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European Journal of Pediatric Surgery :... Feb 2024Artificial intelligence (AI) is a growing field in medical research that could potentially help in the challenging diagnosis of acute appendicitis (AA) in children....
INTRODUCTION
Artificial intelligence (AI) is a growing field in medical research that could potentially help in the challenging diagnosis of acute appendicitis (AA) in children. However, usefulness of AI in clinical settings remains unclear. Our aim was to assess the accuracy of AIs in the diagnosis of AA in the pediatric population through a systematic literature review.
METHODS
PubMed, Embase, and Web of Science were searched using the following keywords: "pediatric," "artificial intelligence," "standard practices," and "appendicitis," up to September 2023. The risk of bias was assessed using PROBAST.
RESULTS
A total of 302 articles were identified and nine articles were included in the final review. Two studies had prospective validation, seven were retrospective, and no randomized control trials were found. All studies developed their own algorithms and had an accuracy greater than 90% or area under the curve >0.9. All studies were rated as a "high risk" concerning their overall risk of bias.
CONCLUSION
We analyzed the current status of AI in the diagnosis of appendicitis in children. The application of AI shows promising potential, but the need for more rigor in study design, reporting, and transparency is urgent to facilitate its clinical implementation.
PubMed: 38290564
DOI: 10.1055/a-2257-5122 -
Cureus Jan 2024Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications... (Review)
Review
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
PubMed: 38694948
DOI: 10.7759/cureus.52371 -
Surgical Endoscopy Apr 2024Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conventional three-access laparoscopic appendectomy (CLA) is currently the gold standard treatment, however, Single-Port Laparoscopic Appendectomy (SILA) has been proposed as an alternative. The aim of this systematic review/meta-analysis was to evaluate safety and efficacy of SILA compared with conventional approach.
METHODS
Per PRISMA guidelines, we systematically reviewed randomised controlled trials (RCTs) comparing CLA vs SILA for acute appendicitis. The randomised Mantel-Haenszel method was used for the meta-analysis. Statistical data analysis was performed with the Review Manager software and the risk of bias was assessed with the Cochrane "Risk of Bias" assessment tool.
RESULTS
Twenty-one studies (RCTs) were selected (2646 patients). The operative time was significantly longer in the SILA group (MD = 7,32), confirmed in both paediatric (MD = 9,80), (Q = 1,47) and adult subgroups (MD = 5,92), (Q = 55,85). Overall postoperative morbidity was higher in patients who underwent SILA, but the result was not statistically significant. In SILA group were assessed shorter hospital stays, fewer wound infections and higher conversion rate, but the results were not statistically significant. Meta-analysis was not performed about cosmetics of skin scars and postoperative pain because different scales were used in each study.
CONCLUSIONS
This analysis show that SILA, although associated with fewer postoperative wound infection, has a significantly longer operative time. Furthermore, the risk of postoperative general complications is still present. Further studies will be required to analyse outcomes related to postoperative pain and the cosmetics of the surgical scar.
