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Surgical Infections Mar 2022The effect of diagnosing appendicitis at re-assessment on post-operative outcomes is not clear. This study aims to compare patients diagnosed with appendicitis at...
The effect of diagnosing appendicitis at re-assessment on post-operative outcomes is not clear. This study aims to compare patients diagnosed with appendicitis at initial presentation versus patients who were diagnosed at re-assessment. Data from the Dutch SNAPSHOT appendicitis collaborative was used. Patients with appendicitis who underwent appendectomy were included. Effects of diagnosis at re-assessment were compared with diagnosis at initial presentation. Primary outcomes were the proportion of patients with complicated appendicitis and the post-operative complication rate. Of 1,832 patients, 245 (13.4%) were diagnosed at re-assessment. Re-assessed patients had a post-operative complication rate comparable to those diagnosed with appendicitis at initial presentation (15.1% vs. 12.7%; p = 0.29) and no substantial difference was found in the proportion of patients with complicated appendicitis (27.9% vs. 33.5%; p = 0.07). For patients with complicated appendicitis, more post-operative complications were seen if diagnosed at re-assessment than if diagnosed initially (38.2% vs. 22.9%; p = 0.006). For patients in whom appendicitis was not diagnosed at first presentation, but at re-assessment, both the proportion of complicated appendicitis and the post-operative complication rate were comparable to those who were diagnosed with appendicitis at initial presentation. However, re-assessed patients with complicated appendicitis encountered more post-operative complications.
Topics: Acute Disease; Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Postoperative Complications; Postoperative Period; Retrospective Studies
PubMed: 34935523
DOI: 10.1089/sur.2021.193 -
Clinics and Research in Hepatology and... Dec 2023To assess the efficacy and safety of endoscopic retrograde appendicitis treatment (ERAT) for acute appendicitis (AA) by conducting a meta-analysis of clinical randomized... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the efficacy and safety of endoscopic retrograde appendicitis treatment (ERAT) for acute appendicitis (AA) by conducting a meta-analysis of clinical randomized trials (RCTs).
METHODS
Eight electronic databases were searched. Study quality was assessed using the Cochrane risk of bias tool. RevMan5.3 and STATA14 software were used to for statistical analysis.
RESULTS
Twenty-six RCTs with 2236 subjects were analyzed. First, operative time, length of hospital stay and duration of bed rest were shorter in the ERAT groups than in the control groups, with the pooled MD and 95 % CI being -13.22(-20.09, -6.35)(p = 0.0002), -2.13 (-2.47, -1.80)(p < 0.00001) and -3.15 (-3.76, -2.53)(p < 0.00001), respectively. Second, patients in the ERAT groups had a lower incidence of complications than the control groups, with a pooled RR and 95 % CI of 0.25(0.18, 0.35)(p < 0.00001). Third, patients who received ERAT returned to normal temperature faster than the control groups, the pooled MD and 95 % CI was -3.39(-4.36, -2.42)(p<0.00001). Finally, the result showed that the recurrence rate in the ERAT groups was approximately twice that of control groups, with the pooled RR and 95 % CI being 2.10(1.02, 4.32)(p < 0.00001).
CONCLUSIONS
ERAT results in fewer complications and shorter recovery time. And compared to appendectomy, ERAT reduces operative time and intraoperative bleeding. However, the recurrence of acute appendicitis after ERAT remains a concern. And more multicenter and large-scale RCTs are needed to confirm the benefits of ERAT.
SYSTEMATIC REVIEW REGISTRATION
We have registered on the PROSPERO [https://www.crd.york.ac.uk/PROSPERO/], and the registration number is CRD42023420171.
Topics: Humans; Appendicitis; Treatment Outcome; Endoscopy; Appendectomy; Acute Disease; Multicenter Studies as Topic
PubMed: 37925019
DOI: 10.1016/j.clinre.2023.102241 -
Seminars in Pediatric Surgery Aug 2016Appendectomy is currently considered the standard of care for children with acute appendicitis. Although commonly performed and considered a safe procedure, appendectomy... (Review)
Review
Appendectomy is currently considered the standard of care for children with acute appendicitis. Although commonly performed and considered a safe procedure, appendectomy is not without complications. Non-operative management has a role in the treatment of both uncomplicated and complicated appendicitis. In uncomplicated appendicitis, initial non-operative management appears to be safe, with an approximate 1-year success rate of 75%. Compared to surgery, non-operative management is associated with less disability and lower costs, with no increase in the rate of complicated appendicitis. In patients with complicated appendicitis, initial non-operative management with interval appendectomy has been shown to be safe with reported success rates between 66% and 95%. Several studies suggest that initial non-operative management with interval appendectomy may be beneficial in patients with perforated appendicitis with a well-formed abscess or inflammatory mass. Recent data suggest that interval appendectomy may not be necessary after initial non-operative management of complicated appendicitis.
