Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

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Risk Factors of Perforation of Appendix and Unfavorable Outcome in Delayed Presentation of Acute Appendicitis: A Cross-Sectional Analysis

TAJ Journal of Teachers Association ◽

10.3329/taj.v30i1.39122 ◽

2018 ◽

Vol 30 (1) ◽

pp. 42-48

Author(s):

Sheikh Mohd A Hakim ◽

Md Habibullah Sarkar ◽

Manzurur Rahman Shah Chowdhury

Keyword(s):

Risk Factors ◽

Acute Appendicitis ◽

Hospital Stay ◽

Abscess Formation ◽

Delayed Presentation ◽

Cross Sectional ◽

Generalized Peritonitis ◽

Operative Complications ◽

Appendiceal Perforation ◽

Post Operative Complications

Background: Perforated or gangrenous appendicitis in patient with a lately presented acute appendicitis remains a challenge for practicing surgeons and continues to be associated with more deadly complications. Results might improve with earlier consideration of the diagnosis followed by prompt surgical intervention. Objective: To identify the risk factors of appendiceal perforation, gangrene and other sequelae in patients with delayed presentation of acute appendicitis and its effects on the prognosis. Patients and Methods: This cross-sectional study was carried out from January, 2015 to July, 2017 (2½ years) in Rajshahi medical college hospital and also it’s neighboring several private hospitals. Those patients of both genders between 12 years to 65 years old, admitted during that period with signs and symptoms of acute appendicitis for more than 48 hours but otherwise healthy (i.e. not having any other comorbidities) were subjected to the present study. The parameters of our study were incidence of appendiceal perforation or gangrene, peri-appendiceal abscess formation, generalized peritonitis, length of hospital stay and post-operative complications. Results: During the study period, a total of 73 patients underwent appendicectomies and 23 patients were excluded, leaving 50 who met the inclusion criteria, 23 males (46%) and 27 females (54%). Of all the risk factors studied, the patient’s pre-hospital time delay was the most important risk factor for perforation (43 patients i.e. 86%) and there were little number of patients with the in-hospital delay (7 patients i.e. 14%). The reasons behind this pre-hospital as well as in-hospital delay were multifactorial. Overall appendiceal perforation occurred in 22 (44%) patients, patients presented with gangrenous appendicitis were 14 (28%), periappendiceal abscess formation was found in 9 (18%) patients, and patients presented with generalized peritonitis were 5 (10%). The duration of hospital stay ranged from several days to several weeks. Post-operative complications occurred in 40 (80%) cases. Post-operative complications were monitored and addressed as: prolonged ileus, wound sepsis as major and minor wound infection, intra-abdominal sepsis as pelvic abscess and faecal fistula. Conclusion: As the time course increases from the initiation of the first symptoms to the definitive management, the complication rate increases and acutely inflamed appendicitis gradually converts to more lethal forms.TAJ 2017; 30(1): 42-48

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Is faster better? Impact of operative time on postoperative outcomes after VATS anatomical pulmonary resection

British Journal of Surgery ◽

10.1093/bjs/znab202.075 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

C Forster ◽

A Ojanguren ◽

J Y Perentes ◽

M Zellweger ◽

T Krueger ◽

...

Keyword(s):

Multivariate Analysis ◽

Postoperative Complications ◽

Operative Time ◽

Pulmonary Resection ◽

Length Of Hospital Stay ◽

Postoperative Outcomes ◽

Individual Risk ◽

Operative Complications ◽

The Impact ◽

Post Operative Complications

Abstract Objective Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections. Methods Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short (<150 minutes) and long (≥150 minutes) OTs. A multivariate analysis was carried out to identify predictors of longer OTs and post-operative complications. Results A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p < 0.00001) and the length of hospital stay (6 vs. 7 days; p < 0.00001) were significantly reduced in the short OT group. Two predictors of long OT were identified on multivariate analysis: male sex (OR 1.41, p = 0.04) and neoadjuvant chemotherapy (OR 3.46, p = 0.003). A long OT was identified as an individual predictor of postoperative complications (OR 1.84, p < 0.0001). Conclusion A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.

