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Chirurgia (Bucharest, Romania : 1990) 2001The appendectomy is still the most frequent operation in general surgery, being after performed without complete investigation. Because the appendix, through its... (Review)
Review
The appendectomy is still the most frequent operation in general surgery, being after performed without complete investigation. Because the appendix, through its lymphoid tissue with implication in the immunoglobuline secretion, has an important role in immunitary system criteria were searched to justify the appendectomy and to reduce the number of useless appendectomies, the proportion of the normal appendices being around 15%. Instead the basic triad-fever over 38 degrees C, parietal reaction and leucocitosis over 10.000/ml--measuring of reactive protein C, echography, CT, laparoscopy and antileucocite antibody labelled with TC99, would contribute to a better selection of patients for appendectomy. Surgeon's responsibility regarding the technique and the moment of operation, oblige him to take the proper decision.
Topics: Appendectomy; Appendicitis; Appendix; Diagnosis, Differential; Humans; Practice Guidelines as Topic; Unnecessary Procedures
PubMed: 12731177
DOI: No ID Found -
Journal of Paediatrics and Child Health Nov 2017Acute appendicitis is the most common reason for abdominal surgery in children. Luminal obstruction of the appendix progresses to suppurative inflammation and... (Review)
Review
Acute appendicitis is the most common reason for abdominal surgery in children. Luminal obstruction of the appendix progresses to suppurative inflammation and perforation, which causes generalised peritonitis or an appendix mass/abscess. Classical features include periumbilical pain that migrates to the right iliac fossa, anorexia, fever, and tenderness and guarding in the right iliac fossa. Atypical presentations are particularly common in preschool children. A clinical diagnosis is possible in most cases, after a period of active observation if necessary; inflammatory markers and an ultrasound scan are useful investigations when the diagnosis is uncertain. Treatment is by appendicectomy after appropriate fluid resuscitation, analgesia and intravenous antibiotics. Laparoscopic appendicectomy is better than open appendicectomy in most cases because it is associated with less postoperative pain and a shorter hospital stay, but recovery after acute appendicitis is mostly dictated by whether the appendix was perforated or not. Management of the appendix mass remains controversial and not all affected children need an interval appendicectomy. This article discusses tips and pitfalls in diagnosis and addresses many of the controversies that surround the management of this condition.
Topics: Abdominal Pain; Acute Disease; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Appendix; Child; Diagnosis, Differential; Female; Humans; Laparoscopy; Male
PubMed: 29044790
DOI: 10.1111/jpc.13737 -
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 -
Updates in Surgery Jun 2019More than 10,000 appendectomies are performed every year in Switzerland. The aim of this study was to investigate the treatment strategy for appendicitis among Swiss...
More than 10,000 appendectomies are performed every year in Switzerland. The aim of this study was to investigate the treatment strategy for appendicitis among Swiss surgeons with particular interest in laparoscopic technique, method of appendiceal stump closure, and abdominal lavage. We performed an anonymous survey among 540 members of the Swiss Surgical Society. Technical details and differences between the surgical procedures in adults and children as well as in complicated and non-complicated appendicitis were investigated. The overall response rate was 45% (n = 243). 78% of the surgeons perform laparoscopic appendectomies in children and 95% in adult patients. Only 3% use a single incision site technique. Surgeons consider pus or stool in the abdomen (94%), an abscess (86%) or perforation of the appendix (82%), but not an inflamed appendiceal base (16%) as complicated appendicitis. 41% of surgeons use endoloops, 36% a stapling device, and 20% polymeric clips in non-complicated appendicitis for appendiceal stump closure. However, 82% of the surgeons use a stapler in complicated appendicitis. Most (76%) of surgeons do not plunge the appendiceal stump. 24% of surgeons lavage the abdomen with > 1 L of fluid independent of the intraabdominal finding. Most Swiss surgeons perform multiport laparoscopic appendectomies. Endoloops and staplers are mostly used for appendiceal stump closures in uncomplicated appendicitis, and staplers in complicated appendicitis. Only a minor part of surgeons plunge the appendiceal stump or perform routine abdominal lavage.
