scholarly journals Non-operative management of appendicitis in children

2017 ◽  
Vol 103 (5) ◽  
pp. 498-502 ◽  
Author(s):  
Nigel J Hall ◽  
Simon Eaton
Keyword(s):  
Acute Appendicitis ◽  
Operative Treatment ◽  
Current Knowledge ◽  
Operative Management ◽  
Knowledge Gaps ◽  
Recent Interest ◽  
Non Operative Management ◽  
Initial Results

While appendicectomy has been considered the mainstay of treatment for children with acute appendicitis for many decades, there has been a great deal of recent interest in non-operative treatment (NOT) with antibiotics alone. Initial results suggest that many children with appendicitis can indeed be safely treated with NOT and can be spared the surgeon’s knife. Many as yet unanswered questions remain, however, before NOT can be considered a realistic and reliable alternative to surgery. This review summaries current knowledge and understanding of the role of NOT in children with appendicitis and outlines and discusses the outstanding knowledge gaps.

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.

scholarly journals 1553 Non-Operative Management of Acute Appendicitis at A Major Trauma Centre – A Retrospective Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S J K Chong ◽  
M Kaur ◽  
C Palmer ◽  
S Jaunoo
Keyword(s):  
Acute Appendicitis ◽  
Operative Treatment ◽  
Treatment Strategy ◽  
Major Trauma ◽  
Case Series ◽  
Operative Management ◽  
Trauma Centre ◽  
Retrospective Case ◽  
Major Trauma Centre ◽  
Non Operative Management

Abstract Aim The recent CODA trial concluded that appendicitis patients with confirmed faecolith are at higher risk of appendicectomy and complications than those without faecolith. A retrospective case series of patients undergoing non-operative management of appendicitis at a major trauma centre was conducted to determine the success of non-operative management, defined as lack of operative management within 30 and 90 days of diagnosis, and the impact of presence of faecolith on outcomes. Method All patients who received a working diagnosis of appendicitis over a 16-week period between March and June 2020 were identified and their electronic records interrogated for: preliminary and final diagnoses; imaging modality and result; operative or non-operative initial treatment strategy; final treatment strategy; and histopathology results where applicable. Patients who received an initial operative treatment strategy were excluded. Patients for whom appendicitis was not confirmed on either imaging or histopathology were excluded. Results 24 patients received an initial non-operative treatment strategy and were eligible for inclusion. 15 patients (62.5%) underwent successful non-operative management. The remaining 9 patients (37.5%) required operative management within 30 days. Presence of faecolith was confirmed in 9 patients (37.5%). 3 patients (33%) with presence of faecolith required operative management, while 3 patients (25%) without presence of faecolith required operative management. 1 patient with confirmed faecolith developed a large intra-abdominal abscess while undergoing a non-operative treatment strategy and subsequently required right hemicolectomy. Conclusions The majority of our eligible appendicitis patients were successfully managed non-operatively. Presence of faecolith in acute appendicitis is associated with increased risk of requiring operative management.

The Role of Angioembolization in Hepatic Trauma

2020 ◽  
pp. 000313482097372
Author(s):  
Ali Cadili ◽  
Jonathan Gates
Keyword(s):  
Gold Standard ◽  
Management Strategy ◽  
Operative Management ◽  
Hepatic Trauma ◽  
Anatomy And Physiology ◽  
Liver Injuries ◽  
Hepatic Injuries ◽  
Non Operative Management ◽  
Type Of Injury

The liver is one of the most commonly injured solid organs in blunt abdominal trauma. Non-operative management is considered to be the gold standard for the care of most blunt liver injuries. Angioembolization has emerged as an important adjunct that is vital to the success of the non-operative management strategy for blunt hepatic injuries. This procedure, however, is fraught with some possible serious complications. The success, as well as rate of complications of this procedure, is determined by degree and type of injury, hepatic anatomy and physiology, and embolization strategy among other factors. In this review, we discuss these important considerations to help shed further light on the contribution and impact of angioembolization with regards to complex hepatic injuries.

scholarly journals The role of grade of injury in non-operative management of blunt hepatic and splenic trauma

Medicine ◽  
2019 ◽  
Vol 98 (35) ◽  
pp. e16746 ◽  
Author(s):  
Paolo Ruscelli ◽  
Alessandro Gemini ◽  
Massimiliano Rimini ◽  
Sergio Santella ◽  
Roberto Candelari ◽  
...  
Keyword(s):  
Operative Management ◽  
Splenic Trauma ◽  
Non Operative Management

