1565 In Covid-19 Pandemic, Following the Updated Royal College of Surgeons of England Guidelines in Management of Acute Appendicitis; A General District Hospital Audit

Abstract Aim The Aim of the study is assessment of the compliance with the updated Royal College of Surgeons of England (RCS) guidelines in management of acute appendicitis in a general district hospital during COVID-19 pandemic. Conservative treatment of acute appendicitis is encouraged unless unresponsiveness to treatment or complications ensues. Method Collection of retrospective data using hospital coding system was done from 63 patients medical records who were diagnosed with acute appendicitis from April 2020 to June 2020. Results The collected data analysis showed adherence to conservative treatment in 16 out of 63 (16/63) patients (25.4%). It succeeded in 10/16 patients (63 %). 6/16 patients were switched to operative intervention (37 %). There were no complications in patients who needed operative intervention after failure of conservative management. Operative management was primarily chosen in 47/63 patients (74.6 %). Re-admissions were 3/16 patients (18.75 %) in conservative group in comparison to 1/47 patient (2.12 %) in primarily operative group. Conclusions The work showed a promising rate of success of conservative treatment. However, there is a low level of compliance with RCS guidelines in management of acute appendicitis during COVID-19 pandemic. The study showed increased re-admission rate for conservative management versus primarily operative management pathways. No complications were detected in cases who needed operative intervention after failure of conservative management. Re-auditing is to follow. The study recommends national comparison of data as it might be worthwhile considering primary management of acute appendicitis.

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Surgical treatment of medial patellofemoral ligament injuries achieves better outcomes than conservative management in patients with primary patellar dislocation: a meta-analysis

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000152 ◽

2017 ◽

Vol 3 (2) ◽

pp. 98-104 ◽

Cited By ~ 3

Author(s):

Amre Hussein ◽

Asser A Sallam ◽

Mohamed A Imam ◽

Martyn Snow

Keyword(s):

Conservative Treatment ◽

Surgical Management ◽

Conservative Management ◽

Patellar Dislocation ◽

Medial Patellofemoral Ligament ◽

Meta Analysis ◽

Treated Group ◽

Current Evidence ◽

Conservative Group ◽

Kujala Score

ImportanceLateral patellar dislocation is a commonly encountered disorder that affects mainly young and active adults and is associated with potential long-term morbidity. Primary traumatic dislocations can result in injury to the medial patellofemoral ligament (MPFL). There is controversy in literature about the superiority of early surgical intervention over conservative treatment of MPFL injuries.ObjectiveThe aim of this project was to undertake a meta-analysis to evaluate the clinical outcomes of the surgical management of MPFL injuries compared with conservative treatment in patients with primary patellar dislocation.Evidence reviewA systematic review of the English literature combining electronic databases Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and MEDLINE ((Ovid) and PubMed) and the reference lists of the final studies was performed during the last week of June 2017 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four eligible randomised controlled trials comparing MPFL repair/reconstruction to conservative management met our inclusion criteria. They were identified and critically appraised, and the results were quantitatively evaluated giving data of a total of 171 patients. They were divided into two groups: surgically treated group (92 patients) and conservatively treated group (79 patients). The performed surgical procedures included: reconstruction and repair of the MPFL. The conservative management group included mainly physiotherapy. The outcomes evaluated were the rate of recurrent dislocation of the patella and the Kujala score.FindingsOur analysis showed high statistical significance favouring the surgical management in reducing the redislocation rate (6.74%) in comparison with the conservative group (28.5%) (P<0.001). The surgical group also demonstrated significantly higher Kujala score (70.8) compared with the conservative group (59.8) (P<0.001).Conclusions and relevanceContrary to the available current evidence in the literature, we report that the surgical management of MPFL injuries in patients with primary patellar dislocation results in a significantly reduced rate of redislocation when compared with non-operative management.Level of evidenceMeta-analysis, therapeutic type II.