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The impact of COVID-19 on emergency surgical presentations in a university teaching hospital

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02709-w ◽

2021 ◽

Author(s):

Ahmed M. Kamil ◽

Matthew G. Davey ◽

Fadi Marzouk ◽

Rish Sehgal ◽

Amy L. Fowler ◽

...

Keyword(s):

Acute Appendicitis ◽

Teaching Hospital ◽

Historical Data ◽

Severe Disease ◽

University Teaching ◽

Readmission Rates ◽

Descriptive Data ◽

Operative Complications ◽

Hospital Patients ◽

The Impact

Abstract Introduction The Coronavirus-19 (COVID-19) pandemic has led to a 50–70% reduction in acute non-COVID-19 presentations to emergency departments globally. Aim To determine the impact of COVID-19 on incidence, severity, and outcomes of acute surgical admissions in an Irish University teaching hospital. Methods Descriptive data concerning patients presenting with acute appendicitis, diverticulitis, and cholecystitis were analysed and compared from March–May 2020 to March–May 2019. Results Acute surgical admissions decreased in March from 191 (2020) to 55 (2019) (55%), before increasing by 28% in April (2019: 119, 2020: 153). Admissions due to acute cholecystitis reduced by 33% (2019: 33, 2020: 22), with increased severity at presentation (P = 0.079) and higher 30-day readmission rates (P = 0.056) reported. Acute appendicitis presentations decreased by 44% (2019: 78, 2020: 43, P = 0.019), with an increase in severity (P < 0.001), conservative management (P < 0.001), and post-operative complications (P = 0.029) in 2020 compared to the same period in 2019. Conclusion COVID-19 has potentiated a significant reduction in acute surgical presentations to our hospital. Patients presenting with acute appendicitis during the pandemic had more severe disease, were more likely to have complications, and were significantly more likely to be managed conservatively when compared to historical data.

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Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

International Surgery Journal ◽

10.18203/2349-2902.isj20192078 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1954

Author(s):

Sailendra Nath Paul ◽

Dilip Kumar Das

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Scoring System ◽

Clinical Symptoms ◽

Lower Abdominal Pain ◽

Complication Rates ◽

Alvarado Score ◽

Negative Appendicectomy ◽

Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

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The impact of pre-operative biologic therapy on post-operative surgical outcomes in ulcerative colitis: a systematic review and meta-analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820937089 ◽

2020 ◽

Vol 13 ◽

pp. 175628482093708

Author(s):

Jasmine Zanelli ◽

Subashini Chandrapalan ◽

Abhilasha Patel ◽

Ramesh P. Arasaradnam

Keyword(s):

Ulcerative Colitis ◽

Biologic Therapy ◽

Meta Analysis ◽

Complication Rates ◽

Surgical Morbidity ◽

Biologic Treatment ◽

Operative Care ◽

Operative Complications ◽

The Impact ◽

Post Operative Complications

Background and aims: Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still debatable. This review evaluates the risk of post-operative complications following biologic treatment in patients with UC. Methods: A systematic search of the relevant databases was conducted with the aim of identifying studies that compared the post-operative complication rates of UC patients who were either exposed or not exposed to a biologic therapy prior to their surgery. Outcomes of interest included both infection-related complications and overall surgical morbidity. Pooled odds-ratio (OR) and 95% confidence intervals (CI) were calculated using Review Manager 5.3. Results: In all, 20 studies, reviewing a total of 12,494 patients with UC, were included in the meta-analysis. Of these, 2254 patients were exposed to a biologic therapy prior to surgery. The pooled ORs for infection-related complications ( n = 8067) and overall complications ( n = 11,869) were 0.98 (95% CI 0.66–1.45) and 1.14 (95% CI 1.04–1.28), respectively, which suggested that there was no significant association between the use of pre-operative biologic therapy and post-operative complications. Interestingly, the interval between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection. Conclusions: This meta-analysis suggests that pre-operative biologic therapy does not increase the overall risk of having post-operative infection-related or other complications. PROSPERO registration id-CRD42019141827.

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How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis?

Gastroenterology Report ◽

10.1093/gastro/goz022 ◽

2019 ◽

Vol 7 (4) ◽

pp. 258-262

Author(s):

Aldo Bove ◽

Paolo Panaccio ◽

Raffaella di Renzo ◽

Gino Palone ◽

Marco Ricciardiello ◽

...

