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World Journal of Surgery May 2022Non-operative management (NOM) of uncomplicated acute appendicitis (AA) has been introduced as an alternative to appendectomy. This umbrella review aimed to provide an... (Review)
Review
BACKGROUND
Non-operative management (NOM) of uncomplicated acute appendicitis (AA) has been introduced as an alternative to appendectomy. This umbrella review aimed to provide an overview of the efficacy and safety of NOM of uncomplicated AA in the published systematic reviews.
METHODS
This umbrella review has been reported in line with the PRISMA guidelines and umbrella review approach. Systematic reviews with and without meta-analyses on the efficacy of NOM of AA were analyzed. The quality of the reviews was assessed with the AMSTAR 2 tool. The main outcomes measures were the treatment failure and complication rates of NOM and hospital stay as compared to appendectomy.
RESULTS
Eighteen systematic reviews were included to this umbrella review. Eight reviews documented higher odds of failure with NOM, whereas two reviews revealed similar odds of failure. Six reviews reported lower odds of complications with NOM, six reported similar odds, and one reported lower odds of complications with surgery. Eight reviews reported similar hospital stay between NOM and appendectomy, one reported longer stay with NOM and another reported shorter stay with NOM. Pooled analyses showed that NOM was associated with higher treatment failure overall, in children-only, adults only, and RCTs-only meta-analyses. NOM was associated with lower complications overall, yet children-only and RCTs-only analyses revealed similar complications to surgery. NOM was associated with shorter stay in the overall and adult-only analysis, but not in the children-only analysis.
CONCLUSIONS
NOM of AA is associated with higher treatment failure, marginally lower rate of complications and shorter stay than appendectomy.
Topics: Acute Disease; Adult; Anti-Bacterial Agents; Appendectomy; Appendicitis; Child; Humans; Length of Stay; Treatment Failure; Treatment Outcome
PubMed: 35024922
DOI: 10.1007/s00268-022-06446-8 -
African Journal of Paediatric Surgery :... 2020In our institution, we avoid emergency nighttime appendectomies, instead performing the surgery during daylight hours the following day. We examined whether emergency or...
BACKGROUND
In our institution, we avoid emergency nighttime appendectomies, instead performing the surgery during daylight hours the following day. We examined whether emergency or early appendectomies affect the outcome of patient morbidity.
MATERIALS AND METHODS
Medical records of children treated for appendicitis between 2010 and 2012 were retrospectively reviewed. Outcomes were compared between Group 1, defined as those patients who presented to the hospital during the day and underwent appendectomy on the same day and Group 2, defined as those patients who presented to the hospital at night and underwent appendectomy the next day. Incidences of perforation at surgery, operative time, complications and length of stay were analysed. Cases with perforation were also analysed to determine if the perforations could have been identified preoperatively.
RESULTS
A total of 74 patients met the study criteria, including 41 and 33 in Groups 1 and 2, respectively. There were no significant differences in the incidence of perforation at surgery, operative time, complications and length of stay. A total of nine cases of perforation were identified during surgery, and there were no significant differences in the pre-operative characteristics between perforated and non-perforated cases.
CONCLUSIONS
The results of this study indicate that early appendectomy is safe and did not increase patient morbidity. We, therefore, recommend performing appendectomies in the daytime.
Topics: Appendectomy; Appendicitis; Child; Emergencies; Emergency Service, Hospital; Female; Humans; Japan; Length of Stay; Male; Morbidity; Operative Time; Retrospective Studies; Time Factors
PubMed: 33106449
DOI: 10.4103/ajps.AJPS_122_16 -
Medicinski Glasnik : Official... Aug 2020In contrast to classical appendectomy where the appendiceal stump is secured by a single or double ligature, in laparoscopic appendectomy various ways of securing the... (Review)
Review
In contrast to classical appendectomy where the appendiceal stump is secured by a single or double ligature, in laparoscopic appendectomy various ways of securing the stump are mentioned. Each of these methods has advantages and disadvantages. Since different possibilities exist for closing the stump, it is very important to find the optimum method for closure of the appendiceal stump, bearing in mind their simplicity, biocompatibility and price. The aim of this review article has been to present the problem of securing the base of the appendix during laparoscopic appendectomy.
Topics: Appendectomy; Appendix; Humans; Laparoscopy; Postoperative Complications
PubMed: 32253902
DOI: 10.17392/1131-20 -
Prilozi (Makedonska Akademija Na... Jul 2022: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. : In...