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EP.TU.70The Conservative Management of Perforated Diverticulitis Based on Abscess Size and Presence of Distant Air

British Journal of Surgery ◽

10.1093/bjs/znab311.012 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Sanad Isswiasi ◽

Sarah El-Zahab ◽

Elisabeth Drye

Keyword(s):

Supportive Care ◽

Ct Scan ◽

Conservative Management ◽

District Hospital ◽

Therapeutic Option ◽

Operative Management ◽

Best Supportive Care ◽

Perforated Diverticulitis

Abstract Aims To determine the effectiveness of conservative management in perforated diverticulitis (PD) in a single District Hospital based on the size of the abscess and the presence of distant air (DA). Methods Data on 112 Patients who were admitted between 2013-2018 with PD was collected retrospectively. CT scan reports were used to document the size of abscess and presence of DA. Failed conservative management with antibiotics (ABx) was defined as the need for another therapeutic option after 48 hours of admission or readmission within 90 days. Results Overall, 40 patients (36%) needed operative management, 12 patients (11%) required washout, 6 patients (5%) underwent radiological drainage and 8 patients (7%) were offered best supportive care. In total, 46 patients (41%) were successfully managed with ABx only. ABx were tried on 45 patients who had <4cm abscess and no DA. This was successful in 30 of them (66%). However, 6 out of 17 patients (35%) with >4cm abscess and no DA were treated with ABx only. Despite presence of DA, 8 out of 17 (47%) cases with <4cm abscess were successfully treated with Abx only. Only 2 patients out of 19 (10%) with >4cm and DA were successfully treated with ABx only. Conclusion Abscess size and presence of DA in PD should be considered in predicting the outcome of the management. Even in presence of DA, nearly half of patients with small abscesses (<4cm) diverticular abscesses were successfully managed conservatively. The majority of patients with larger abscesses with DA failed ABx treatment.

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Is There a Place for Conservative Treatment of Acute Appendicitis?

Journal of King Abdulaziz University-Medical Sciences ◽

10.4197/med.17-1.2 ◽

2010 ◽

Vol 17 (1) ◽

pp. 1-17

Author(s):

Jamal T. Hamdi

Keyword(s):

Retrospective Study ◽

Conservative Treatment ◽

Acute Appendicitis ◽

District Hospital ◽

Normal Appendix ◽

Female Ratio ◽

Male And Female ◽

Perforated Appendix ◽

A Prospective Study ◽

Surgical Condition

Acute appendicitis is the most common acute surgical condition of the abdomen. The diagnosis of acute appendicitis continues to present clinicians with problems despite the advances in the investigating technology. This retrospective study aims to review appendiceal histopathological records in a district hospital in Makkah in 2007. The study was based on all appendices removed during emergency appendectomies to identify the proportion of normal and mildly inflamed appendices, in addition to their sex ratio, so that a prospective study can be carried out with conservative treatment with antibiotics, if justified. The records were divided into negative, mild and severely inflamed or perforated appendix. The number of the operations was 405, with nearly equal male and female ratio. The ratio of normal appendix was 24.2%, mild appendicitis was 26.4%, and severe appendicitis was 49.4%. Over 50% of all emergency appendectomies were performed on normal or mildly inflamed appendix, which rises to over 60% in females alone. The number of the males with severe appendicitis is nearly 50% more than that of the females. Patients, especially females, with normal or mildly inflamed appendix, if identified before surgery, may benefit from conservative treatment with antibiotics.

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1185 Acute Paediatric Appendicitis(AA)-Decreasing The Negative Rate Of Appendicectomy

British Journal of Surgery ◽

10.1093/bjs/znab259.685 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

G Karagiannidis ◽

O Toma ◽

E Mallidis ◽

F Youssef

Keyword(s):

Data Collection ◽

Conservative Treatment ◽

Observational Study ◽

Acute Appendicitis ◽

First Trimester ◽

Operative Management ◽

Open Appendicectomy ◽

Number Of Children ◽

Negative Rate ◽

Negative Appendicectomy

Abstract Aim The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow. Method Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020. Results During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period. Conclusions The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.

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Evaluation of conservative management in uncomplicated acute appendicitis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213179 ◽

2021 ◽

Author(s):

Vignesh M. ◽

Rajkumar Chejara ◽

S. V Arya ◽

Ankit Bhatia ◽

Rohit Chaudhary ◽

...

