Laparoscopic Appendectomy Protocol Expedites Management of Uncomplicated Acute Appendicitis

2017 ◽  
Vol 83 (6) ◽  
pp. 673-676
Author(s):  
Alvaro M. Bada ◽  
Joseph A. Ibrahim ◽  
Karen Safcsak ◽  
Andrew C. Gratzon ◽  
Chadwick P. Smith ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Patient Care ◽  
Laparoscopic Appendectomy ◽  
Perioperative Management ◽  
Tertiary Care ◽  
Clinical Findings ◽  
Emergency Department Visits ◽  
Management Protocol ◽  
Uncomplicated Acute Appendicitis

Bed availability remains a constant struggle for tertiary care centers resulting in the use of management protocols to streamline patient care and reduce length of stay (LOS). A standardized perioperative management protocol for uncomplicated acute appendicitis (UA) was implemented in April 2014 to decrease both CT scan usage and LOS. Patients who underwent laparoscopic appendectomy for UA from April 2012 to May 2013 (PRE group) and April 2014 to May 2015 (POST group) were compared retrospectively. There were no differences in patient demographics or clinical findings between the groups. All patients in the PRE group had a CT scan for the diagnosis of appendicitis, whereas there was a 14 per cent decrease in the POST group (P = 0.002). There was a significant decrease in median LOS between the groups [PRE 1.3 vs POST 0.9 days; (P < 0.001)]. There was no difference in subsequent emergency department visits for complications [3 (4%) vs 4 (4%); P = 1.0] or 30-day readmission rate [1 (1%) vs 5 (5%); P = 0.22] between the groups. A standardized perioperative management protocol for UA patients significantly decreased CT scan utilization and LOS without compromising patient care.

Adenocarcinoma of the Appendix in Elderly: Diagnostic dilemma

2020 ◽  
Vol 01 ◽  
Author(s):  
Heba Nofal ◽  
Hayder Al-Masari ◽  
Marwan Mohammed Rashed ◽  
Reham Ainawi ◽  
Desh Idnani ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Ct Scan ◽  
Laparoscopic Appendectomy ◽  
Signs And Symptoms ◽  
Morbidity And Mortality ◽  
Diagnostic Dilemma ◽  
Increased Risk

: Acute appendicitis in elderly continue to be a diagnostic dilemma as it raises both the suspicion of malignancy and increased risk of morbidity and mortality. Cancers of the appendix are rare and most of them are found accidentally on appendectomies performed for acute appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of appendix are only 0.08% of all cancers and the treatment remains controversial. This paper presents a case of 75-year-old female presented to emergency (ER) with signs and symptoms mimicking acute appendicitis, laparoscopic appendectomy was planned after a CT scan was done as it was suggesting acute appendicitis. The specimen then was sent foe pathology lab and a diagnosis of adenocarcinoma of the appendix was made.

scholarly journals A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023623 ◽  
Author(s):  
Suvi Sippola ◽  
Juha Grönroos ◽  
Ville Sallinen ◽  
Tero Rautio ◽  
Pia Nordström ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Ct Scan ◽  
Symptomatic Treatment ◽  
Spontaneous Resolution ◽  
University Hospital ◽  
Controlled Study ◽  
Double Blind ◽  
Uncomplicated Acute Appendicitis

IntroductionRecent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking.Methods and analysisThe APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18–60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher’s one-sided test and CI will be calculated for proportion difference.Ethics and disseminationThis protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals.Trial registration numberNCT03234296; Pre-results.

scholarly journals Endoscopic retrograde appendicitis therapy vs. Laparoscopic appendectomy for uncomplicated acute appendicitis

Endoscopy ◽  
2022 ◽  
Author(s):  
Baohong Yang ◽  
Lingjian Kong ◽  
Ullah Saif ◽  
Lixia Zhao ◽  
Dan Liu ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Hospital Length Of Stay ◽  
Adverse Event Rate ◽  
Recurrence Time ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
One Year ◽  
Uncomplicated Acute Appendicitis ◽  
Matching Criteria

