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International Journal of Surgery... Dec 2017Acute appendicitis is one of the most frequent disorders in abdominal surgery. Therefore, appendectomy is a matter of significant interest in that field. Yet, four... (Review)
Review
Acute appendicitis is one of the most frequent disorders in abdominal surgery. Therefore, appendectomy is a matter of significant interest in that field. Yet, four different techniques are available: open appendectomy, (conventional) laparoscopic appendectomy, single port laparoscopic appendectomy and NOTES-appendectomy with its different variations. To evaluate the current state of the art in appendectomy a bibliographic search was conducted. All prospectively randomized trials and national register cohort studies published between 1/2010 and 5/2016 were included into the analysis. Overall, 25 respective studies were identified. All studies were screened for the following parameters: surgical site infection (SSI) (wound infection (WI) or intraabdominal abscess (IAA)), postoperative pain (PP), length of surgery (LoS), length of hospital stay (LHS), return to normal activities (RNA). Today the rate of laparoscopic appendectomy is reported to be up to 86% in the recent literature. Open appendectomy remains a safe and effective technique. Single port laparoscopic appendectomy presented almost equal in terms of safety and patient satisfaction. The method is still not as widespread as conventional three port laparoscopic appendectomy, presumably due to the necessity of special equipment and training. NOTES appendectomy is the newest development in appendectomy technique. First prospective cohort studies proved the safety and feasibility in experienced hands. However, the method is still experimental and further prospectively randomized trials are necessary. Concluding the current evidence, a laparoscopic approach, which is most commonly and increasingly frequently used, could be called "state of the art" in the treatment of appendicitis.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Natural Orifice Endoscopic Surgery; Patient Safety; Patient Satisfaction
PubMed: 29155250
DOI: 10.1016/j.ijsu.2017.11.028 -
Neurology India 2020The association between appendectomy and multiple sclerosis (MS) is unknown. In this study, we explored the association between appendectomy and MS and neuromyelitis...
BACKGROUND
The association between appendectomy and multiple sclerosis (MS) is unknown. In this study, we explored the association between appendectomy and MS and neuromyelitis optica spectrum disorder (NMOSD).
PATIENTS AND METHODS
MS and NMOSD patients older than 40 were identified from neurology records from hospitals in Malaysia. The diagnoses were based on the Revised McDonald (2010) and Wingerchuk (2015) criteria. Controls were sampled from Malaysia's normal population. Individuals were interviewed telephonically or face-to-face. The age inclusion criterion (over 40) differentiated high or low lifetime risk of appendicitis, as appendicitis incidence is rare after 40.
RESULTS
49 MS, 71 NMOSD, and 880 controls met the inclusion criteria. Seventy-two individuals (9 MS, 4 NMOSD, 59 control) had undergone appendectomy. Appendectomy rates were 18.37% in the MS group (95% CI 7.5-29.2%), 5.6% in the NMOSD group (0.3%, 11%), and 6.7% among controls (5.1%, 8.4%), (MS vs NMOSD P = 0.036, MS vs controls P = 0.007). Binary regression analysis showed that MS was an independent risk factor for appendectomy (OR 2.938, 95% CI 1.302, 6.633, P = 0.009). NMOSD showed no association with appendectomy.
CONCLUSION
MS is positively associated with appendectomy, unlike ulcerative colitis, which is negatively associated. We hypothesize that there is a commonality in the microflora in persons who have had these two illnesses.
Topics: Appendectomy; Humans; Incidence; Multiple Sclerosis; Neuromyelitis Optica
PubMed: 32859827
DOI: 10.4103/0028-3886.293469 -
Annals of the Royal College of Surgeons... Apr 2021The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised... (Observational Study)
Observational Study
INTRODUCTION
The COVID-19 pandemic stimulated a national lockdown in the UK. The public were advised to avoid unnecessary hospital attendances and health professionals were advised to avoid aerosol-generating procedures wherever possible. The authors hypothesised that these measures would result in a reduction in the number of patients presenting to hospital with acute appendicitis and alter treatment choices.
