Treatment Of Perforated Appendicitis Research Articles

Is Laparoscopic Appendectomy Recommended in Perforated Appendicitis?

Objective: To compare Open Appendectomy and Laparoscopic Appendectomy in the treatment of perforated Appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital, Abbottabad Pakistan, from Dec 2016 to Jan 2022. Methodology: A total of 240 patients underwent either open (Group-A) or laparoscopic (Group-B) appendectomy. Patients of Perforated Appendicitis fulfilling inclusion criteria were included in the study after getting informed consent. Variables of operative time, hospital stays, surgical site infection and Intra-abdominal infection were recorded. Results: Mean operating time for the Open Appendectomy-Group (49.7±6.10 minutes) was significantly shorter than the time of Laparoscopic Surgery-Group (58.93±5.41 minutes; p<0.001). The mean hospitalization time was shorter (2.57±0.77 days) in Laparoscopic Appendectomy than Open Surgery-Group (3.23±0.62 days, p=0.001). Two port sites (6.7%) in the Laparoscopic Group and nine surgical sites (30.0%) in the Open Surgery-Group got infected (p=0.021). Two patients (6.7%) in Open Appendectomy-Group and three patients (10.0%) in Laparoscopic Appendectomy-Group had postoperative complication of intra-abdominal abscess (p=1.00). Conclusion: As compared to open approach, laparoscopic appendectomy had significantly lesser surgical site infections, shorter hospital stays and longer operating time. There was no statistically significant difference in the intra-abdominal infection in both techniques.

Is there a need for revised guidelines in the treatment of perforated appendicitis in children? A study of risk factors for prolonged hospital stay and postoperative complications

PurposeTo study the need for revised guidelines in the treatment of children with acute perforated appendicitis (APA) by describing the clinical course of children surgically treated for APA in one county in Sweden, with focus on length of hospital stay (LOS) and risk of postoperative complications. The study also aimed to identify variation in practice, comparing a university children's hospital (UCH) to county hospitals (CH). MethodsTwo thousand children, <16 years, who had surgery for acute appendicitis 2014–2018 in four public hospitals (1 UCH and 3 CH), were identified. Patients with perforation of the appendix, n = 383(19 %) were selected for study and retrospective assessment of patient records. Uni and multivariable logistic regression analyses were done to identify risk factors for prolonged length of stay (PLOS) and complications. ResultsThe median LOS was 5.05 days (0.5–61.9), 6.79 (1.81–61.91) for the UCH (n = 186) and 3.65 (0.54–35.65) for CH's (n = 197)(p < 0.0001). PLOS (=>5 days in hospital) was seen in 147 (79 %) at UCH and 53(26.9 %) at CH's(p < 0.0001). Intra-abdominal abscess within 30 days was identified in 36 (9.4 %) and surgical re-intervention was needed in 19 (5 %) with no differences between hospitals. The need for readmission within 30 days was higher at CH n = 22(11.4 %) than at UCH n = 4(2.2 %), (p = 0.0006). Multivariable analyses showed independent predictors of PLOS to be: male gender(OR 2.97 (1.68–5.23)), treatment at UCH (OR 10.24 (6.38–16.44)), CRP >135 mg/l(OR per 50 units 1.42 (1.16–1.73)), prehospital delay>2.5 days(OR 1.22 (1.01–1.47)), delayed time to surgery(OR per 10 h 1.74 (1.26–2.41)) extended surgery time(OR per 2 h 4.59 (1.43–14.76)) and use of urinary catheter(OR 2.99 (1.42–6.29)). ConclusionGuidelines for treatment of childhood APA, focusing on minimizing antibiotics and facilitating early discharge, would optimize care of the patients but also the economical use of resources. Most children with APA have an uncomplicated course, but factors predicting PLOS have been identified. We found a pronounced variation in practice between the UCH and CH's, without increasing the risk of postoperative complications. Level of evidenceLevel III

The advantages and intraoperative management of the laparoscopic approach in perforated appendicitis.