Background and study aims: To assess the efficacy and clinical outcomes of endoscopic retrograde appendicitis therapy (ERAT) versus laparoscopic appendectomy (LA) for patients with uncomplicated acute appendicitis (AA). Patients and methods: We adopted propensity score matching (1:1) to compare ERAT and LA patients with uncomplicated AA from April 2017 to March 2020. We reviewed a total of 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated AA met the matching criteria (ERAT, 79; LA, 343), yielding 78 pairs of patients. Results: The rate of curative treatment within one year after ERAT was 92.1%; 95% CI, [83.8% - 96.3%]. The percentage of Visual Analog Scale (VAS) ≤ 3 at six hours after treatment was 94.7%; 95% CI [87.2% - 97.9%] in the ERAT group, and significantly higher than that in the LA group 83.3%; 95% CI [73.5% - 90.0%]. Median operative/procedure time and median hospital length of stay in the ERAT group were significantly lower compared to the LA group. At one year, the median recurrence time was 50 days (IQRs, 25-127) in the ERAT group. The overall adverse event rate was 24.3%; 95% CI [14.8% - 33.9%] in the LA group and 18.4%; 95% CI [9.7% - 27.1%] in the ERAT group, with no significant difference between the two groups. Conclusions: ERAT is a technically feasible method to treat uncomplicated AA compared to LA.

scholarly journals Leucocyte count in children with complicated and uncomplicated acute appendicitis: a comparative study

2019 ◽  
Vol 6 (12) ◽  
pp. 4308
Author(s):  
Liya Joseph
Keyword(s):  
Acute Appendicitis ◽  
Leucocyte Count ◽  
Tertiary Care ◽  
Age Groups ◽  
Complicated Appendicitis ◽  
Total Leucocyte Count ◽  
Chi Square ◽  
Uncomplicated Appendicitis ◽  
Uncomplicated Acute Appendicitis ◽  
Complicated Acute Appendicitis

Background: Identification of complicated and uncomplicated acute appendicitis is important in children. In acute appendicitis, along with clinical evaluation and staging, many laboratory tests have been used. The aim of the study was to compare total leucocyte count in children with uncomplicated and complicated acute appendicitis in different age groups.Methods: Retrospective cohort study was performed in children who underwent appendicectomy, in a Government tertiary care institution between January 2017 and December 2018. 206 patients were divided into complicated and uncomplicated appendicitis. Total leucocyte count at time of admission was compared according to age. Unpaired t test and Chi-square test were used for statistical analysis.Results: There were 136 males and 70 females. 107 patients (51.94%) had complicated and 99 (48.06%) had uncomplicated appendicitis. Mean leucocyte count per µl in uncomplicated appendicitis was 18993±3540 in <5 years, 17155±3386 in 5-10 years and 15833±3613 in 10-15 years. The mean leucocyte count for complicated appendicitis was 19974±3658 in <5 years, 17727±4487 in 5-10 years and 17220±3411 in 10-15 years age group. In 10-15 years group, patients with complicated acute appendicitis had statistically significant higher values of mean total leucocyte count.Conclusions: Total leucocyte count can be used as marker of severity of acute appendicitis in children older than 10 years. In children with clinical suspicion of acute appendicitis, total leucocyte count >20000 per µl signifies complicated appendicitis in all age groups.

scholarly journals Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis

2020 ◽  
Vol 36 (1) ◽  
pp. 30-34
Author(s):  
Tae Gyeong Lee ◽  
Soomin Nam ◽  
Hyung Soon Lee ◽  
Jin Ho Lee ◽  
Young Ki Hong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Appendicitis ◽  
Surgical Site Infection ◽  
Postoperative Complication ◽  
Laparoscopic Appendectomy ◽  
Operative Time ◽  
Multiple Logistic Regression Analysis ◽  
Operation Time ◽  
Site Infection ◽  
Uncomplicated Acute Appendicitis

Purpose: To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis.Methods: Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic.Results: A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis.Conclusion: There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Outpatient Laparoscopic Appendectomy for Acute Appendicitis

2012 ◽  
Vol 78 (2) ◽  
pp. 213-215 ◽  
Author(s):  
Cassadra L. Cash ◽  
Richard C. Frazee ◽  
Randall W. Smith ◽  
Matthew L. Davis ◽  
John C. Hendricks ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Laparoscopic Surgery ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Clinical Course ◽  
Wound Infections ◽  
Outpatient Management ◽  
Abdominal Bleeding ◽  
Superficial Wound ◽  
Uncomplicated Acute Appendicitis

Laparoscopic appendectomy is the widely accepted treatment for acute appendicitis. This approach offers the potential of less pain, shorter hospital stay, and quicker return to activities. Traditionally, patients are hospitalized for 24 hours after laparoscopic appendectomy. This practice can be questioned due to the good results of other outpatient laparoscopic surgery. A retrospective review of 119 patients undergoing laparoscopic appendectomy for uncomplicated acute appendicitis was undertaken from January through September 2009; outpatient and in-patient laparoscopic appendectomies were compared. Patients were selected for outpatient management based upon physician discretion and their clinical course in operation and recovery rooms. Forty-two patients were dismissed on the day of surgery and 77 were admitted for 1 to 5 days postoperatively. No significant differences in age, gender, and preoperative comorbidities between outpatient and inpatient groups were found. Postoperative complications occurred in 2.4 per cent of outpatients and 11.7 per cent of inpatients ( P = 0.16). Complications included superficial wound infections, urinary retention, urinary tract infection, intra-abdominal bleeding, pneumonia, and infected hematoma. Based upon this study, outpatient laparoscopic appendectomy can be performed safely in selected patients. This study provides the background for the present prospective protocol for routine outpatient laparoscopic appendectomy at our institution.