: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. : In this prospective interventional clinical study we compared the intraoperative data and the postoperative outcome of 77 patients presented with complicated appendicitis, operated with open and laparoscopic appendectomy within a period of 20 months. One surgeon performed all of the laparoscopic procedures and two other senior surgeons performed the open procedures. : Operative time was shorter in the laparoscopic group (p = 0.033). Conversion rate was 2.3%. Overall postoperative morbidity was 25.97%. There was one operative revision due to postoperative small bowel obstruction in the laparoscopic group. Appendicular stump leakage occurred in one patient in the open group. One intra-abdominal abscess occurred in the laparoscopic group (p = 0.38). Wound infection occurred only in the open group (p = 0.018). Length of stay was shorter in the laparoscopic group (p = 0.0052). One patient from the laparoscopic group was readmitted. : Laparoscopy is a reliable method in the treatment of complicated appendicitis. It offers a shorter operative time, low conversion rate, an acceptable rate of major postoperative complications and a shorter length of stay.
Topics: Appendectomy; Appendicitis; Humans; Laparoscopy; Length of Stay; Postoperative Complications; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 35843917
DOI: 10.2478/prilozi-2022-0019 -
Canadian Journal of Surgery. Journal... 2023Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This... (Review)
Review
BACKGROUND
Internationally, Indigenous Peoples experience worse surgical outcomes than non-Indigenous patients, but equity of surgical care is less well studied in Canada. This study compares outcomes after appendectomy in First Nations and non-First Nations patients.
METHODS
In this population-based study, we reviewed administrative data of patients who underwent appendectomy between Apr. 1, 2004, and Mar. 31, 2017, in Northern Alberta. Demographic variables and characteristics of surgical care for First Nations and non-First Nations patients were collected. We identified adverse outcomes by the presence of predefined administrative codes. We identified variables related to a complex postoperative course (at least 1 of wound dehiscence, surgical site infection, abscess, bowel obstruction, pneumonia, deep vein thrombosis, sepsis, emergency department visit, readmission or death within 30 d after appendectomy) through a logistic regression model, and those related to longer length of stay using a Cox proportional hazards model.
RESULTS
A total of 28 453 patients met the selection criteria, of whom 1737 (6.1%) had First Nations status. Compared to non-First Nations patients, First Nations patients were younger, lived farther away from the hospital of their appendectomy, were in lower socioeconomic quintiles, and had higher rates of obesity and diabetes (all < 0.001). After adjustment for age, sex, distance to hospital, socioeconomic deprivation and comorbidities, First Nations status remained independently associated with higher rates of adverse outcomes (odds ratio 1.548, 95% confidence interval [CI] 1.384-1.733) and longer lengths of stay (hazard ratio 0.877, 95% CI 0.832-0.924).
CONCLUSION
Although rurality, comorbidities and socioeconomic status contributed to worse outcomes after appendectomy for First Nations patients, First Nations status remained independently associated with worse surgical outcomes. Surgical care, an integral component of health care delivery, must be improved for First Nations patients in order to achieve equitable health care.
Topics: Humans; Length of Stay; Alberta; Appendectomy; Surgical Wound Infection; Hospitals; Retrospective Studies; Appendicitis
PubMed: 37967970
DOI: 10.1503/cjs.011222 -
Scandinavian Journal of Surgery : SJS :... Dec 2023Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics...
BACKGROUND AND AIMS
Appendectomy has historically been the standard treatment of acute appendicitis, but lately, conservative treatment of uncomplicated acute appendicitis with antibiotics has successfully been used in selected patients. Complicated acute appendicitis is often treated conservatively initially, but may benefit from interval appendectomy due to the higher risk of appendiceal malignancy and recurrence. Recommendations for follow-up after conservatively treated appendicitis vary. Furthermore, the risk of underlying malignancy and the necessity of routine interval appendectomy are unclear. This study aims to evaluate follow-up status, recurrence, and underlying appendiceal malignancy in conservatively treated uncomplicated and complicated acute appendicitis.
METHODS
This study included patients with conservatively treated acute appendicitis at Skåne University Hospital, Sweden during 2012-2019. Information on patient demographics at index admission and data on follow-up, recurrence, number of appendectomies after initial conservative treatment, and underlying malignancy were retrieved from medical charts.
RESULTS
The study cohort included 391 patients, 152 with uncomplicated and 239 with complicated acute appendicitis. Median time of study follow-up was 52 months. The recurrence risk was 23 (15.1%) after uncomplicated and 58 (24.3%) after complicated acute appendicitis ( = 0.030). During follow-up, 55 (23%) patients with complicated acute appendicitis underwent appendectomy. Appendiceal malignancies were found in 12 (5%) patients with previous complicated acute appendicitis versus no appendiceal malignancies after uncomplicated acute appendicitis ( = 0.002).
CONCLUSION
The risk of appendiceal malignancy and recurrent appendicitis was significantly higher in patients with complicated acute appendicitis compared with uncomplicated acute appendicitis.
Topics: Humans; Appendicitis; Appendiceal Neoplasms; Anti-Bacterial Agents; Appendectomy; Hospitalization; Acute Disease
PubMed: 37705259
DOI: 10.1177/14574969231190293 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2020This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy...