Gangrene/perforated appendicitis entails high rates of morbidity and mortality. The purpose of this study is to discuss the reliability, surgical management and post-operative complications of laparoscopic interventions in the treatment of perforated appendicitis. One hundred and ten patients (50 men and 60 women) diagnosed with perforated appendicitis based on history, physical examinations, laboratory and computed tomography findings between January 2016 and May 2022 were analysed retrospectively. Preoperative laboratory and radiological findings, surgical methods and post-operative complications were evaluated. Abdominal pain defence and rebound were present in all patients. In terms of radiological findings, intra-abdominal free fluid was present in all patients and abscess in 42. Post-operative abdominal surgical site infection developed in six patients. No intra-abdominal abscess or incisional hernia was observed during follow-ups. As a diagnostic tool, permitting better visualisation of the abdominal cavity, entailing fewer post-operative complications and obviating the need for large incisions, laparoscopy can represent the approach of choice in the treatment of perforated appendicitis.

Feasibility of Single Port Laparoscopic Surgery in Patients with Perforated Appendicitis

Purpose: In recent years, single-port laparoscopic appendectomy (SPLA) has been gaining in popularity and there have been many reports on the results of SPLA. The purpose of this study is to investigate feasibility, safety, and cosmetic satisfaction with SPLA in treatment of perforated appendicitis. Methods: From September 2012 to March 2015, 227 patients underwent SPLA at Damsoyu hospital. The patients were divided into the simple and gangrenous appendicitis group (the S & G group) and the perforated appendicitis group (the P group). Operation time, hospital stay, drain insertion rate, surgical complication, and cosmetic satisfaction were evaluated. Results: A total of 227 patients consisted of 32 patients in the P group and 195 patients in the S & G group. There were no significant differences in the demographic data of the patients. The operation time and hospital stay were significantly longer in the P group (p=0.002 and p Conclusion: SPLA for perforated appendicitis is a feasible, safe, and cosmetically acceptable procedure. However, longer operation time and hospital stay and higher drain insertion rate should be considered for patients undergoing SPLA for perforated appendicitis.

Comparison of the effect of laparoscopic and open appendectomy in the treatment of perforated appendicitis

Objective To compare the clinical effect of laparoscopic and open appendectomy in the treat-ment of perforated appendicitis. Methods 107 patients with perforated appendicitis were selected as the research object and were divided into two groups. The observation group(54cases)received laparoscopic appendectomy while the control group(53cases)received traditional open appendectomy. The size of incision, the amount of bleeding during operation, time of operation and hospitalization and other perioperative indexes and the incidence rate of complications were compared between the two groups. Results The operation time between the two groups had no statistical significance(t＝1.286,P＞0.05). The incision size［（2.5±0.3)cm］, the amount of intraoperative bleeding［（10.3±3.4)mL］and hospitalization time［（5.4±0.9)d］of the observation group were better than those of(4.2±0.4)cm,(19.4±4.2)mL and(6.5±1.1)d in the control group, the differences were statistically significant(t＝24.901,12.329,5.666,all P＜0.05). The occurrence rate of complications of the observation group was 3.4%, which was lower than 15.1% of the control group, the difference was statistically significant(χ2＝3.940,P＜0.05). Conclusion Laparoscopic appendectomy has the advantages of less trauma, faster recovery, less complications, shorter hospitalization time, etc. And its effect is better than open appendectomy and worthy of populari-zation and application. Key words: Appendicitis; Intestinal perforation; Laparoscopy; Surgical procedures, Operative

Comparing the Cost and Outcomes of Laparoscopic versus Open Appendectomy for Perforated Appendicitis in Children

Although laparoscopic appendectomy (LA) is accepted treatment for perforated appendicitis (PA) in children, concerns remain whether it has equivalent outcomes with open appendectomy (OA) and increased cost. A retrospective review was conducted of patients younger than age 17 years treated for PA over a 12.5-year period at a tertiary medical center. Patient characteristics, preoperative indices, and postoperative outcomes were analyzed for patients undergoing LA and OA. Of 289 patients meeting inclusion criteria, 86 had LA (29.8%) and 203 OA (70.2%), the two groups having equivalent patient demographics and preoperative indices. Inpatient costs were not significantly different between LA and OA. LA had a lower rate of wound infection (1.2 vs. 8.9%, P = 0.017), total parenteral nutrition use (23.3 vs. 50.7%, P < 0.0001), and length of stay (5.56 ± 2.38 days vs. 7.25 ± 3.77 days, P = 0.0001). There was no significant difference in the rate of postoperative organ space abscess, surgical re-exploration, or rehospitalization. In children with PA, LA had fewer surgical site infections and shorter lengths of hospital stay compared with OA without an increase in inpatient costs.