Topics: Acute Disease; Anti-Bacterial Agents; Appendectomy; Appendicitis; Child; Combined Modality Therapy; Humans; Recurrence; Treatment Outcome
PubMed: 27521709
DOI: 10.1053/j.sempedsurg.2016.05.002 -
Radiographics : a Review Publication of... 2015
Review
Topics: Appendicitis; Contrast Media; Diagnosis, Differential; Humans; Tomography, X-Ray Computed
PubMed: 25590392
DOI: 10.1148/rg.351140122 -
Journal of Special Operations Medicine... 2015The series objective is to review various clinical conditions/presentations, including the latest evidence on management, and to dispel common myths. In the process,...
The series objective is to review various clinical conditions/presentations, including the latest evidence on management, and to dispel common myths. In the process, core knowledge and management principles are enhanced. A clinical case will be presented. Cases will be drawn from real life but phrased in a context that is applicable to the Special Operations Forces (SOF) or tactical emergency medical support (TEMS) environment. Details will be presented in such a way that the reader can follow along and identify how they would manage the case clinically depending on their experience and environment situation. Commentary will be provided by currently serving military medical technicians. The medics and author will draw on their SOF experience to communicate relevant clinical concepts pertinent to different operational environments including SOF and TEMS. Commentary and input from active special operations medical technicians will be part of the feature.
Topics: Abdominal Pain; Adult; Appendicitis; Diagnosis, Differential; Humans; Male; Practice Guidelines as Topic
PubMed: 25770809
DOI: No ID Found -
The Journal of Surgical Research Dec 2022We performed a systematic review and meta-analysis to evaluate the diagnostic value of fibrinogen (FB) for acute appendicitis and whether it can distinguish between... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
We performed a systematic review and meta-analysis to evaluate the diagnostic value of fibrinogen (FB) for acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis.
METHODS
A search of electronic information sources was conducted to identify all studies reporting FB in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons: (1) appendicitis versus no appendicitis and (2) uncomplicated appendicitis versus complicated appendicitis. To assess the diagnostic value of FB, sensitivity, specificity, diagnostic odds ratios, summary receiver operating characteristic curves, area under the curve, and 95% confidence intervals (95% CIs) were estimated.
RESULTS
Seven studies (917 confirmed appendicitis and 1026 controls) for overall appendicitis and eight studies (602 complicated appendicitis and 1386 uncomplicated appendicitis) for complicated appendicitis were identified. The pooled sensitivity and specificity of FB for the diagnosis of appendicitis were 0.62 (95% CI: 0.58-0.65) and 0.79 (95% CI: 0.77-0.82), respectively. FB was more accurate in diagnosing complicated appendicitis, with a pooled sensitivity of 0.74 (95% CI: 0.69-0.78), specificity of 0.76 (95% CI: 0.73-0.78), and the area under the curve was 0.84.
CONCLUSIONS
As per this meta-analysis, FB has a potential diagnostic value in overall appendicitis and that it has a higher diagnostic value in the diagnosis of complicated appendicitis. Future well-designed prospective studies are needed to corroborate the findings.
Topics: Humans; Fibrinogen; Appendicitis; ROC Curve; Sensitivity and Specificity; Acute Disease; Biomarkers; Hemostatics
PubMed: 35944446
DOI: 10.1016/j.jss.2022.07.001 -
Surgery May 2024
Topics: Humans; Appendicitis; Anti-Bacterial Agents; Treatment Outcome; Acute Disease; Appendectomy
PubMed: 38373871
DOI: 10.1016/j.surg.2024.01.017 -
European Review For Medical and... Dec 2021We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and...
OBJECTIVE
We aimed to predict the risk of complicated appendicitis in children, constructing a risk-based prediction tool with the optimal combination of sensitivity and specificity outcomes.