Topics: Adult; Humans; Child; Appendectomy; Treatment Outcome; Laparoscopy; Randomized Controlled Trials as Topic; Pain, Postoperative; Appendicitis; Length of Stay; Cicatrix
PubMed: 38332174
DOI: 10.1007/s00464-023-10659-w -
Cureus Jan 2024The opioid epidemic has become a critical public health issue, driven by the widespread distribution and misuse of prescription opioids. This paper investigates... (Review)
Review
The opioid epidemic has become a critical public health issue, driven by the widespread distribution and misuse of prescription opioids. This paper investigates analgesic management in the context of laparoscopic appendectomy (LA) as an alternative to open appendectomy, aiming to reduce the reliance on opioids for postoperative pain control. A comprehensive literature review was conducted from January 1, 2003, to November 1, 2023, utilizing PubMed, ProQuest, and ScienceDirect databases. The search focused on peer-reviewed experimental and observational studies involving adults (18 years and older) undergoing LA. The original search resulted in 18,258 publications, which were then screened using PRISMA guidelines. Among the filtered 18 studies included for analysis and review, the transition from open to LA demonstrated a consistent decrease in postoperative pain, leading to a reduced need for opioid prescriptions. Analgesic strategies included the use of local anesthetics (lidocaine, bupivacaine, ropivacaine), spinal/epidural anesthesia, nerve blocks, and a multimodal approach with NSAIDs and acetaminophen. Studies demonstrated the efficacy of local anesthetics in reducing postoperative pain, prompting a shift toward non-opioid analgesics. The use of spinal/epidural anesthesia and nerve blocks further supported the trend of minimizing opioid prescriptions. While some variations in anesthetic approaches existed, overall, patients undergoing LA required fewer opioid doses, reflecting a positive shift in postoperative pain management. Patients undergoing LA experienced lower rates of readmission, reduced post-operative pain, better cosmetic outcomes, and shorter recovery times, contributing to a diminished demand for opioid medications. This review underscores the potential for non-opioid analgesic strategies in surgical contexts, aligning with the broader imperative to address the opioid epidemic and promote safer and more sustainable pain management practices.
PubMed: 38344561
DOI: 10.7759/cureus.52037 -
F1000Research 2023Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an... (Meta-Analysis)
Meta-Analysis Comparative Study
Acute appendicitis is the most common surgical emergency in pregnant women. There has been a wide variance in clinical practice worldwide, with some favoring an antibiotic-only approach while others prefer surgery as the first-line management. Therefore, we designed the current analysis to synthesize the available evidence on the efficacy and safety of antibiotics versus surgery management. We searched PubMed, Scopus, EuropePMC, and Cochrane Central from March 4, 1904 until November 25, 2022, to look for studies comparing antibiotics and surgery in pregnant patients with acute appendicitis. We only included studies that provided a comparison between the two treatments. We included preterm delivery, fetal loss, maternal death, and complications as outcomes. The results were compared using an odds ratio and 95% confidence interval. We also performed a sensitivity analysis by excluding studies with a serious risk of bias. We included five non-randomized studies for the analysis. We found that patients in the antibiotic group had a lower risk of preterm labor (OR 0.63 [95% CI 0.43-0.92]; p 0.02) but a higher risk of complications (OR 1.79 [95% CI 1.19-2.69]; p 0.005). We did not find any difference in the other outcomes. The increased risk of complications should caution clinicians about using antibiotics as the first-line management. More studies are required to identify patients who would benefit the most before antibiotics could be adopted as a treatment for acute appendicitis in pregnant patients.
Topics: Humans; Appendicitis; Pregnancy; Female; Anti-Bacterial Agents; Pregnancy Complications; Appendectomy; Acute Disease
PubMed: 38919838
DOI: 10.12688/f1000research.129906.2 -
Journal of Gastrointestinal Cancer Mar 2024Acute appendicitis resulting from inflammation of the mucosa is the most common cause of emergency surgical causes. However, acute appendicitis caused by metastasis from...
BACKGROUND
Acute appendicitis resulting from inflammation of the mucosa is the most common cause of emergency surgical causes. However, acute appendicitis caused by metastasis from other organs is very rare. Patients having this entity were only described in the literature as case reports. This study aims to analyze data from published articles about this condition.
METHODS
We performed a systematic review using the PRISMA protocol. PubMed/MEDLINE, Embase and the Google Scholar Library were searched up to the end of December 2022.
RESULTS
A total of 34 patients were included, of which 22 were male. The mean age was 58.94. Primary site of tumors were mainly lungs (32.35%), breast (20.59%), and stomach (17.65%). All patients underwent surgical treatment except one patient who was given medical treatment. In 10 patients (29.41%), acute appendicitis was the initial manifestation to diagnose the primary malignancy and in 21 patients (61.77%), there were other sites of secondary lesions. Post operative mortality was reported in 1 patient (2.93%).
