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

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.

Ultrasonographic Findings after Conservative Treatment of Acute Appendicitis and Open Appendicectomy

1995 ◽  
Vol 36 (2) ◽  
pp. 173-177 ◽  
Author(s):  
S. Eriksson ◽  
Å. Tisell ◽  
L. Granström
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Antibiotic Treatment ◽  
Randomized Study ◽  
Open Appendicectomy ◽  
Recurrent Appendicitis ◽  
Us Findings

In a randomized study we investigated the effects of antibiotics as the only treatment in acute appendicitis. Forty patients were examined, 19 after antibiotic treatment (one operated due to perforation) and 21 after surgery. All patients were examined prior to randomization, after 10 days and after 30 days. Of the positive ultrasonographic (US) findings, 18 (86%) of the 21 operated patients had histologically proven acute appendicitis. At the 10th day, 9 patients had a seroma under the scar, which had disappeared a month after surgery in all patients. In the 19 patients conservatively treated with antibiotics, the appendix could be visualized in 8 symptom-free cases on the 10th day. In 5 of the 8 patients the appendix was still visualized after 1 month. Three of these 5 had recurrent appendicitis within a year. It is concluded that US can be used not only in diagnosing acute appendicitis, but also in the evaluation of treatments such as antibiotics.

scholarly journals 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

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Dorra ◽  
M Abdellatif ◽  
W Fahmy ◽  
Y Salama
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Royal College ◽  
Conservative Management ◽  
District Hospital ◽  
Admission Rate ◽  
Operative Management ◽  
Operative Intervention ◽  
Coding System ◽  
Conservative Group

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.

scholarly journals A comparison of intra-operative diagnosis to histopathological diagnosis of acute appendicitis in paediatric and adult cohorts: an analysis of over 1000 patients

2021 ◽  
Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Histopathological Diagnosis ◽  
Open Appendicectomy ◽  
Normal Appendix ◽  
Macroscopic Appearance ◽  
Surgical Department ◽  
Suspected Appendicitis ◽  
Final Histological Diagnosis ◽  
Negative Appendicectomy ◽  
Operating Surgeon

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.

scholarly journals P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
H Pringle ◽  
U Donigiewicz ◽  
M Bennett ◽  
G F Fowler ◽  
E Walker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Medical Records ◽  
Operative Management ◽  
Open Appendicectomy ◽  
Single Centre ◽  
Delivery Of Healthcare ◽  
The Uk ◽  
Non Operative Management ◽  
Guide Care

Abstract Introduction The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics. Methods This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes. Results There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative. Conclusion During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

scholarly journals 353 AIR Score Based Management of Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Carlile
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Acute Abdomen ◽  
General Surgery ◽  
Diagnostic Laparoscopy ◽  
Open Appendicectomy ◽  
Common Cause ◽  
Retrospective Audit ◽  
Negative Appendicectomy ◽  
Score Risk

Abstract Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.

scholarly journals Study of conservative treatment in uncomplicated acute appendicitis

2017 ◽  
Vol 4 (4) ◽  
pp. 1409 ◽  
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.

scholarly journals NON OPERATIVE MANAGEMENT OF ACUTE APPENDICITIS- A PROSPECTIVE STUDY.

2019 ◽  
pp. 1-3
Author(s):  
Rakesh Kumar Verma ◽  
Surit Majumdar
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Prospective Study ◽  
Success Rate ◽  
Operative Treatment ◽  
Operative Management ◽  
Oral Antibiotic ◽  
Lower Quadrant ◽  
Non Operative Management

BACKGROUND: Right lower quadrant abdominal pain is a common cause of Emergency department admission.Acute appendicitis is one of the commonest diagnosis in this setting.The natural history of acute appendicitis non-operatively treated with antibiotics remains unclear. In this prospective study, operative and non-operative management of acute appendicitis were evaluated regarding their safety and cost effectiveness. AIMS AND OBJECTIVE: The purpose of this study was to assess the feasibility, initial safety and efficacy, early and late success rate of non-operative treatment of confirmed acute uncomplicated appendicitis and to monitor the long-term follow-up of non-operated patients. METHODS AND MATERIALS: Selected Acute Appendicitis patients were enrolled in this prospective comparative study (Conservative or non-operative vs operative or surgical treatment).Conservative treatment was based on a brief gut rest (partial or complete) and antibiotic therapy (Initially parenteral and then followed up with oral antibiotic). 105 patients of AA were selected for study, as per inclusion criteria. They were offered the options of conservative and surgical treatment. 52 patients opted for and complied with conservative treatment; rest (53) declined and opted for surgery,so were operated (Laparoscopic/Open) and taken as controls.Enrolment in study was done from March 2015 to February 2017 and they were further followed up for a period of 2 plus years. Secondary outcomes include hospital length of stay and cost,days of missed works and return to normal activity at home;and these were compared in both the groups (conservative vs.operative). RESULT: In non-operative group (52 patients), 4 patients (7.69 %) failed to respond satisfactorily and managed by appendectomy. 2 patients (3.85 %) developed appendicular lump in the course and they were also operated with interval appendicectomy, so 6 patients were considered as early failures (11.54%) with early success rate of 88.46%. Four patients experienced recurrent attacks of acute appendicitis (AA);in them, repeat conservative approach was not tried and they were managed with appendectomy.This brought down the Late success rate to 80.76%.In appendectomy group, 2 patients complained of persistent discomfort in right lower abdomen, five patients developed wound or port site infection and one patient developed incisional hernia. In non-operative group, hospital stays were shorter with lesser hospital costs and days of missed work and also statistically significant as compared to appendectomy group. CONCLUSION:This study confirms the feasibility,safety and optimum success rate of non-operative treatment of early AA in selected patients.

PENERAPAN METODE STORY READING UNTUK MENINGKATKAN KEMAMPUAN BERBICARA ANAK USIA 5 - 6 TAHUN DI TK MELATI / ABA 005 PULAU BALAI

2015 ◽  
Vol 4 (2) ◽  
pp. 143
Author(s):  
Hasnidar '
Keyword(s):  
Data Collection ◽  
Initial Data ◽  
Research Data ◽  
Class Action ◽  
Percentage Increase ◽  
Story Reading ◽  
Reading Methods ◽  
Number Of Children ◽  
Class Actions ◽  
Speaking Skills

This study aims to improve speaking skills of children aged 5-6 through methods Story Reading in TK Melati/ ABA 005 Pulau Balai. The method used is a Class Action Research. Class actions that researchers do the research is to use the method Story Reading to improve speaking skills of children aged 5-6 years in TK Melati TK Melati/ ABA 005 Pulau Balai, and is observed by the observer. Samples taken are TK Melati/ ABA 005 Pulau Balai with the number of children of 20 people, consisting of 13 men and 7 women. Data collection techniques in this research is through observation of teachers and children as well as data capability speaking children aged 5-6 years with use of methods Story Reading. Hipotesis in this study is if the method will be applicable Story Reading can improve speaking skills of children aged 5-6 years in TK Melati/ ABA Pulau Balai 005 can be enhanced through storytelling. Results of the research data obtained by using the method Story Reading can improve the ability to speak of children aged 5-6 years in TK Melati / ABA 005 Pulau Balai. The percentage increase in the ability to speak the child at the age of 5-6 years using Story Reading methods in TK Melati/ ABA 005 Pulau Balai, from initial data to the second cycle increased by 32.2%. The implication of this study is the use of methods Story Reading used properly, can improve speaking skills of children aged 5-6 years in TK Melati/ ABA 005 Pulau BalaiKeywords: story reading, speech

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