Keyword(s):

Bile Duct ◽

Surgical Technique ◽

Operative Time ◽

Single Stage ◽

Surgical Time ◽

Rendezvous Technique ◽

Conversion Rates ◽

Operative Complications ◽

The One ◽

Post Operative Complications

AbstractBackgroundWe utilized transcystic clearance and intra-operative papillotomy through a rendezvous technique for the treatment of cholecysto-choledocolithiasis. The goal of this study was to evaluate the reliability of pre-operative parameters to address the most suitable surgical procedure.MethodsA total of 180 patients affected by calculi of the gallbladder and bile duct underwent the single-stage treatment. According to several pre-operative parameters, 141 patients had to supposedly undergo transcystic clearance of the bile duct, while 39 patients had to be treated with the rendezvous technique. All patients were treated with the sequential procedure: first, we tried the transcystic procedure and, if there was a failure, we used a rendezvous technique. We prospectively analysed each group based on a series of variables such as sex, age, operative time, success rate of proposed treatment, conversion rate, post-operative complications and hospital stay.ResultsTranscystic clearance was successful in 134 out of 141 patients (95.0%), while 2 patients needed to undergo a laparo-endoscopy procedure (failure). Thirty-five out of 39 patients (89.7%) obtained common bile-duct (CBD) clearance through the rendezvous technique, while 1 patient obtained clean-up through the simple transcystic procedure (failure). Five out of 141 patients with transcystic clearance and 3 out of 39 patients with the rendezvous technique underwent laparotomy CBD clearance with conversion rates of 3.5% and 7.7%, respectively. Post-operative complications showed similar percentages for both procedures. However, the surgical time turned out to be longer for the rendezvous technique.ConclusionsThe one-stage procedure for the treatment of cholecysto-choledocolithiasis was possible in 94% of the cases utilizing a surgical technique selected according to the patient’s case history. The pre-operative parameters, such as jaundice, CBD diameters and stone diameters, have certified their reliability as good predictors of the most suitable procedure to follow.

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Selecting the surgical approach in complex reoperative partial nephrectomies: Does robotics have a role?

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.658 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 658-658

Author(s):

Sandeep Gurram ◽

Siobhan Telfer ◽

Winston Li ◽

Heather Chalfin ◽

W. Marston Linehan ◽

...

Keyword(s):

Multivariate Analysis ◽

Robotic Surgery ◽

Surgical Approach ◽

Open Surgery ◽

Perioperative Outcomes ◽

Open Approach ◽

Renal Surgery ◽

Estimated Blood Loss ◽

Operative Complications ◽

Post Operative Complications

658 Background: Minimally invasive surgery (MIS) has shown equal oncologic efficacy as the open approach for treating small renal masses but results in improved perioperative parameters. Surgical principles also dictate that the open technique should be considered when facing difficult surgeries though this is experience and not evidenced based. The goal of our study is to explore differences in outcomes amongst open or robotic approaches in complex reoperative partial nephrectomies. Methods: 194 patients who had prior renal surgery from 2008 to 2019 were identified, the majority of which presented with multiple tumors due to known or suspected hereditary kidney cancer syndrome. Patients were stratified into the following cohorts based on surgical history: open after open surgery, open after MIS, robotic after open surgery, and robotic after MIS. Perioperative outcomes were compared amongst cohorts. Results: Significant differences were noted in estimated blood loss (EBL), number of tumors resected, and postoperative complications as assessed by Clavien score. Univariate regression analysis of EBL showed that the number of tumors resected (p <.0001, coefficient: 111 ml), number of prior renal procedures (p=.012, coefficient: 419 ml), hilar clamping (p = .015, coefficient: 840 ml), and intended surgical approach (p = .001; coefficient: 905 ml) were significant. On multivariate analysis, number of tumors resected (p<.0001, coefficient: 97 ml) was the only significant factor. Univariate analysis on post-operative complications showed that number of prior surgeries (p = 0.03, OR: 1.5) and final intended approach (p < .0001, OR: 4.6) were significant. On multivariate analysis, the final intended surgical approach (p = .001, OR: 4.3) was shown to be significant. Conclusions: These data show that the surgical approach of prior procedures is not a significant factor that affects perioperative outcomes, but the use of robotic surgery was associated with decreased post-operative complications in reoperative renal surgery . While open surgery will likely continue to be the standard of care for complex reoperative procedures, these data suggest that robotic surgery is safe and well tolerated in select cases.