Single Daily Dosing of Ceftriaxone and Metronidazole is as Safe and Effective as Ampicillin, Gentamicin and Metronidazole for Non-operative Management of Complicated Appendicitis in Children

Introduction: Perforated appendicitis very common abdominal emergency in children and nonoperative management with Ampicillin Gentamicin and Metronidazole (AGM) has shown good results. Recent data show that single daily dosing of Ceftriaxone and Metronidazole (CM) is as safe and effective as ampicillin gentamicin and clindamycin for treatment of perforated appendicitis after surgery in children. Treatment of complicated appendicitis in children with once daily CM can decrease the risk of in drug administration’s mistake, require the patient to be connected to the IV line for short time only once a day, may cause less IV line infection and may cost less. The aim of this study was to compare the effectiveness, and safety of CM with the traditional triple antibiotic for conservative treatment of complicated appendicitis children. Methods: A prospective, open, randomized study conducted from July 1st 2008 to June 30th 2009. Included were children younger than 14 years with complicated appendicitis who were randomly assigned to therapy with either CM as a single daily dose or AGM. The outcome variables compared were maximum daily temperature, duration of fever, time return to oral diet, length of antibiotic therapy, results of repeat WBC counts, need for abdominal abscess drainage, length of hospitalization and complication. Results: Overall 22 and 21 children were assigned to CM and AGM regimens respectively. There were no any significant differences in all clinical outcomes parameters between the two groups. Conclusions: Single daily dosing of CM is as safe and effective as the triple antibiotic regimen and has significant advantages for the conservative therapy of complicated appendicitis in children.

The Role of Antibiotic Therapy in the Management of Acute Appendicitis

Nonsurgical treatment with antibiotics has recently been proposed as the first line of treatment for noncomplicated appendicitis. This has met with considerable interest, illustrated by the number of reviews and meta-analyses, which exceed the number of original reports of the issue. The results in these studies are seriously biased due to inclusion of patients with resolving appendicitis. At a time when we need to reduce inappropriate use of antibiotics in the struggle against the increasing rate of antibiotics resistance, there must be strong requirements of a proven effect and an improved cost-benefit ratio before antibiotics treatment is introduced for a new group of patients. These requirements have not yet been met for nonsurgical treatment with antibiotics for assumed uncomplicated appendicitis. Due to the high rate of spontaneous resolution, a randomized placebo-controlled trial is needed that can compare the efficiency of antibiotics treatment and expectant management in this group of patients. Antibiotics treatment, however, remains indicated for treatment of perforated appendicitis with localized abscess or phlegmone and in selected surgical high-risk patients.

Treatment of perforated appendicitis in children: what is the cost?

Background/PurposeWe compared direct hospital costs and indirect costs to the family associated with immediate appendectomy or initial nonoperative management for perforated appendicitis in children. MethodsFrom June 2009 through May 2010, 61 prospectively identified families completed a cost diary, documenting the numbers of missed school days for the child and missed employment days for the adult caregiver(s) over the treatment course. Hospital costs were obtained from hospital financial databases. Mann-Whitney U tests and Fisher exact tests were used to compare outcome measures for each treatment strategy. ResultsPatients treated by initial nonoperative management had a significantly longer median length of stay (9 days vs 7 days, P = .02) and a significantly greater median total hospital cost per patient ($31,349 vs $21,323, P = .01) when compared with those treated by immediate appendectomy. There was no significant difference in median number of missed school days (9 days vs 10 days, P = .23) or missed employment days for adult caregiver(s) (5 days vs 7 days, P = .18) between treatment strategies. ConclusionsPatients with perforated appendicitis treated by initial nonoperative management had a greater length of stay and a significantly greater total hospital cost but were not burdened by significantly greater indirect costs compared with those treated by immediate appendectomy.

