with acute appendicitis. Materials and Methods: This study was a retrospective assessment of laboratory findings (RDW, MPV, PDW) of patients who underwent surgical treatment for acute appendicitis from January 2019 to December 2020. Result: During this period, 223 appendectomies were performed at our Institute. In 107 (43%) cases appendicitis was uncomplicated, while in 116 (46.6%) it was complicated. WBC and RDW/MPV ratio were significant parameters for the diagnosis of acute appendicitis with cut-off values of 12.86 (susceptibility: 66.3%; specificity: 73.2%) and 1.64 (susceptibility: 59.8%; specificity: 71.9%), respectively. WBC and RDW/RBC ratio were independent variables for the diagnosis of complicated appendicitis. The cut-off values were 15.05 for WBC (sensitivity: 60.5%; specificity: 70.7%) and 2.5 for RDW/RBC ratio (sensitivity: 72%; specificity: 52.8%). Conclusions: WBC is an important predictor of appendicitis and complicated appendicitis. RDW, MPV and PDW alone have no diagnostic value in pediatric acute appendicitis or predicting the degree of appendix inflammation. However, the RDW/MPV ratio can be an important predictor of appendix inflammation, with higher values in patients with more severe appendix inflammation. RDW/RBC ratio may be an important predictor of complicated appendicitis.

Systematic review and meta-analysis of the effects of the perioperative enhanced recovery after surgery concept on the surgical treatment of acute appendicitis in children

BackgroundEnhanced recovery after surgery (ERAS), as a new concept in surgery, has dramatically changed the mode of perioperative treatment for children with acute appendicitis.MethodsThe retrieval strategy developed by the Cochrane Collaboration was conducted using the CNKI database, Wanfang Medical Network, PubMed, EBSCO, Medline, and Cochrane database by combining subject headings and free words. A review of the randomized controlled trials on the use of the ERAS concept in the perioperative treatment of acute appendicitis in children was conducted between the establishment of the database and May 15, 2021. Keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, child, infant, and appendicitis. The quality of the literature was evaluated according to the RevMan 5.3 software provided by the Cochrane Collaboration.ResultsFive randomized controlled trials on ERAS in children with acute appendicitis were finally included. The heterogeneity of postoperative stay time was tested in 4 studies using continuous variables, with Chi-squared test (Chi2) =221.52, degree of freedom (df) =3, I2=99%>50%. An overall analysis using a random effects model showed that the ERAS group was significantly different compared to the control group [Z=5.26; mean difference (MD) =−1.65; 95% CI: −2.27 to −1.03; P<0.00001]. The heterogeneity of the readmission rate was tested in 5 studies using dichotomous variables, with Chi2=5.11, df =3, I2=41%<50%, P=0.91. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group [Z=0.80; odds ratio (OR) =1.16; 95% CI: 0.81 to 1.66; P=0.42]. The heterogeneity of the recurrence rate was tested in 4 studies using dichotomous variables, with Chi2=3.73, df =3, I2=20%<50%, P=0.29. Overall analysis using a fixed effects model showed no statistically significant difference between the ERAS group and the control group (Z=1.14; OR =0.76; 95% CI: 0.47 to 1.22; P=0.26).DiscussionThe results of the meta-analysis confirmed that perioperative application of the ERAS concept in children with acute appendicitis can promote the rehabilitation of children, reduce the postoperative stay time, and reduce the readmission rate and reoperation rate.

Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study

BackgroundAcute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methodsRetrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Resultsn = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3–30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1–16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. ConclusionSurgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of “complication” in order to collate reliably the outcomes presented in the literature.