METHODS
A multicentred, prospective observational study was undertaken during April 2020 to identify adults treated for acute appendicitis. Searches of operative and radiological records were performed to identify patients treated during April 2018 and April 2019 for comparison.
RESULTS
A total of 190 patients were treated for acute appendicitis pre-lockdown compared with 64 patients treated during lockdown. Patients treated during the pandemic were more likely to have a higher American Society of Anesthesiology (ASA) score ( = 0.049) and to have delayed their presentation to hospital (2 versus 3 days, = 0.03). During the lockdown, the use of computed tomography (CT) increased from 36.3% to 85.9% ( < 0.001), the use of an antibiotic-only approach increased from 6.2% to 40.6% ( < 0.001) and the rate of laparoscopic appendicectomy reduced from 85.3% to 17.2% ( < 0.001). The negative appendicectomy rate decreased from 21.7% to 7.1% during lockdown (< 0.001).
CONCLUSIONS
The COVID-19 lockdown was associated with a decreased incidence of acute appendicitis and a significant shift in the management approach. The increased use of CT allows the identification of simple appendicitis for conservative treatment and decreases the negative appendicectomy rate.
Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Appendectomy; Appendicitis; COVID-19; Conservative Treatment; Delayed Diagnosis; Female; Health Services Accessibility; Humans; Incidence; Male; Middle Aged; Pandemics; Patient Acceptance of Health Care; Practice Patterns, Physicians'; Prospective Studies; Severity of Illness Index; United Kingdom
PubMed: 33682449
DOI: 10.1308/rcsann.2020.7128 -
Polski Przeglad Chirurgiczny Nov 2021<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general...
<b>Aim:</b> The study was conducted to analyze stump appendicitis which is a long-term complication of appendectomy - the otherwise commonest general surgical procedure conducted in the world. </br></br> <b>Methods:</b> 48 cases included from 36 articles published in the peer reviewed journals of repute were evaluated for eight variables including: (I) age of the patient, (II) gender, (III]) duration of symptoms, (IV) imaging, (V) interval time since initial operation, (VI) details of initial operation, (VII) management, (VIII) stump length if managed by operation. </br></br> <b> Results:</b> 48 cases (27 males and 19 females) ranging in age from 2 to 72 years reported after a wide range of time (3 days - 46 years) after primary appendectomy. The duration of symptoms ranged from 1 day to 7 months. As many as 31 (64.5%) cases had inflamed stump appendix whereas 17 (33.5%) had perforation. Twenty-one (43.7%) had undergone laparoscopic primary appendectomy and 27 (56.3%) had undergone open appendectomy. Management of the retained stump included stump appendectomy in 42 (87.5%), right hemicolectomy in 2 (4.2%) and conservative in 4 (8.3%) cases. In the 44 cases managed by surgical intervention, the approach was open in 27 (61.4%) and laparoscopic in 17 (38.6%) cases. The length of the retained appendix stump ranged from 0.5 cm to 6.5 cm (mean 2.14 cm). </br></br> <b>Conclusion:</b> Stump appendicitis is an entity that a physician needs to suspect if a patient reports with features of appendicitis even after appendectomy had been conducted. Management is generally surgical and aimed at removal of the retained appendiceal stump.
Topics: Amputation Stumps; Appendectomy; Appendicitis; Appendix; Child, Preschool; Female; Humans; Laparoscopy; Male; Postoperative Complications
PubMed: 35195078
DOI: 10.5604/01.3001.0015.4553 -
International Journal of Environmental... Oct 2022: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for...
: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. The study was conducted at two public hospitals in Kosovo that have benefited from quality-improvement interventions. The participants included 22 surgeons. The primary outcome was the overall effect of clinical attributes on the decision to perform appendectomy and make the preoperative preparations for appendectomy. : In the regression analyses, several attributes demonstrated statistically significant effects on the clinical decision to perform appendectomy and on the practice of preoperative preparation. We found that several factors influenced the decision to perform appendectomy and the practices for preoperative preparation. Nevertheless, the small sample size limited our efforts to interpret the results. These findings could assist Kosovo in the design and implementation of future similar studies and in fostering quality improvement measures that address clinical decision making and the lack of process standardization in the delivery of surgical care.