Non-union of Non-operatively Treated Displaced Olecranon Fractures

2012 ◽  
Vol 4 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Wendy Bruinsma ◽  
Anneluuk Lindenhovius ◽  
Michael Mckee ◽  
George S. Athwal ◽  
David Ring
Keyword(s):  
Operative Treatment ◽  
Case Series ◽  
Operative Management ◽  
Olecranon Fracture ◽  
Loss Of Function ◽  
Non Union ◽  
Flexion Extension ◽  
Displaced Fracture ◽  
And Function ◽  
Non Operative Management

Background With this case series, we report the management of patients who present with non-union after no treatment or intentional non-operative management of a displaced olecranon fracture. We hypothesized that the majority of these patients would be satisfied with their symptoms and function. Methods Ten patients (six women and four men) with a mean age of 59 years (range 21 years to 94 years) presented to one of seven surgeons with non-union of a displaced fracture of the olecranon a mean of 17 months (range 3 months to 7 years) after injury. Results The mean flexion-extension arc at presentation was 117° (range 100° to 135°) with a mean flexion of 137° (range 120° to 150°) and a mean extension of 21° (range 10° to 40°). Forearm rotational arc was a mean of 172° (range 150° to 180°) with a mean pronation of 86° (range 75° to 90°) and a mean supination of 86° (range 75° to 90°). Two patients who had difficulty participating in daily activities because of pain or loss of function requested operative treatment. Eight patients declined operative treatment. Conclusions Patients who present with a non-union after a displaced olecranon fracture managed non-operatively have reasonable elbow function and uncommonly request operative treatment.

scholarly journals The role of non-operative management (NOM) in blunt hepatic trauma

2013 ◽  
Vol 49 (3) ◽  
pp. 223-227
Author(s):  
Ayman Zaki Azzam ◽  
Abdel Hamid Gazal ◽  
Mohammed I. Kassem ◽  
Magdy A. Souror
Keyword(s):  
Operative Management ◽  
Hepatic Trauma ◽  
Non Operative Management

scholarly journals Non-operative treatment of acute appendicitis in selected patients

2017 ◽  
Vol 4 (10) ◽  
pp. 3190
Author(s):  
Nazim Agaoglu ◽  
Mehmet Ulusahin
Keyword(s):  
Length Of Stay ◽  
Acute Appendicitis ◽  
Success Rate ◽  
Operative Treatment ◽  
Operative Management ◽  
Treatment Method ◽  
Normal Activity ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Success Rates

Background: Surgical approach for acute appendicitis (AA) is a standard live saving treatment method. The purpose of this study was to assess the feasibility, initial safety and success rate of non-operative treatment of AA in selected patients.Methods: Selected AA patients were enrolled in this prospective study (non-operative treatment). This was based on IV antibiotic therapy and followed up with oral antibiotic. Patients who declined to participate or excluded were managed with appendectomy and considered as controls. The primary goal of the study was to determine the feasibility, initial safety, early and late success rates of non-operative management. Secondary outcomes include hospital length of stay and charge, days of missed works and return to normal activity at home of patients treated non-operatively in comparison to appendectomy group.Results: In non-operative group (36 patients), 7 patients failed to response and managed by appendectomy with early success rate of 80.5%. Three patients experienced recurrent attacks of AA were managed with appendectomy. Late success rate was 72.2%. In appendectomy group (53 patients) one patient with adenocarcinoma of the colon detected during surgery and in ten patients the appendix was perforated. One patient died due to generalized peritonitis. In non-operative group length of stay and hospital charge were lower but only days to resume home activities and days of missed work were shorter and statistically significant as compared to appendectomy group.Conclusions: This study confirms the feasibility, safety and optimum success rate of non-operative treatment of early AA in selected patients.

scholarly journals Faecoliths in Appendicitis: Does It Influence the Course and Treatment of the Disease in the Acute Setting?

2021 ◽  
Author(s):  
Rossi Adu-Gyamfi
Keyword(s):  
Acute Appendicitis ◽  
Treatment Failure ◽  
Operative Treatment ◽  
Predictive Factor ◽  
Complicated Appendicitis ◽  
Current Evidence ◽  
Failure Rates ◽  
Independent Factor ◽  
Acute Setting

Luminal obstruction has been widely considered as one of the major causes of appendicitis. Faecolith, in this case called appendicolith, is a hardened lump of faeces in varying sizes, have over the years been closely associated with appendicitis as a potential cause of luminal obstruction. There are varying opinions with regards to role of appendicolith in both uncomplicated and complicated acute appendicitis. While some authors have reported that the presence of appendicolith is a predictive factor for high failure rates, others are of the opinion that appendicolith does not necessarily predict non-operative treatment failure, and even if so, not as an independent factor. Opinions also seem to be divided on the correlation between complicated appendicitis and the presence of appendicolith. This chapter seeks to discuss the evidence available and attempt to clarify the controversies surrounding the role of appendicolith in acute appendicitis using current evidence available.

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