Laparoscopic appendectomy protocol expedites management of uncomplicated acute appendicitis

2015 ◽  
Vol 221 (4) ◽  
pp. e86-e87
Author(s):  
Joseph A. Ibrahim ◽  
Alvaro M. Bada ◽  
Andrew C. Gratzon ◽  
Karen Safcsak ◽  
Chadwick P. Smith ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Uncomplicated Acute Appendicitis

645 An EGS-Led Service for Acute Appendicitis Enhances Surgical Training Whilst Improving Outcomes for Patients: Results of A 6-Month Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Issa ◽  
L A Sommereux ◽  
J Osuji ◽  
R Meredith ◽  
M H Muhammed ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Clinical Findings ◽  
Negative Appendectomy ◽  
Complication Rates ◽  
Emergency Unit ◽  
Open Conversion ◽  
Operative Outcomes ◽  
Operative Findings

Abstract Introduction Appendicitis is common &treatment by appendectomy is usually undertaken. Variations in diagnostics &imaging are accompanied by high negative appendectomy rates (NAR) of around 20%. This study evaluated the outcomes of appendectomy in a dedicated Surgical Emergency Unit. Method All patients undergoing emergency appendectomy between 1stSept 2019&29thFeb 2020 were identified. Demographics, clinical findings, pre-operative investigations, intra-operative findings &post-operative outcomes were recorded. Results There were 192 patients (102 [53.1%] female;90 [46.9%] male). Median age was 36 years(range 8-80)with 25 below 14.Some 58.3% underwent imaging (ultrasound 33.5%; CT 32.5%). Laparoscopic appendectomy (LA) was performed in 84.4% of cases with 11.4% open; conversion from laparoscopic to open was only 4.2%. Some 56% paediatric patients had open appendectomy & 44% laparoscopic with no conversions. Trainees were the sole or first operators in 63% of cases. NAR was just 5.7%. Some 21(10.9%) patients were readmitted within 30 days of which 8 had a collection; all were treated conservatively. Conclusions Accurate clinical diagnosis & selective use of imaging in a dedicated EGS unit optimizes outcomes for appendectomy with low NAR & low complication rates. Appendectomy is effectively undertaken by trainees. LA is safely performed in children.

scholarly journals A clinical study on conservative management of acute appendicitis in a tertiary care centre

2021 ◽  
Vol 8 (4) ◽  
pp. 1190
Author(s):  
Bhanu Bharath Naik
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Alvarado Score ◽  
Uncomplicated Appendicitis ◽  
Laboratory Investigations ◽  
Modified Alvarado Score ◽  
Uncomplicated Acute Appendicitis

Background: Acute appendicitis is the most common clinical entity which is treated surgically by appendectomy. In recent years acute uncomplicated appendicitis can also be managed non surgically with antibiotic therapy. Aim and Objective was to assess the outcome of conservative treatment in the management of acute appendicitis.Methods: All patients who were diagnosed as acute appendicitis radiologically were enrolled into the study considering inclusion and exclusion criteria. Modified Alvarado score (MAS) was calculated based on clinical symptoms, signs and laboratory investigations. Injection ceftriaxone and injection metronidazole was given for 48-72 hours. Patients who responded for i.v. antibiotics were switched to tablet ciprofloxacin and tablet metronidazole for 7 days and followed for 6 months. Patients who didn’t respond to conservative treatment or had recurrence were classified as treatment failure/recurrence.Results: Totally 100 patients were enrolled in the study, 43 males and 57 females with a ratio of 1:1.32. Majority were in age group of 21-30. Ultrasound was performed in 91 patients, CT scan in 9 patients. 28 patients had MAS between 4-6 and 72 had between 7-9. 82 patients were successfully managed conservatively. 12 patients had failure of conservative treatment and 6 patients had recurrence.Conclusions: Success rate of conservative treatment in patients with MAS 4-6 was more than those with MAS 7-9 in this study. Complicated acute appendicitis should be managed surgically and uncomplicated acute appendicitis can be managed by conservative treatment provided they are strictly followed every month for 6 months to detect recurrences.

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