BACKGROUND
This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis.
METHODS
Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features.
RESULTS
No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality.
CONCLUSION
Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.
Topics: Adult; Appendectomy; Appendicitis; Female; Humans; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Ultrasonography
PubMed: 32589240
DOI: 10.14744/tjtes.2020.12544 -
Surgical Endoscopy Jan 2020Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this... (Observational Study)
Observational Study
BACKGROUND
Few large-scale epidemiologic studies evaluate the clinical and economic burden of appendicitis. These data may impact future research and treatment strategies. In this study, the objective was to determine the burden of appendectomy for appendicitis in terms of incidence rates, length of hospital stay (LOS) and hospital costs on a national level. In addition, outcomes were compared for subgroups based on surgical treatment, age and hospital setting.
METHODS
Observational retrospective population-based cohort study using the national Dutch healthcare reimbursement registry, which covers hospital registration and reimbursement for 17 million inhabitants. Patients with a diagnosis of appendicitis who underwent appendectomy between 2006 and 2016 were included. Primary outcomes were incidence rates, LOS and hospital costs.
RESULTS
A total of 135,025 patients were included. Some 53% of patients was male, and 64% was treated in a general hospital. The overall incidence rate of appendectomy was 81 per 100,000 inhabitants and showed a significant decreasing trend across time and age. Mean ± SD LOS per patient was 3.66 ± 3.5 days. LOS showed a significant increase with age and was significantly longer for open versus minimally invasive appendectomy. Mean ± SD hospital costs per patient were €3700 ± 1284. Costs were initially lower for open compared to minimally invasive appendectomy, but were similar from 2012 onward. Compared to non-university hospitals, patients treated in university hospitals had a significantly longer LOS and higher costs.
CONCLUSIONS
Appendectomy for appendicitis represents a substantial clinical and economic burden in the Netherlands. A preference for minimally invasive technique seems justified.
Topics: Adult; Appendectomy; Appendicitis; Cohort Studies; Cost of Illness; Female; Hospital Costs; Humans; Length of Stay; Male; Middle Aged; Netherlands; Retrospective Studies
PubMed: 30919056
DOI: 10.1007/s00464-019-06738-6 -
JSLS : Journal of the Society of... 2019The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility.
BACKGROUND AND OBJECTIVES
The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility.
METHODS
We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation.
RESULTS
In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions ( < .001) and patients with adhesions tended to have compromised tubal patency ( = .05). However, there was no direct correlation between a previous appendectomy and tube pathology ( = .727).
CONCLUSION
Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.
Topics: Adult; Appendectomy; Cohort Studies; Fallopian Tube Diseases; Female; Humans; Infertility, Female; Laparoscopy; Retrospective Studies; Tissue Adhesions
PubMed: 30846898
DOI: 10.4293/JSLS.2018.00099 -
Mini-incision open appendectomy versus laparoscopic appendectomy: An experience in a rural hospital.Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2021There is still no consensus about whether laparoscopic appendectomy should be performed in selected cases or routinely in all cases for treatment of acute appendicitis....
BACKGROUND
There is still no consensus about whether laparoscopic appendectomy should be performed in selected cases or routinely in all cases for treatment of acute appendicitis. Especially for rural hospitals with laparoscopic equipment shortages, it is critical to develop surgical methods alternative to LA. This prospective study aimed to compare mini-incision open appendectomy (MOA) and laparoscopic appendectomy (LA) procedures.
METHODS
A total of 102 patients who had been operated on by a single surgeon for acute appendicitis between July 2018 and February 2020 and whose body mass index (BMI) was <30 were included in this study. Fifty-one patients were operated on with MOA and 51 with LA technique. The patients were evaluated concerning operation time, postoperative pain, hospital stay, postoperative infectious complications and cost-effectiveness.
RESULTS
Operation time was shorter in the MOA group than LA group (p<0.001). VAS scores at postoperative 12th and 24th hours were significantly lower in the MOA group than those in the LA group (p<0.001). Total hospitalization costs were lower in the MOA group than those in the LA group (p<0.001). No significant difference was found between the two groups concerning length of hospital stay and postoperative infectious complications (p=0.061 and p>0.999, respectively).
CONCLUSION
Mini-incision open appendectomy is a reliable method in patients with acute appendicitis who have a BMI of <30 and it is superior to laparoscopic appendectomy concerning the operation time, postoperative pain and cost.
Topics: Appendectomy; Appendicitis; Hospitals, Rural; Humans; Laparoscopy; Length of Stay; Minimally Invasive Surgical Procedures; Operative Time; Postoperative Complications; Treatment Outcome
PubMed: 33884604
DOI: 10.14744/tjtes.2020.83023