Aminoglycoside-Based Triple-Antibiotic Therapy Versus Monotherapy for Children With Ruptured Appendicitis

We conducted a retrospective cohort study to compare the use of triple therapy versus monotherapy for children and adolescents with perforated appendicitis and to determine whether there has been a transition to monotherapy within the freestanding children's hospitals that contribute to the Pediatric Health Information System database. We used the Pediatric Health Information System database, which includes billing and discharge data for 32 children's hospitals in the United States, to examine the trend in antibiotic usage and whether the postappendectomy antibiotic regimen was associated with differences in complication-related readmissions, length of stay, or charges in a population of children and adolescents with ruptured appendicitis and discharge dates between March 1, 1999, and September 30, 2004. Pairwise regression analyses were performed to compare the most common monotherapy regimens with the triple therapy. A total of 8545 patients met the inclusion criteria, of whom 58%, over the entire study period, received the aminoglycoside-based triple antibiotic therapy on postoperative day 1. There was, however, a notable transition over this 6-year period, from 69% to 52% of surgeons using aminoglycoside-based combination therapy. There were no significant differences in the odds of readmission at 30 days except for the group receiving ceftriaxone, which was associated with significantly decreased odds. The subgroup receiving piperacillin/tazobactam monotherapy demonstrated significantly decreased length of stay (-0.90 days) and total hospital charges, and the group receiving cefoxitin demonstrated significantly decreased length of stay (-1.89 days), as well as decreased pharmacy and total hospital charges. Single-agent antibiotic therapy in the treatment of perforated appendicitis is being used with increasing frequency, is at least equal in efficacy to the traditional aminoglycoside-based combination therapy, and may offer improvements in terms of length of stay, pharmacy charges, and hospital charges.

Risk Factors for the Development of Abdominal Abscess Following Operation for Perforated Appendicitis in Children

The morbidity following treatment for perforated appendicitis in children is significant, with intra-abdominal abscess being one of the more serious complications. This can lead to prolonged hospitalizations and antibiotic administration, multiple computed tomographic scans, and invasive procedures. The purpose of our study was to determine risk factors for developing an intra-abdominal abscess following treatment for perforated appendicitis. Case-control study. Four tertiary care children's hospitals. Children aged 1 to 18 years with appendicitis. Multivariable logistic regression. Development of postoperative abscess, length of hospital stay, presence or absence of fever, and tolerance of diet on postoperative day 3. Thirty-five (13.2%) of 265 children developed an abscess. Ten factors with a bivariate P value <.20 were included in the regression model. The final multivariable model revealed only 2 factors influencing abscess development: an intraoperative fecalith (odds ratio, 8.77 [95% confidence interval, 1.50-51.40]) and diarrhea at presentation. Many factors proposed to be associated with abscess were not, including pain history, type and timing of preoperative antibiotics, abscess at operation, laparoscopic procedure, and length of antibiotics postoperatively. Thiry-seven children were discharged on or before postoperative day 3. Another 21 children were afebrile and tolerating a diet at that time but remained in the hospital. There were no significant differences between the 2 groups. None of the early-discharge group developed an abscess, and 2 of those remaining in the hospital developed an abscess (P = .06). Clinical factors commonly thought to be predictive of abscess formation following perforated appendicitis were not reliable predictors of this outcome. Our results suggest that if children are afebrile and eating on postoperative day 3 they can be discharged with a low rate of abscess development.

Current practice patterns in the treatment of perforated appendicitis in children.

The treatment of perforated appendicitis in children often involves a combination of surgical and medical therapy. The aim of this study was to document the degree of consensus in the current management of perforated appendicitis in children. A survey was sent to all practicing pediatric surgeons in North America in April 2000 who were members of the American Pediatric Surgical Association for 1999-2000. Survey questions pertained to preoperative, perioperative, and postoperative practice patterns, particularly those issues related to use of antibiotic therapy. Among eligible surgeons, 80.2% completed the survey. Although more than 80% of respondents practiced in an academic setting, only 17% of surgeons used a formal clinical practice guideline to direct care. Responses varied substantially in the duration of postoperative antibiotic therapy, the use of intravenous or oral agents or both, and the duration of hospitalization. A considerable number of patients are receiving a portion of their intravenous antibiotic therapy as outpatients. There is little apparent consensus in the many aspects of perioperative and postoperative care of perforated appendicitis in children across North America. Only a fraction of surgeons currently uses a formal clinical practice guideline for treatment of perforated appendicitis, although increased pressures to develop more cost-effective therapeutic strategies can encourage development of additional guidelines. Definitive evidence to inform development of such guidelines and enhance consensus is lacking. Further studies are needed across institutions to better inform clinical decisions in light of a changing practice environment and treatment alternatives.

