The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

Abstract Background: Appendiceal mass sometimes requires extended resection and difficult to treat postoperative complications. Interval appendectomy has been performed mainly in the field of pediatric surgery to avoid them. Recently, there are a few reports on interval laparoscopic appendectomy (ILA). We examined not only the safety and effectiveness of ILA for adult appendiceal mass (AAM), but also the appropriateness of ILA for which cases should be treated non-surgically for ILA or converted to surgical treatment. Methods: Among 956 appendectomies performed between April 2012 and March 2018, there were 49 cases of AAM, of which 34 cases underwent ILA; ILA group. The safety and efficacy of ILA were examined by comparing with 477 cases of adult uncomplicated appendicitis underwent laparoscopic appendectomy (LA); LA group. The appropriateness of ILA was examined by comparing with the remaining 15 cases of AAM; non-ILA group. Results: The ILA group had a longer operation time than the LA group, but the postoperative hospital stay was shorter, and no significant difference were found in the bleeding volume, the days required for oral intake of solid food, and the perioperative complications. Examining the factors for failure of non-surgical treatment or relapse of inflammation during interval period, higher WBC day3 / day0 was found to be an independent risk factor. Conclusion: ILA against AAM was almost as safe and effective as LA for adult uncomplicated appendicitis. WBC day3 / day0 may be effective as an objective parameter for judging the termination of non-surgical treatment for ILA. This determination to convert ineffective non-surgical treatment to surgical treatment earlier may reduce the burden on the patient.

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Defining treatment strategy for uncomplicated appendicitis based on patient satisfaction feedback: A cross-sectional study

10.21203/rs.3.rs-31365/v1 ◽

2020 ◽

Author(s):

Kyota Tatsuta ◽

Shinichiro Miyazaki ◽

Masahito Ogiku ◽

Takashi Harada ◽

Nishiwaki Yoshiro

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Surgical Intervention ◽

Length Of Hospital Stay ◽

Operation Time ◽

Uncomplicated Appendicitis ◽

Significant Difference ◽

Degree Of Satisfaction

Abstract Background Two surgical strategies are available for appendicitis: emergency laparoscopic appendectomy and interval laparoscopic appendectomy. However, timing of surgical intervention remains debatable. This study aimed to compare the surgical outcomes of emergency laparoscopic appendectomy (ELA) and interval laparoscopic appendectomy (ILA) and conduct a questionnaire survey to investigate the use of ELA and patient satisfaction with regard to treatment. Methods We included 162 patients who underwent laparoscopic appendectomy at our hospital. Outcomes were assessed by operation time, blood loss, postoperative fasting time, length of hospital stay, and complication rate. Patient satisfaction was measured by questionnaire addressing degree of satisfaction, pre-surgery anxiety, and length of hospital stay. Continuous variables were compared by Student’s t-test, and discrete variables, expressed as percentages, were analyzed via chi-squared test. Results Of 162 patients, 74 (46%) and 88 (54%) received emergency and ILA, respectively. No significant difference was observed in the operation time, blood loss, length of hospital stay, or complication rate. Among 66 patients who responded to the questionnaire (28 emergency, 38 interval), a significant difference was observed only in the degree of satisfaction regarding the timing of the surgical intervention (p = 0.04). Conclusions Surgical outcomes of emergency and interval appendectomy were equivalent; however, patient satisfaction favored emergency appendectomy, suggesting it is a preferable approach for the treatment of uncomplicated appendicitis. Trial registration: NA

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0003 ◽

2016 ◽

Vol 16 (2) ◽

pp. 12-16

Author(s):

Elina Silina ◽

Asnate Jurgele ◽

Arturs Viksne ◽

Zane Abola ◽

Arnis Engelis ◽

...

Keyword(s):

Treatment Outcome ◽

Surgical Treatment ◽

Acute Appendicitis ◽

Clinical Signs ◽

Drug Combinations ◽

Antimicrobial Drug ◽

Nonsurgical Management ◽

Unsuccessful Treatment ◽

Significant Difference ◽

Non Surgical Treatment

SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

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Evidence-based treatment of osteoporotic vertebral compression fracture

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.3.200 ◽

2021 ◽

Vol 64 (3) ◽

pp. 200-207

Author(s):

Subum Lee ◽

Dae-Chul Cho ◽

Kyong-Tae Kim ◽

Young-Seok Lee

Keyword(s):