Keyword(s):

Standard Deviation ◽

Conservative Treatment ◽

Acute Appendicitis ◽

Conservative Management ◽

Significant Proportion ◽

Alvarado Score ◽

Intravenous Antibiotics ◽

Uncomplicated Appendicitis ◽

Uncomplicated Acute Appendicitis

Background: Appendectomy has been the treatment for acute appendicitis for years based on the understanding that acute appendicitis always leads to perforation and peritonitis. However, there is growing evidence that a significant proportion of patients can be successfully managed with conservative treatment without developing gangrene or perforation. Conservative treatment avoids discomfort, surgery-related morbidities and minimizes treatment cost.Methods: 60 patients taken up for conservative management were evaluated and followed up for 6 months. Study patients received intravenous antibiotics for 2 days. Repeated clinical and TLC monitoring were done. In patients whose clinical condition did not improve, appendectomy was performed. Follow-up at 10 days, 30 days, 3 months and 6 months were carried out to assess recurrence in conservatively managed patients.Results: In this study, the mean age was 25.65 years with a standard deviation of ±8.96 years. The incidence of uncomplicated appendicitis was 63.3% in males and 36.7% in females. Mean Alvarado score was 7.75 with a standard deviation of ±1.20. Failure of conservative management (conversion to appendectomy) was observed in 11.7% of patients and 4 patients (6.6%) had recurrence within 6 months. The overall treatment efficacy was 81.7%.Conclusions: In many cases, first attack of uncomplicated acute appendicitis can be treated successfully by conservative management. Treatment failure on primary admission as well as short-term recurrence up to six months after conservative treatment is low and acceptable. Incidence of complications like perforation and abscess formation are also statistically low.

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1475 Management of Appendicitis During COVID19 - A Shift to Conservative Management

British Journal of Surgery ◽

10.1093/bjs/znab259.507 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Bhattacharya ◽

S Stonelake ◽

E Peterknecht ◽

S Zaman ◽

M Budhoo

Keyword(s):

Ct Scan ◽

Conservative Management ◽

Operative Management ◽

Median Length ◽

Conservative Group ◽

Uncomplicated Appendicitis ◽

Retrospective Data Collection ◽

Surgical Conditions ◽

Versus Risk

Abstract Introduction The COVID19 pandemic posed challenges in dealing with common surgical conditions, by causing a redirect of manpower and resources as well as having correlation of added morbidity if present in patients undergoing surgery Aim To find out the proportion of patients undergoing conservative management and their outcomes compared to operative management Method Retrospective data collection of patients admitted with appendicitis from 25/03/2020 to 15/07/2020. Results A total of 72 encounters had a discharge diagnosis of appendicitis.35 (48.6%) patients were treated with conservative management. while 37 (51.4%) patients had operative management. In the conservative group CT scan was done in 64%, which showed simple appendicitis in 78% and complicated in 17 %, whereas in the operative group CT scan was done in 59.4% , 86 % had simple appendicitis and 9% and complicated appendicitis. Median length of stay in both groups were 2 days. There were no readmissions in the operative group and 84.3% patients had no readmissions in the conservative group in the study in a follow up period up to 6 months. 2 patients initially treated conservative were eventually offered surgery on readmission. Conclusions 1. Conservative management of appendicitis has proved to be a valuable alternative to surgical management during this pandemic 2. Patients should be offered a choice of conservative management for simple appendicitis with prior discussion of benefits of avoiding surgery versus risk to recurrence (up to 39% reported in literature for uncomplicated appendicitis)

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Conservative Management of Acute Appendicitis In The Era Of COVID 19: A Multicenter prospective observational study at The United Arab Emirates

10.1101/2020.09.30.20204503 ◽

2020 ◽

Author(s):

Fatima Y. AL Hashmi ◽

Abeer Al Zuabi ◽

Ibrahim Y. Hachim ◽

Guido H.H. Mannaerts ◽

Omar Bekdache

Keyword(s):