PATIENTS AND METHODS
This is a prospective study on a random sample of children with acute appendicitis who underwent appendectomy. Clinical examination, history, routine laboratory tests, Alvarado and pediatric appendicitis scores, operative and histopathological findings were taken into consideration. The predictive ability of the outcome variables was assessed by the Receiver Operating Characteristics (ROC) analysis. The overall predictive ability and determination of the best cut-off value (the higher sum of sensitivity plus specificity) were calculated. A Classification and Regression Tree (CRT) was used to create a multi-level classification algorithm. The model was set to predict the outcome of complicated appendicitis, considering as potential predictors the demographic characteristics, the clinical findings, and the outcome parameters.
RESULTS
The various combinations of clinical and laboratory parameters did not improve their overall diagnostic ability. However, the CRT analysis resulted in a short classification algorithm based on the Pediatric appendicitis score, neutrophils percentage and the CRP. This model yielded a significantly better predictive ability than all the other combinations of the outcome parameters. The application of the model would predict complicated appendicitis with 90% sensitivity and 78.6% specificity.
CONCLUSIONS
The constructed predictive model may be a useful tool for daily practical use by the clinician, especially in areas where modern diagnostic imaging facilities are absent or not always available. Clinical evaluation and close follow-up remain the more accurate preoperative method to decide the performance and timing of appendectomy.
Topics: Adolescent; Algorithms; Appendectomy; Appendicitis; Child; Female; Humans; Male; Prospective Studies; Risk Assessment; Sensitivity and Specificity
PubMed: 34919234
DOI: 10.26355/eurrev_202112_27428 -
Vnitrni Lekarstvi 2015Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be easy in patients who present with classic signs and symptoms. Atypical... (Review)
Review
Appendicitis is the most common abdominal emergency. While the clinical diagnosis may be easy in patients who present with classic signs and symptoms. Atypical presentations may result in diagnostic embarrassment and delay in treatment. Typical sign is abdominal pain. Furthermore, it can be nausea, vomiting and anorexia. Abdominal examination reveals localised tenderness and muscular rigidity in the right lower abdominal quadrant. Laboratory data usually reveal an elevated leukocytosis with a left shift and elevated C-reactive protein. To establish the diagnosis greatly help native abdominal X-ray, ultrasound or CT. In 1889, an appendectomy was accepted as the standard treatment, because they save lives and since then dictum: removal of the inflamed appendix changed, it is necessary!
Topics: Abdominal Pain; Appendectomy; Appendicitis; C-Reactive Protein; Humans
PubMed: 26375700
DOI: No ID Found -
Medical Sciences (Basel, Switzerland) Jul 2022Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of...
Several studies have reported elevated serum bilirubin or reduced serum sodium levels in patients with complicated appendicitis (CA). This study examined the efficacy of hyperbilirubinemia, hyponatremia, and both combined in the preoperative diagnosis of CA. Patients who underwent surgery for acute appendicitis were included in this retrospective review. In total, 247 patients were included in the final analysis. Of these, 36 (14.2%) had early appendicitis, 177 (72.0%) had acute suppurative appendicitis, 32 (13.0%) had necrotizing/gangrenous acute appendicitis, and 2 (0.8%) had other types of appendicitis. The mean total bilirubin (TBIL) level was significantly higher in patients with CA than in those with uncomplicated appendicitis. Conversely, the mean serum sodium level was significantly lower in patients with CA than in those with uncomplicated appendicitis. The levels of TBIL (odds ratio: 1.098, 95% CI: 1.052-1.147) and serum sodium (odds ratio: 0.743, 95% CI: 0.646-0.855) were associated with CA. Hyponatremia combined with hyperbilirubinemia yielded significant discriminatory value for the diagnosis of CA. TBIL and serum sodium levels can be considered as adjuvant parameters in the diagnosis of perforated/necrotizing appendicitis. Although hyperbilirubinemia and hyponatremia together were better able to determine the risk of CA than either marker alone, other markers are required to definitively predict CA. Furthermore, large-scale studies are needed to confirm these findings.
Topics: Acute Disease; Appendicitis; Bilirubin; Biomarkers; Humans; Hyperbilirubinemia; Hyponatremia; Sodium
PubMed: 35893118
DOI: 10.3390/medsci10030036