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Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

Asian Journal of Medical Sciences ◽

10.3126/ajms.v13i1.40294 ◽

2022 ◽

Vol 13 (1) ◽

pp. 123-128

Author(s):

Pranita Somani ◽

Priyanka Singh ◽

Mangala Shinde

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Vaginal Discharge ◽

Operative Time ◽

Intraoperative Complications ◽

Vaginal Route ◽

Background Removal ◽

Operative Complications ◽

Post Operative Complications

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

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1106 Timing of Free Flap Reconstruction in Sarcoma Patients

British Journal of Surgery ◽

10.1093/bjs/znab259.719 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A T Misky ◽

S Williams ◽

A Woollard

Keyword(s):

Free Flap ◽

Negative Impact ◽

Trauma Surgery ◽

Surgical Reconstruction ◽

Complication Rates ◽

Tissue Destruction ◽

Microsurgical Reconstruction ◽

Operative Complications ◽

Extremity Reconstruction ◽

Post Operative Complications

Abstract Aim In 1986 Godina reported that microsurgical reconstruction of traumatic wounds in the extremities undertaken with >72-hour delay caused significant tissue damage, hampering the microsurgical reconstruction and significantly increasing complication rates. It is our opinion that surgical treatment of sarcoma in the extremity is comparable to trauma surgery, given the extent of tissue destruction. The nature of sarcoma management often means that performing definitive reconstruction within 72 hours is not possible. We analyse the outcomes of our ‘delayed’ extremity reconstruction. Method We performed a retrospective analysis of 52 consecutive cases of free flap extremity reconstruction following sarcoma excision. Data was analysed for time from resection to reconstruction, significant patient demographics, details of the flap and post-operative complications. Results Between March 2017 and December 2020, we performed 52 free flaps for sarcoma reconstruction in the extremities. Mean time to reconstruction was 28 days (Median 15 days, Range: 0-316 days), with two reconstructions within 72 hours of excision. 9 patients had neoadjuvant chemo- or radiotherapy. Three patients had significant post-operative complications; two flaps failed intra-operatively (3.8%) and one patient (1.9%) experienced wound infection. Conclusions Godina’s study demonstrated the negative impact of delaying surgical reconstruction in the traumatised extremity, with a 12% failure and 17.5% infection rate in delayed reconstruction (72 hours to 3 weeks). Our results show that with advancements in microsurgical techniques and physiological optimization, it is possible to safely and successfully undertake delayed (>72 hours) microsurgical extremity reconstruction in sarcoma patients and achieve low flap failure and infection rates.

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Clinical outcome of appendectomy: laparoscopic vs open technique

International Surgery Journal ◽

10.18203/2349-2902.isj20215137 ◽

2021 ◽

Vol 9 (1) ◽

pp. 93

Author(s):

Jan M. Rather ◽

Sobia Manzoor ◽

Mubashir Shah

Keyword(s):

Clinical Outcome ◽

Acute Appendicitis ◽

Standard Care ◽

Operative Time ◽

Open Appendectomy ◽

Laparoscopic Group ◽

Open Group ◽

Complication Rates ◽

Open Technique ◽

Duration Of Hospital Stay

Background: Acute appendicitis is a common abdominal surgical emergency. Appendectomy has been proven to be the standard care for the treatment of acute appendicitis. Objective of the study was to compare laparoscopic and open appendectomy in terms of clinical outcome and complication rates.Methods: This was a single centric, retrospective study conducted at SKIMS, Soura from May 2018 to April 2021. Open and laparoscopic appendectomy patients were compared in terms of operative times, conversion rate, complication rates and duration of hospital stay.Results: Total 120 patients were included in this study with 40 in laparoscopic group while 80 patients in the open group. Increased operative time in laparoscopic group (p=0.033) and longer duration of hospital stay (p=0.021) with open group while as comparable complication rate in both procedures were observed. Higher rates of intra-abdominal collection in laparoscopic group as compared to open groupConclusions: Both laparoscopic and open appendectomy procedures can be performed routinely for acute appendicitis without the additional risks of complications.

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