Surgical Treatment ◽

Outcome Measurement ◽

Treatment Guideline ◽

Treatment Modalities ◽

Vertebral Compression Fractures ◽

Controlled Trials ◽

Evidence Based ◽

Evidence Based Treatment ◽

Significant Difference ◽

Non Surgical Treatment

The prevalence and medical costs of osteoporotic vertebral compression fractures (OVCFs) are on the rise. However, a concrete evidence-based treatment guideline has not yet been established. Despite that numerous randomized controlled trials (RCTs) were performed, the study design and outcome measurement were heterogeneous, and the results were not unified. The purpose of this review is to compare the results of high level-evidence studies to provide a background for evidence-based OVCF treatment. Many reports showed that vertebroplasty has better clinical outcomes than non-surgical treatment for OVCF, but the results of three double-blinded RCTs with the highest level of evidence did not show a significant difference between vertebroplasty and sham procedure. Whether undergoing surgical or non-surgical treatment, OVCF patient management should be started by managing osteoporosis first. Meanwhile, in the results of RCTs related to the comparison of conservative treatment modalities, the benefit of braces and a specific analgesic prescription protocol was also unclear. The presented results of each clinical trial were generally inconsistent and may not be appropriate in all situations. Any decision by clinicians to apply this evidence must be made considering individual patients and available resources. At present, controversy remains about the best treatment modality for OVCF. Large, multicenter, placebo/sham-controlled trials are needed to address this gap and establish strong evidence-based guidelines.

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Comparison of the Efficacy of Standard Decompressive Craniectomy Combined with Cerebrospinal Fluid Circulation Reconstruction in the Treatment of Severe Craniocerebral Injury

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v3i2.733 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Zhanqing Han ◽

Jianbin Sun ◽

Jingyang Zhong

Keyword(s):

Cerebrospinal Fluid ◽

Surgical Treatment ◽

Decompressive Craniectomy ◽

Operation Time ◽

Control Group ◽

Craniocerebral Injury ◽

Fluid Circulation ◽

Cerebrospinal Fluid Circulation ◽

Significant Difference ◽

Experimental Group

Abstractï¼š Objective: To observe and discuss the clinical effect of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury. Methods: Seventy patients who underwent surgery in our hospital were selected as subjects for this study. The time was from August 2016 to August 2018, and patients were divided into experimental group (35 cases) and control group (35 cases) according to the random number table method. The control group was treated with a single standard decompressive craniectomy according to clinical symptoms. The experimental group was treated with standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction. The surgical treatment effect, GCS (Glasgow Coma Scale) score and operation time were compared between the two groups. Results: After comparison, the surgical treatment effect of the experimental group was higher than that of the control group and there was a significant difference between the two groups (P<0.05). The GCS score and operation time of the experimental group were also better than of the control group and there was a significant difference the two groups (P<0.05). Conclusion: The use of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury is more effective and worthy of widespread promotion and application.

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Arthroplasty Is Not Superior Than Internal Fixation for Intertrochanteric Fractures in the Elderly: a Meta-analysis

10.21203/rs.3.rs-146667/v1 ◽

2021 ◽

Author(s):

Kexiao Yu ◽

Weizhong Lu ◽

Qiuke Xiao ◽

Ruijie Wan ◽

Lujue Dong ◽

...

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Internal Fixation ◽

Meta Analysis ◽

Operation Time ◽

The Elderly ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Increased Risk ◽

Significant Difference

Abstract Background: Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods: The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results: A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR=1.24; 95% CI= 0.90, 1.70; P=0.19), hospital stay (SMD=0.16; 95% CI= -0.5, 0.82; P =0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P =0.71). AR group had a significantly lower rate of complications-related operation (OR= 2.21; 95% CI= 1.41, 3.45; P=0.0005) and reoperation (OR=2.74; 95% CI= 1.57, 4.76; P=0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P<0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P=0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR= 0.67; 95% CI= 0.52, 0.86; P=0.002).Conclusion: AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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Appendix Diameter: A Predictor of Wound Infection after Laparoscopic Appendectomy

The American Surgeon ◽

10.1177/000313481107700319 ◽

2011 ◽

Vol 77 (3) ◽

pp. 307-310 ◽

Cited By ~ 1

Author(s):

Hung-Hua Liang ◽

Weu Wang ◽

Ming-Te Huang ◽

Chin-Sheng Hung ◽

Ko-Li Yen ◽

...