Topics: Humans; Appendectomy; Kosovo; Clinical Decision-Making; Hospitals, Public; Quality Improvement
PubMed: 36360907
DOI: 10.3390/ijerph192114027 -
Medicine Nov 2019Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of... (Review)
Review
INTRODUCTION
Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of the remnant part of the appendix. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis of stump appendicitis is often delayed.
METHODS
Between January 2008 and December 2017, 6 patients were diagnosed with stump appendicitis with or without perforation at a single institution. They had undergone operative management with laparoscopic approach. The clinical data of these patients were retrospectively analyzed by reviewing the medical records and pathologic reports.
RESULTS
Five patients were male, with a mean age of 42.4 years (range 11-77 years). The time interval after initial appendectomy ranged from 2 weeks to 30 years. Three patients underwent laparoscopic completion appendectomy, and the others underwent laparoscopic ileocecectomy. The mean hospital stay was 9 days (range 5-13 days). There were no cases of open conversion.
CONCLUSIONS
Stump appendicitis is a rare complication after appendectomy. A laparoscopic procedure can be performed for management of stump appendicitis with or without perforation.
Topics: Adolescent; Adult; Aged; Appendectomy; Appendicitis; Child; Female; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Young Adult
PubMed: 31764839
DOI: 10.1097/MD.0000000000018072 -
Scandinavian Journal of Surgery : SJS :... Jun 2021Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort,...
INTRODUCTION
Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis.
MATERIALS AND METHODS
Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations.
RESULTS
A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes.
DISCUSSION
We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32662330
DOI: 10.1177/1457496920938605 -
JAMA Surgery Jun 2023Although the incidence of acute appendicitis among adults 65 years and older is high, these patients are underrepresented in randomized clinical trials comparing...
IMPORTANCE
Although the incidence of acute appendicitis among adults 65 years and older is high, these patients are underrepresented in randomized clinical trials comparing nonoperative vs operative management of appendicitis; it is unclear whether current trial data can be used to guide treatment in older adults.
OBJECTIVE
To compare outcomes following nonoperative vs operative management of appendicitis in older adults and assess whether they differ from results in younger patients.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study used US hospital admissions data from the Agency for Healthcare Research and Quality's National Inpatient Sample from 2004 to 2017. Of 723 889 adult patients with acute uncomplicated appendicitis, 474 845 with known procedure date who survived 24 hours postprocedure and did not have inflammatory bowel disease were included (43 846 who were treated nonoperatively and 430 999 with appendectomy) were included. Data were analyzed from October 2021 to April 2022.
EXPOSURES
Nonoperative vs operative management.
MAIN OUTCOMES AND MEASURES
The primary outcome was incidence of posttreatment complications. Secondary outcomes included mortality, length of stay, and inpatient costs. Differences were estimated using inverse probability weighting of the propensity score with sensitivity analysis to quantify effects of unmeasured confounding.
RESULTS
The median (IQR) age in the overall cohort was 39 (27-54) years, and 29 948 participants (51.3%) were female. In patients 65 years and older, nonoperative management was associated with a 3.72% decrease in risk of complications (95% CI, 2.99-4.46) and a 1.82% increase in mortality (95% CI, 1.49-2.15) along with increased length of hospitalization and costs. Outcomes in patients younger than 65 years were significantly different than in older adults, with only minor differences between nonoperative and operative management with respect to morbidity and mortality, and smaller differences in length of hospitalization and costs. Morbidity and mortality results were somewhat sensitive to bias from unmeasured confounding.
CONCLUSIONS AND RELEVANCE
Nonoperative management was associated with reduced complications in older but not younger patients; however, operative management was associated with reduced mortality, hospital length of stay, and overall costs across all age groups. The different outcomes of nonoperative vs operative management of appendicitis in older and younger adults highlights the need for a randomized clinical trial to determine the best approach for managing appendicitis in older patients.
