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 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 Non-Operative Management of Femoroacetabular Impingement: A Prospective Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006 ◽  
Author(s):  
Andrew T. Pennock ◽  
James D. Bomar ◽  
Kristina Parvanta ◽  
Vidyadhar Vinayak Upasani
Keyword(s):  
Prospective Study ◽  
Operative Treatment ◽  
Femoroacetabular Impingement ◽  
Steroid Injection ◽  
Operative Management ◽  
Harris Hip Score ◽  
Labral Tears ◽  
A Prospective Study ◽  
Non Operative Management

Objectives: Little attention has been given to the non-operative management of femoroacetabular impingement (FAI) in the literature despite a rapidly expanding body of research on the topic. The purpose of the current project was to perform a prospective study utilizing a non-operative protocol on a consecutive series of patients presenting to our clinic with FAI. Methods: Between 2013 and 2016, patients referred to our clinic for hip pain that had a positive impingement sign were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification with a focus on avoidance of high hip flexion (Activity Mod group). Patients who remained symptomatic were then treated with an image-guided intra-articular steroid injection (Injection group). Patients with residual symptoms were then offered arthroscopic treatment (Surgery group). Outcome scores were collected at 12 and 24 months. Statistical analysis was performed to identify risk factors for failure of non-operative treatment. Results: 129 symptomatic hips in 100 patients were enrolled. After our exclusion criteria were applied, 110 hips in 84 patients remained with a mean follow-up of 25.5 months. Eighty-one hips (73.6%) were managed with PT, rest, and activity modification alone. Thirteen hips (11.8%) required a steroid injection, but did not progress to surgery. Sixteen hips (14.5%) required arthroscopic management. All three groups saw similar improvements in modified Harris hip score (mHHS)(p=0.706) and non-arthritic hips score (NAHS)(p=0.712). Initial, and most recent, mHHS and NAHS can be found in Table 1. Labral tears were distributed similarly among the three groups (n=41, p=0.09) and saw similar improvements in outcomes (p>0.5) as hips without labral tears. The surgical patients attempted non-operative treatment for a mean of 8.8 months prior to surgical intervention. Delays in surgery were not associated with worse outcomes. Cam lesion size, acetabular coverage, and the presence of a labral tear were not associated with non-operative treatment failure (p=0.579). Conclusion: A large majority of adolescent patients presenting with FAI can be managed nonoperatively with significant improvements in outcomes scores and continuation of sport at a mean follow up of two years. This is the first prospective study evaluating the outcomes of a standardized non-operative protocol for the management of FAI. Our results show that a commitment to non-operative care can work for a large percentage of patients. We will be following these patients further into the future to examine the durability of these results. [Table: see text]

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 Management of acute appendicitis during the COVID-19 pandemic: Views of two Brazilian surgical societies

2021 ◽  
Vol 48 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
LOUISIE GALANTINI LANA DE-GODOY ◽  
TERCIO DE-CAMPOS ◽  
PEDRO DE SOUZA LUCARELLI-ANTUNES ◽  
LUIZ GUSTAVO DE-OLIVEIRA-E-SILVA ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Operative Management ◽  
Chest Ct ◽  
Therapeutic Options ◽  
Non Operative Management

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.

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.

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.

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