CONCLUSION
Acute appendicitis secondary to metastatic disease is uncommon but rarely will be the presenting sign of new cancer diagnosis. Most of the patients have other sites of secondary lesions. Surgical treatment is commonly performed to treat appendicitis.
Topics: Female; Humans; Male; Middle Aged; Acute Disease; Appendicitis; Breast Neoplasms; Lung Neoplasms; Neoplasm Metastasis; Stomach Neoplasms
PubMed: 37976003
DOI: 10.1007/s12029-023-00986-5 -
Minerva Surgery Aug 2023The significance of laparoscopy after appendectomy is still unclear, despite the fact that it is thought to be an appropriate technique for the detection and management...
INTRODUCTION
The significance of laparoscopy after appendectomy is still unclear, despite the fact that it is thought to be an appropriate technique for the detection and management of postoperative complications. We aimed to determine the incidence, risk factors, diagnosis, and laparoscopic approach for the treatment of acute complications after appendectomy performing a systematic review of the literature.
EVIDENCE ACQUISITION
We performed systematic review of the PubMed/MEDLINE, Embase and GoogleScholar bibliographic databases between 1995 and 2022 regarding laparoscopic resolution of early postoperative complications after appendectomy. Demographics, peri-operative variables, and postoperative outcomes were analyzed.
EVIDENCE SYNTHESIS
A total of 9 studies comprising 116 cases of laparoscopic resolution of early complications after appendectomy were included. The primary surgery showed a 60% of perforated or gangrenous appendicitis. Time elapse between the appendectomy and the diagnosis of the postoperative complication was from 2 to 15 days (median 5.8 days). The procedures performed at laparoscopy were as follows: laparoscopic washout and drainage of generalized peritonitis and intra-abdominal abscesses (95.6%), laparoscopic lysis of adhesions due to small bowel obstruction (1.7%), running suturing for unnoticed small bowel lesion (1.7%) and one patient required a right colectomy due to stump leakage (0.8%). Conversion to an open approach was necessary in 9 patients (7.8%). Postoperative complications after early re-laparoscopy washout were reported in 4 publications (15.5%). Finally, 15 (12.9%) patients required an additional intervention. The mean LOS was of 5 days.
CONCLUSIONS
Infectious complications are not uncommon after appendectomy, but their incidence increases significantly in complicated appendicitis, with IAA being the most feared complication. When re-exploration is mandatory, the laparoscopic approach is a safe and highly effective tool for the diagnosis and treatment of these complications, adding the benefits of minimally invasive surgery.
Topics: Humans; Appendectomy; Appendicitis; Retrospective Studies; Postoperative Complications; Laparoscopy
PubMed: 36789906
DOI: 10.23736/S2724-5691.22.09835-5 -
In Vivo (Athens, Greece) 2024Primary omental torsion is uncommon, mimicking appendicitis and other acute abdominal pathologies. It often escapes diagnosis on imaging investigation or conventional...
BACKGROUND/AIM
Primary omental torsion is uncommon, mimicking appendicitis and other acute abdominal pathologies. It often escapes diagnosis on imaging investigation or conventional open laparotomy. This study aimed to evaluate the effect of laparoscopy on the various parameters of this entity, including incidence, diagnosis, and treatment.
MATERIALS AND METHODS
A systematic review was performed, including PubMed and Scopus databases, without a time limit, following the PRISMA principles. A total of 16 articles from January 2000 to December 2023, corresponding to 56 children with primary omental torsion, complied with the research criteria.
RESULTS
Primary omental torsion was associated with obesity. Symptoms were right abdomen oriented, often compared to those of acute appendicitis. Preoperative ultrasound displayed low diagnostic accuracy, whereas computerized tomography diagnosed only two thirds of cases. In all patients, the vermiform appendix was normal.