Topics: Humans; Female; Aged; Adult; Middle Aged; Male; Appendicitis; Treatment Outcome; Retrospective Studies; Appendectomy; Incidence
PubMed: 37017955
DOI: 10.1001/jamasurg.2023.0284 -
Cirugia Pediatrica : Organo Oficial de... Apr 2022Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications...
INTRODUCTION
Acute appendicitis is the most frequent cause of acute abdomen in children. The objective of this study was to analyze the causes, approach, and results of complications requiring surgery following appendectomy.
MATERIAL AND METHODS
A retrospective study of the appendectomies conducted in three third-level institutions from 2015 to 2019 was carried out. Complications, causes, and number of re-interventions, time from one surgery to another, surgical technique used, operative findings at baseline appendectomy according to the American Association for the Surgery of Trauma (AAST) classification, and hospital stay were collected.
RESULTS
3,698 appendicitis cases underwent surgery, 76.7% of which laparoscopically, with 37.2% being advanced (grades II-V of the AAST classification). Mean operating time was 50.4 minutes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery, p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2 vs. 49.1 ± 19.3, p < 0.001). 76 re-interventions (2.05%) were carried out. The causes included postoperative infection (n = 46), intestinal obstruction (n = 20), dehiscence (n = 4), and others (n = 6). Re-intervention risk was not impacted by the baseline approach used (open surgery or laparoscopy, OR: 1.044, 95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% advanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3). There was a tendency to use the same approach both at baseline appendectomy and re-intervention. This occurred in 72.2% of laparoscopic appendectomies, and in 67.7% of open appendectomies. The minimally invasive approach (50/76) was more frequent than the open one (27 laparoscopies and 23 ultrasound-guided drainages vs. 26 open surgeries) (p < 0.05). 55% of obstruction patients underwent re-intervention through open surgery (p > 0.05).
CONCLUSION
Re-intervention rate was higher in advanced appendicitis cases. In this series, the minimally invasive approach (laparoscopic or ultrasound-guided drainage) was the technique of choice for re-interventions.
Topics: Appendectomy; Appendicitis; Child; Humans; Laparoscopy; Length of Stay; Retrospective Studies
PubMed: 35485754
DOI: 10.54847/cp.2022.02.14 -
Journal of Korean Medical Science Jan 2022Advances in medicine and changes in the medical environment can affect the diagnosis and treatment of diseases. The main purpose of the present study was to investigate...
BACKGROUND
Advances in medicine and changes in the medical environment can affect the diagnosis and treatment of diseases. The main purpose of the present study was to investigate whether the difference in accessibility to diagnosis and treatment facilities influenced the occurrence of appendectomy in Korea.
METHODS
We collected data on 183,531 appendectomy patients between 2003 and 2017 using the National Health Insurance Services claims. Retrospective analysis of relationship between the age-standardized rate (ASR) of appendectomy and clinical variables affecting medical accessibility was performed. Pearson's correlation analyses were used.
RESULTS
The incidence of appendectomy decreased from 30,164 cases in 2003 to 7,355 cases in 2017. The rate of computerized tomography (CT) scans for diagnosis of appendicitis increased from 4.73% in 2003 to 86.96% in 2017. The ASR of appendectomy in uncomplicated and complicated appendicitis decreased from 48.71 in 2005 to 13.40 in 2010 and 8.37 in 2005 to 2.96 in 2009, respectively. The ASR of appendectomy was higher in the high-income group. The proportion and ASR of appendectomy in older age group increased steadily with years. The total admission days continued to decrease from 6.02 days in 2003 to 4.96 days in 2017.
CONCLUSION
The incidence of appendectomy was seemingly associated with the rate of CT scan. In particular, the incidence of appendectomy in uncomplicated appendicitis was markedly reduced. Through enhanced accessibility to CT scans, accurate diagnosis and treatment of appendicitis can be facilitated.
Topics: Adolescent; Adult; Aged; Appendectomy; Female; Humans; Incidence; Male; Middle Aged; Registries; Republic of Korea; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35075826
DOI: 10.3346/jkms.2022.37.e27