Topics: Adult; Appendectomy; Appendicitis; Appendix; Child; Humans; Laparoscopy; Procedures and Techniques Utilization; Surgical Staplers; Surveys and Questionnaires; Switzerland
PubMed: 30982171
DOI: 10.1007/s13304-019-00654-z -
Surgical Infections Apr 2018Acute appendicitis is a common surgical emergency worldwide. Early intervention is associated with better outcomes. In low and middle Human Development-Index Countries... (Review)
Review
BACKGROUND
Acute appendicitis is a common surgical emergency worldwide. Early intervention is associated with better outcomes. In low and middle Human Development-Index Countries (LMHDICs), late presentation and poor access to healthcare facilities can contribute to greater illness severity and higher complication rates, such as post-operative surgical site infections (SSIs). The current rate of SSIs post-appendectomy in low- and middle-index settings has yet to be described.
METHODS
We performed a systemic review of the literature describing the incidence and management of SSIs after appendectomy in LMHDICs. We conducted qualitative and quantitative analysis of the data in manuscripts describing patients undergoing appendectomy to establish a baseline SSI rate for this procedure in these settings.
RESULTS
Four hundred twenty-three abstracts were initially identified. Of these, 35 studies met the criteria for qualitative and quantitative analysis. The overall weighted, pooled SSI rated were 17.9 infections/100 open appendectomies (95% confidence interval [CI] 10.4-25.3 infections/100 open appendectomies) and 8.8 infections/100 laparoscopic appendectomies (95% CI 4.5-13.2 infections/100 laparoscopic appendectomies). The SSI rates were higher in complicated appendicitis and when pre-operative antibiotic use was not specified.
CONCLUSIONS
Observed SSI rates after appendectomy in LMHDICs are dramatically higher than rates in high Human Development-Index Countries. This is particularly true in cases of open appendectomy, which remains the most common surgical approach in LMHDICs. These findings highlight the need for SSI prevention in LMHDICs, including prompt access to medical and surgical care, routine pre-operative antibiotic use, and implementation of bundled care packages and checklists.
Topics: Appendectomy; Developed Countries; Female; Humans; Laparoscopy; Male; Surgical Wound Infection
PubMed: 29058569
DOI: 10.1089/sur.2017.188 -
Surgical Endoscopy May 2002Laparoscopic appendectomy is a feasible and a safe alternative to open appendectomy. Several laparoscopic procedures have been described that use one or more trocars. We...
BACKGROUND
Laparoscopic appendectomy is a feasible and a safe alternative to open appendectomy. Several laparoscopic procedures have been described that use one or more trocars. We report our experience with the treatment of acute appendicitis using a laparoscopy-assisted technique by means of only one transumbilical trocar.
METHODS
From February 1996 to February 1999 we performed 65 laparoscopic appendectomies. In the procedures, a 10-mm operative telescope was used, with a 450-mm atraumatic grasper introduced through the operative channel. After the intraabdominal laparoscopic dissection, the appendix was exteriorized through the umbilical trocar. The appendectomy was performed outside the abdomen as in the open procedure. The procedure was completed using only one trocar in 55 patients (84.6%). Regarding the other 10 cases (15.3%), in 5 we used more than one trocar and in 5 conversion to open surgery was needed.
RESULTS
The average operating time in our series was 25 min and the median time to discharge was 2 days. There were six (11%) postoperative complications (three serous umbilical secretion and three umbilical hematomas).
CONCLUSIONS
Our results suggest that this technique, which combines the advantages of both the open and the laparoscopic procedures, is a valid alternative for the treatment of acute appendicitis. However, this procedure cannot always be completed using only one trocar, as happened in 10 cases in our series.
Topics: Adolescent; Adult; Appendectomy; Female; Humans; Laparoscopy; Male
PubMed: 11997832
DOI: 10.1007/s00464-001-9107-5 -
Infectious Diseases in Obstetrics and... 1998A retrospective review of appendectomies performed at the University of Kansas Medical Center between January 1, 1989, and January 1, 1994, was conducted. In addition,... (Review)
Review
OBJECTIVE
A retrospective review of appendectomies performed at the University of Kansas Medical Center between January 1, 1989, and January 1, 1994, was conducted. In addition, the literature evaluating effectiveness of incidental appendectomy in preventing future operation and morbidity from appendicitis was reviewed. The results of the two reviews were analyzed to formulate guidelines for the appropriateness of performing incidental appendectomy in association with other operative procedures.