Keyword(s):

Wound Infection ◽

Laparoscopic Appendectomy ◽

Independent Risk Factor ◽

Multivariate Logistic Regression Analysis ◽

Oral Intake ◽

Operation Time ◽

Postoperative Wound Infection ◽

Wound Infections ◽

Multivariate Logistic Regression ◽

Factors Associated

Our aim was to investigate whether appendix diameter is an independent risk factor for wound infection in laparoscopic appendectomy (LA). Patients who underwent LA (n = 582) were grouped into those with wound infections and those without. Possible factors associated with wound infection were analyzed using univariate and multivariate logistic regression analysis. When the diameter of the appendix was greater than 15 mm, patients were 2.32 times as likely to have a wound infection (95% CI, 1.02 to 5.29; P = 0.045) than if the appendix was less than 10 mm in diameter. Patients with perforated appendices were 2.51 times as likely to have a wound infection (95% CI, 1.25 to 5.02; P = 0.010) than if the appendix was not perforated. Wound infection was associated with longer operation time, return to oral intake, and hospital stay. Appendix diameter may predict postoperative wound infection after laparoscopic appendectomy.

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Association of treatments for acute appendicitis with pregnancy outcomes in the United States from 2000 to 2016: Results from a multi-level analysis

PLoS ONE ◽

10.1371/journal.pone.0260991 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260991

Author(s):

Jianzhou Yang ◽

Shi Wu Wen ◽

Daniel Krewski ◽

Daniel J. Corsi ◽

Mark Walker ◽

...

Keyword(s):

Surgical Treatment ◽

Acute Appendicitis ◽

Laparoscopic Appendectomy ◽

Pregnancy Outcomes ◽

Preterm Labor ◽

Open Appendectomy ◽

The United States ◽

Hospital Level ◽

Multi Level ◽

Non Surgical Treatment

Background Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. Methods A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. Results A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3–0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. Conclusions Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section.

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TWO-PORT LAPAROSCOPIC APPENDECTOMY IS MORE BENEFECIAL THAN OPEN APPENDECTOMY IN EARLY ACUTE APPENDICITIS

Folia Medica Indonesiana ◽

10.20473/fmi.v52i2.5229 ◽

2017 ◽

Vol 52 (2) ◽

pp. 131

Author(s):

Vicky S Budipramana

Keyword(s):

Acute Appendicitis ◽

Wound Infection ◽

Laparoscopic Appendectomy ◽

Operating Time ◽

Open Appendectomy ◽

Operation Time ◽

T Test ◽

Small Incision ◽

Post Operative Pain ◽

Significant Difference

Open appendectomy has already commonly been performed to treat acute appendicitis, but the relatively more painful and longer incision scar becomes a cosmetical problem. Two port laparoscopic appendectomy can be performed safely, less painful and leaving only two small incision scars. The aim of the study was to evaluate the benefit of two-port laparoscopic appendectomy and that of with open appendectomy in the case of early acute appendicitis. An observational study was conducted from 2012 to 2014; to compare the operating time, post operative pain and wound infection in early acute appendicitis, performed with two-port laparoscopic appendectomy and with open appendectomy. The statistical analysis in this study uses t-test. There were 114 patients (73 men and 41 women) divided into two groups based on the choice made by the patients themselves. The number of samples performed with two-port laparoscopic appendectomy was 64 and that with open appendectomy was 46. Four patients were excluded from this study. In analysis using t-test, we found that the two-port laparoscopic appendectomy was more beneficial than open appendectomy. There was a significant difference between the two groups, the length of operation time was 37.22 minute in two-port laparoscopic appendectomy and 43.83 minute in open appendectomy (p=0.00), VAS pain score was 1.58 in two-port laparoscopic appendectomy and 2.30 in open appendectomy (p=0.00) and no post operative wound infection in both two groups. The conclusion is two-port laparoscopic appendectomy technique is faster and less painful and the same risk of wound infection than open appendectomy in early acute appendicitis.

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Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

10.21203/rs.3.rs-22149/v1 ◽

2020 ◽

Author(s):

Kexiao Yu ◽

Weizhong Lu ◽

Qiuke Xiao ◽

Ruijie Wan ◽

Lujue Dong ◽

...

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Internal Fixation ◽

Meta Analysis ◽

Operation Time ◽

The Elderly ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Increased Risk ◽

Significant Difference

Abstract Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

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