Perforated Appendicitis is Not a Contraindication to Laparoscopy

Recent studies have reported an increased risk of intra-abdominal abscess formation following laparoscopic operation for perforated appendicitis. We undertook this study to compare laparoscopic versus open appendectomy in the treatment of perforated appendicitis. Records of all patients undergoing an appendectomy between January 1994 and June 1997 were reviewed, classifying appendicitis as acute, gangrenous, or perforated based on the intraoperative findings. Operative procedures were categorized as open, laparoscopic converted to open, or laparoscopic. The study group included 690 patients; four hundred fourteen (60%) were acute, 77 (11%) were gangrenous, and 199 (29%) were perforated. Although mean length of stay was shorter for all patients undergoing laparoscopic appendectomy, patients with perforated appendicitis had similar length of stay between treatment groups. Mean operative time for open appendectomy was significantly shorter than for converted or laparoscopic appendectomy regardless of diagnosis (P<0.01). Ten patients (1.4%) developed an intra-abdominal abscess: six after open appendectomy (1.7%), one after converted appendectomy (3.7%), and three after laparoscopic appendectomy (1%). There was no significant difference in rate of abscess formation in patients with perforated appendicitis undergoing open, converted, or laparoscopic appendectomy. We conclude that laparoscopic appendectomy for perforated appendicitis is not associated with an increased rate of intra-abdominal abscess formation.

Inguinal-scrotal suppuration following treatment of perforated appendicitis

Suppuration of a congenital hernia or communicating hydrocele following generalized peritonitis is rare. The lack of reported cases in the recent literature may indicate a decreasing incidence of this unusual complication. We report a case of suppuration of a communicating hydrocele with testicular loss 2 days after treatment of perforated appendicitis in a 10-year-old boy.

Perforated or gangrenous appendicitis treated with aminoglycosides. How do bacterial cultures influence management?

To study the influence of bacterial culture data on the clinical management of gangrenous or perforated appendicitis, we reviewed records of 104 patients who had been treated empirically with aminoglycoside antibiotics. Culture results appeared to influence antibiotic therapy in only 7 patients (7%). The routine cultures obtained at appendectomy affected therapy in only 2 patients. Discriminant analysis identified postoperative infectious complications and related factors as the principal determinants of culture utility. We conclude that, in patients with perforated appendicitis treated empirically with aminoglycoside combination regimens, culture results were seldom used for clinical management except in instances of postoperative infectious complication. Routine cultures and Gram's stains of perforated appendicitis, however, should still be obtained (1) to allow epidemiologic tracking in the hospital; (2) to identify organisms that are recovered infrequently but may cause serious disease (eg, Clostridium); and (3) because newer antibiotics are replacing aminoglycosides in the treatment of perforated appendicitis.

Treatment of Perforated Appendicitis

To the Editor.— The editorial by the late Alton Ochsner, MD (1981; 246:2453), addresses the problem of emergency appendectomy by non-qualified physicians. I remember that during World War II, several patients lost their lives owing to the shortage of trained surgeons in a smaller community. However, with modern, rapid, transport facilities, antibiotic coverage, and general supportive management, the treatment of perforated appendicitis may be less conservative, as the latter approach creates its own problems. I myself have been suffering from extensive peritoneal adhesions following nonsurgical treatment of appendicitis and have had two different attacks of fulminating small-bowel strangulation with gangrene, producing a life-threatening emergency and necessitating each time the sacrifice of about 91 cm of small bowel. Two prominent medical centers failed to recognize the cause of the abdominal symptoms before these attacks. Recently some painful abdominal symptoms have recurred, and I have to be prepared for a third emergency,

TREATMENT OF PERFORATED APPENDICITIS

TREATMENT OF PERFORATED APPENDICITIS

Doxycycline in the treatment of perforated appendicitis

The effect of doxycycline and ampicillin on the incidence of septic complications after surgery for perforated appendicitis was studied in 84 patients. The doxycycline group had a 20% incidence of ...

Drainage in treatment of perforated appendicitis

In treatment of peritonitis drainage of the peritoneal cavity, abdominal wall, and intestinal lumen, may be carried out. Attention is directed to the value of the third type which may prevent the establishment of ileus and a fatal outcome, if performed early after perforation. The effect of tension upon the intestinal capillaries is contrasted with that of pressure on the somatic capillaries. A small series of unselected cases in which enterostomy was added to appendectomy is summarized.