CONCLUSION
Laparoscopy affected both diagnosis and treatment of primary omental torsion in children. Easy peritoneal cavity access rendered possible the diagnosis of cases previously discharged as abdominal pain of unknown etiology. Combined with the increased pediatric obesity, it also affected primary omental torsion incidence. The recent pathogenetic theories may be better supported today, as laparoscopy provides a detailed view in situ, and facilitates harvesting of fat tissue from the omentum for molecular investigation. The diagnostic efficiency of laparoscopy is superior to ultrasonography and computerized tomography. Finally, the removal of the ischemic omentum is technically easier compared to the open laparotomy alternative with all the technical difficulties of traction of a vulnerable hemorrhagic tissue through a small incision.
Topics: Child; Female; Humans; Appendicitis; Laparoscopy; Omentum; Peritoneal Diseases; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Male
PubMed: 38688642
DOI: 10.21873/invivo.13536 -
BMC Surgery Jan 2024Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Abdominal surgical emergencies remain prevalent in various healthcare settings, particularly in regions with limited access to basic surgical care, such as Africa. The aim of this literature review is to systematically assess publications on abdominal surgical emergencies in adults in sub-Saharan Africa to estimate their prevalence and mortality rate.
METHODOLOGY
A systematic review was conducted. The latest search was performed on October 31, 2022. We estimated the pooled prevalence with a 95% confidence interval (CI) for each abdominal surgical emergency, as well as overall postoperative mortality and morbidity rates.
RESULTS
A total of 78 studies were included, and 55.1% were single-center retrospective and monocentric studies. The mean age of the patients was 32.5 years, with a sex ratio of 1.94. The prevalence of each abdominal surgical emergency among all of them was as follows: appendicitis: 30.0% (95% CI: 26.1-33.9); bowel obstruction: 28.6% (95% CI: 25.3-31.8); peritonitis: 26.6% (95% CI: 22.2-30.9); strangulated hernias: 13,4% (95% CI: 10,3-16,5) and abdominal trauma: 9.4% (95% CI: 7.5-11.3). The prevalence of complications was as follows: mortality rate: 7.4% (95% CI: 6.0-8.8); overall postoperative morbidity: 24.2% (95% CI: 19.4-29.0); and surgical site infection 14.4% (95% CI: 10.86-18.06).
CONCLUSION
Our study revealed a high prevalence of postoperative complications associated with abdominal surgical emergencies in sub-Saharan Africa. More research and efforts should be made to improve access and quality of patient care.
Topics: Adult; Humans; Africa South of the Sahara; Emergencies; Prevalence; Retrospective Studies; Surgical Wound Infection
PubMed: 38267892
DOI: 10.1186/s12893-024-02319-0 -
ANZ Journal of Surgery May 2024The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the...
INTRODUCTION
The accessory appendicular artery (AAA) is an accessory source of blood supply to the appendix. Its existence and potential point of origin are seldom addressed in the literature.
METHODS
To fill this knowledge gap, we performed a systematic review of all available studies involving both cadaveric and surgical specimens and documented the presence and the origin of the AAA, following the guidelines outlined in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.
RESULTS
Eleven studies, with an overall of 604 specimens were included. Our research revealed that the AAA is notably absent in most cases (83.6%). When present, it most commonly originates from the posterior cecal artery (12.4%), followed by the descending branch of the ileocolic artery (2%), and the ileal branch of the ileocolic artery (0.7%). Instances of origin from the anterior cecal, common cecal, or the ileocolic trunk were even more infrequent. Based on our observations, we introduced a new simplified classification system.
DISCUSSION
The effect of an accessory artery on the process of appendicitis remains to be clarified. We firmly recommend that surgeons should consider the possible presence and various origins of the AAA during appendectomy procedures to avoid serious complications.
Topics: Humans; Appendix; Cadaver; Appendectomy; Anatomic Variation; Arteries; Appendicitis
PubMed: 38251790
DOI: 10.1111/ans.18874