METHOD
A retrospective review of results of appendectomies performed in 460 patients at the University of Kansas Medical Center with analysis of operative findings, pathology of the removed appendix and operative complications was performed. These results were compared with those of a systematic review of the literature utilizing a Medline search relating to the subject of incidental appendix removal.
RESULTS
Two hundred sixty-one incidental appendectomies were performed in this study of 460 patients (60%). The procedure was most commonly performed with total abdominal hysterectomy (56%), followed by oophorectomy (15%) and exploratory laparotomy (11%). Morbidity was minimal at all ages. Microscopic pathology was found in 25% of the cases.
CONCLUSION
The data from the current survey and literature review support incidental removal of the appendix in the young patient (< 35 years old). In patients 35-50 years old the literature is controversial, and the patient's clinical condition and judgment of the operating surgeon should determine whether incidental appendectomy should be performed. However, routine incidental appendectomy cannot be justified in patients greater than age 50.
Topics: Adult; Appendectomy; Appendicitis; Humans; Length of Stay; Middle Aged; Retrospective Studies
PubMed: 9678145
DOI: 10.1002/(SICI)1098-0997(1998)6:1<30::AID-IDOG7>3.0.CO;2-B -
Journal of Gynecologic Surgery 1991Since early 1987, 62 laparoscopic appendectomies have been performed without any major operative or postoperative complications. Just over half of these patients...
Since early 1987, 62 laparoscopic appendectomies have been performed without any major operative or postoperative complications. Just over half of these patients required hospitalization overnight for observation. The rest went home with activity and dietary restriction for 48 to 72 hours. Indications for the appendectomies included abdominal or pelvic pain or both, with the appendix demonstrating endometriosis, adhesions causing entrapment, or histories compatible with chronic appendicitis. Opportunities for second-look laparoscopies after laparoscopic appendectomy have been accomplished with two patients showing an encouraging lack of adhesion formation in both.
Topics: Appendectomy; Appendicitis; Female; Humans; Laparoscopy; Male; Treatment Outcome
PubMed: 10150024
DOI: 10.1089/gyn.1991.7.93 -
Il Giornale Di Chirurgia Oct 2001In the era of video-laparoscopic surgery there are a lot of surgeons that still continue to perform open appendectomy. This choice is the consequence of the good results... (Comparative Study)
Comparative Study Review
UNLABELLED
In the era of video-laparoscopic surgery there are a lot of surgeons that still continue to perform open appendectomy. This choice is the consequence of the good results of open appendectomy (clinical, cosmetic, hospital stays and hospital costs). Published trials on laparoscopic appendectomy don't show that it is superior to the open approach. The aim of this study is to critically review the literature on laparoscopic and traditional appendectomies and to report a clinical experience on 86 consecutive patients that underwent open appendectomy.
PATIENTS AND METHODS
From September 2000 to March 2001, in the Department of Emergency Surgery of Villa Scassi Hospital in Genoa, 86 patients underwent open appendectomy (32 men; mean age 29.8 years; range 15-54 years/54 women; mean age 22.4 years; range 13-80 years). All the patients underwent blood examinations, abdomino-pelvic ultrasonographys and the women gynecological evaluation. The Authors used, almost always, the Stropeni way of access (cutaneous Mac Burney and right para-rectal incision of the muscles). Discharge has been done as soon as possible. Removed appendices were submitted to histological examination and were classified as normal or pathologic according to the severity of the lesion. Review of articles has been done on Medline.
RESULTS
Suspected appendicitis have been confirmed by histological examination that documented 1 normal appendix, 7 chronic appendicitis, 45 acute catharralis, 22 acute suppurative and 11 gangrenous or perforated appendicitis. The specificity of open appendectomy has been 97.6% (100% for men). Post-operative complications were: 2 wound infections and 1 recurrence of an abscess (2.58%). Open appendectomy did carry an hospital bill of 2,500,000 IT liras (1,200 USA dollars) for non complicated appendicitis and 2,000 USA dollars for perforated appendicitis. The early discharge allowed us to spend 119 millions IT liras less in 7 months (99,600 USA dollars in a year).