Health Care ◽

Acute Appendicitis ◽

United Arab Emirates ◽

Health Care Providers ◽

Conservative Management ◽

Length Of Hospital Stay ◽

Operative Management ◽

Care Providers ◽

The Impact

Background Since its emergence in December 2019, the Novel Coronavirus (COVID-19) pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy in the treatment of proven acute appendicitis during COVID19 pandemic. Methods Our study is a prospective multicenter study that includes a cohort of 160 patients admitted to the surgical departments in both Tawam Hospital and Sheikh Shakhbout Medical City, Abu Dhabi, UAE, for the period from February 2020 till July 2020. Results Our results showed that 56 of our patients (35%) were treated conservatively, while the other 104 (65%) underwent operative management. There was a significant decrease in length of hospital stay (LOS) (2.32 days) among the first group compared to the second (2.8 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed any serious complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Follow up was achieved by using telemedicine-based follow-up with the aim of empowering social distancing and reducing risk of viral exposure to patients as well as the health care providers. In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive is a safe and feasible approach that maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.

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A Combined Bony and Soft Tissue, Thoracic Chance Fracture: Late Displacement following Conservative Treatment

Case Reports in Orthopedics ◽

10.1155/2017/6528673 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

James Thomas Bourne ◽

Alexander David Laing Baker ◽

Manoj Khatri

Keyword(s):

Lumbar Spine ◽

Soft Tissue ◽

Conservative Treatment ◽

Thoracic Spine ◽

Conservative Management ◽

Operative Management ◽

Chance Fracture ◽

First Case ◽

Type Of Fracture ◽

Posterior Elements

We report the first case of a combined bony and soft tissue Chance fracture in the thoracic spine, with late presenting displacement following conservative management. Chance fractures are flexion-distraction injuries to the spine. They consist of disruption and longitudinal separation of the posterior elements of the vertebra, with the fracture extending through the pedicles and into the vertebral body. Both bony and soft tissue Chance fractures of the lumbar spine have been reported, as well as bony Chance fractures in the thoracic spine. This case suggests that this type of fracture is unstable and is an indication for operative management. It is also important to note that the displacement of the fracture occurred at more than eight weeks after injury, suggesting that instability may not present immediately.

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720 Outcomes of Conservative Management of Acute Appendicitis During The COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab134.078 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Oxenham ◽

P Jull ◽

D Karunaratne ◽

N Laskar ◽

R Harshen

Keyword(s):

Acute Appendicitis ◽

Conservative Management ◽

Operative Mortality ◽

Hospital Admissions ◽

Operative Management ◽

Single Centre ◽

Day Range ◽

Uncomplicated Appendicitis ◽

Single Centre Study ◽

Spread Of Infection

Abstract Introduction During the SARS-CoV-2 (COVID-19) pandemic, appendicitis was managed conservatively to reduce peri-operative mortality; spread of infection; and hospital admissions. We describe the outcomes observed from conservative management during the pandemic. Method This prospective single centre study included all patients with clinically acute appendicitis between 31/3/2020 to 31/5/2020. Length of admission and 30-day complications were recorded. This was compared to retrospective data from 31/3/2019 to 31/4/2019. Results Of the 35 patients included between 31/3/2020 to 31/5/2020: 19 patients were managed conservatively with antibiotics; 8 required operative management after trial of antibiotics; and 8 required surgery on admission. Of the initially conservatively managed patients, three suffered complications (Clavien Dindo >1). Length of admission in conservative patients averaged 1.3 days (0-5 day range). In May 2019, 30 patients admitted with clinical appendicitis were all managed with appendicectomy. The average admission was 2.93 days (1-50 day range) with 4 patient complications. There was no difference (P = 0.22) when comparing the length of admissions within the pandemic and non-pandemic cohorts. Conclusions Our study demonstrates no increase in complications or length of admission during the pandemic. We support the recommendation that conservative management of uncomplicated appendicitis is continued during the COVID-19 pandemic.

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Study of conservative treatment in uncomplicated acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20171152 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1409 ◽

Cited By ~ 1

Author(s):

B. S. Gedam ◽

Ajit Gujela ◽

Prasad Y. Bansod ◽

Murtaza Akhtar

Keyword(s):

Conservative Treatment ◽

Acute Appendicitis ◽

Treatment Failure ◽

Tertiary Care ◽

Operative Management ◽

Care Hospital ◽

Alvarado Score ◽

Modified Alvarado Score ◽

Uncomplicated Acute Appendicitis ◽

Non Operative Management

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.

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