DISCUSSION
The role of laparoscopic appendectomy isn't still established. After a critical review of the literature we can suggest that: 1) laparoscopic appendectomy increase operative time (63 vs 43 minutes: p < 0.0001); 2) laparoscopic approach can reduce the length of post-operative stay in hospital; 3) hospital bill is strongly reduced by open appendectomy (4,274 vs 7,923 USA dollars). On our experience the cost of the hospital for uncomplicated appendicitis is 2,500,000 IT liras (1,200 USA dollars). Otherwise it has been suggested that laparoscopic appendectomy has a better diagnostic accuracy respect to open appendectomy. Some Authors report a percentage of "negative" appendices of 16-50%. In Authors experience the percentage of "negative" appendices is 1.3% and so the diagnostic accuracy is 96% in women and 100% in men, probably because we systematically performed a preoperative abdomino-pelvic ultrasonography and, for the women, a gynecological evaluation. In conclusion, laparoscopic appendectomy should be done in case of suspected appendicitis in women. In the other cases, when there is a strong clinical suspect of appendicitis and, in particular, in case of suppurative appendicitis, the Authors recommend to perform an open appendectomy using the Stropeni approach. In case of perforated appendicitis with abdominal abscess they recommend to perform an open appendectomy using the right para-rectal approach or the median umbilical-pubis approach.
Topics: Acute Disease; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Costs and Cost Analysis; Female; Humans; Laparoscopy; Male; Middle Aged; Sex Factors
PubMed: 11816948
DOI: No ID Found -
Surgery May 2023Acute appendicitis represents the leading cause of acute gastrointestinal disorders, but only a small series regarding ambulatory appendectomies are available. The aim...
Ambulatory appendectomy for acute appendicitis: Can we treat all the patients? A prospective study of 451 consecutive ambulatory appendectomies out of nearly 2,000 procedures.
BACKGROUND
Acute appendicitis represents the leading cause of acute gastrointestinal disorders, but only a small series regarding ambulatory appendectomies are available. The aim of this study was to report the results of ambulatory (day-case) appendectomy for acute appendicitis in a large consecutive cohort and to improve selection criteria in order to extend the indications.
METHODS
All appendectomy procedures for acute appendicitis (March 2013 to June 2020) were included retrospectively. Criteria to select patients eligible for ambulatory appendectomy were based on our clinico-radiological St-Antoine's score ≥4.
RESULTS
In total, 1,730 consecutive patients had an appendectomy for acute appendicitis: 1,279 (74%) in conventional settings and 451 (26%) in ambulatory settings. In the conventional group, 360 (28%) patients had surgery deferred to the next morning, whereas in the ambulatory group, 309 patients (70%) were readmitted the next morning (P < .0001). In the ambulatory group, 376 (83%) patients satisfied the criteria (score ≥4), and 90.9% were discharged on postoperative day 0. Rates of unplanned consultation and readmission were not significantly different (5.1% vs 6.6% P = .243). Multivariate analysis of the entire cohort confirmed absence of radiological perforation as highly predictive of early discharge (odds ratio = 6.073). In our cohort, these patients had an early discharge rate of 86.4% compared to 90.2% in those with a St-Antoine's score ≥4. Considering only radiological evidence of perforation as a selection criterion for ambulatory appendectomy, 581 more patients would be eligible for ambulatory surgery (+60%).
CONCLUSION
Ambulatory surgery for acute appendicitis based on St-Antoine's score is safe. We propose to extend the indication for ambulatory management to all patients without radiological evidence of perforation.
Topics: Humans; Appendectomy; Appendicitis; Prospective Studies; Retrospective Studies; Patient Selection; Acute Disease; Ambulatory Surgical Procedures; Laparoscopy; Length of Stay
PubMed: 36775758
DOI: 10.1016/j.surg.2023.01.003