open appendicectomy
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2021 ◽  
pp. 11-12
Author(s):  
V. Manmadha Rao M.S ◽  
D. N. S. Sai Kumar ◽  
K. Neelesh

Acute Appendicitis is a common surgical emergency and Open Appendicectomy is widely performed. This study aims to analyze the difference of outcome in peritoneal closure versus Non closure in open appendicectomy. Adult patients (18- 65 years) admitted and operated for Acute appendicitis were studied prospectively from July 2019 to July 2020 at King George Hospital, Visakhapatnam. The intra operative time, post-operative pain, wound infection and duration of hospital stay were analyzed. Between July 2019 and July 2020 there were 86 patients with diagnosis of Acute appendicitis to the emergency casualty of KGH, Visakhapatnam and underwent Open appendicectomy. They were divided into two groups randomly, Group A: Open appendicectomy with peritoneal closure (39) and Group B: Open appendicectomy with non-closure of peritoneum (47). There was found to be a reduction in the duration of surgery, less post operative pain and shorter duration of hospital stay in patients who underwent non-closure of peritoneum compared to patients who underwent peritoneal closure. There was no difference in incidence of post-operative wound infection when compared to closure of peritoneum. Non closure of peritoneum is associated with shorter operative time, reduced requirement of post-operative analgesia and shorter duration of hospital stay and hence can be safely recommended.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Charles Scott ◽  
Anthony Lambert

Abstract Introduction Females of reproductive age with a clinical diagnosis of appendicitis may undergo laparoscopy prior to appendicectomy. This paper advocates laparoscopy after appendicectomy only if the appendix is macroscopically normal in this patient group.  Method A cohort of patients under the care of a single general surgeon is reported. If the appendix was macroscopically normal a laparoscopic port was inserted through the right iliac fossa incision. This single port was used for laparoscopic assessment of the pelvic organs. Results Fourteen females of reproductive age underwent laparoscopy following a macroscopically normal open appendicectomy. No additional laparoscopic ports were required. A benign dermoid ovarian cyst was identified in a 14 year-old which was electively excised following further investigation by a gynaecologist. Two ruptured simple ovarian cysts were also identified. There were no complications reported in this patient group. Conclusions Laparoscopy following a macroscopically normal open appendicectomy allows assessment of the pelvic organs in females of reproductive age and reduces the number of ports required during surgery.  


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  

Abstract Introduction Concerns relating to COVID-19 and general anaesthesia prompted our department to consider that open appendicectomy under spinal anaesthesia (SA) avoids aerosolisation from intubation and laparoscopy. Whilst common in developing nations, it is unusual in the United Kingdom (UK). We present the first UK case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from 25th March 2020 until the surgical department reverted to laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (4/7) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) post-operative events. Two patients suffered minor post-operative complications. Two experienced intra-operative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days respectively. Although four stated preference in hindsight for general anaesthesia (GA), the majority (5/7) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe, feasible and acceptable in the UK. The technique could be a valuable contingency for COVID suspected cases and patients with high-risk respiratory disease.


2021 ◽  
pp. 74-76
Author(s):  
Manas Karmakar ◽  
Pallab Kanti Nath ◽  
Ashok Das

INTRODUCTION One of the important responsibilities of an Anaesthesiologist is to maintain a patent airway during any surgical procedure. Since the early days of Anaesthesia, various efforts have been made to dispel the problem of airway maintenance. AIMS AND OBJECTIVES The study entitled “LMAProSeal: An alternative to endotracheal intubation in open appendicectomy operation” was conducted with the aims to compare the efcacy of LMA ProSeal and Endotracheal Tube in patients undergoing Open Appendectomy under General Anaesthesia. MATERIALAND METHODS Study Area: This study was conducted in Medical College, Kolkata (West Bengal), under the department of Anaesthesiology in General Surgery Operation Theatre (C. B. Top OT/ Green OTComplex), after clearance from the Hospital ethical committee, during the period from 1st may 2013 to 31st January 2014. Awritten informed consent was taken from all patients included in the study. StudyPopulation:Patients postedforopenAppendicectomyoperationwithBMIbetween18.50–24.99kg/m2andbodyweightbetween30—60kg. Sample Size: 100 RESULTS AND OBSERVATIONS The effects were observed by monitoring heart rate, blood pressure and SPO2 preoperatively (as baseline), after intubation or placement of LMAProSeal at 1 min, 3 mins, 5mins and every 5 mins thereafter till the reading at removal of the device. For both the groups baseline ETCO2 was taken from connection of ETCO2 cable following placement of airway devices. SUMMARY AND CONCLUSION The study revealed that both the airway devices (ET tube and LMA ProSeal) were successful in operative procedure (open appendicectomy) in all the patients without any signicant complication. In experienced hands and following a strict protocol of insertion, the LMA ProSeal can prove to be an efcient and safe alternative to endotracheal tube for airway management of elective patients undergoing laparotomy procedure like open appendicectomy.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Valdone Kolaityte ◽  
Ishani Mukhopadhyay ◽  
Daniel Newport ◽  
Imran Aslam

Abstract Background Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it. Methods This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods. Results 190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = <0.001), open appendicectomy (34.7% vs 3.4% P = <0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p > 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%. Conclusions Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.


2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Matthew Davenport ◽  
Alex Clarke ◽  
Stella Smith ◽  
Panos Stathakis ◽  
Christian Macutkiewicz ◽  
...  

Abstract Aims This study assesses the impact of COVID-19 on the presentation and management of acute appendicitis (AA). Patients presenting with AA during the first wave of the COVID-19 pandemic are compared to a pre-COVID-19 cohort. Methods Patients admitted to a single acute NHS hospital with AA between April and July in 2019 and 2020 were retrospectively identified. Data on presentation, treatment and outcomes was collected. Results 56 patients were identified in 2019, and 37 in 2020. A greater proportion of patients presented later (>3 days of symptoms) in 2020 (2019=15.6%, 2020=32.4%, p < 0.05). There was no significant difference in the proportion of patients presenting systemically unwell (pyrexial & tachycardic) or with high inflammatory markers (CRP > 50 and white cell count > 15). In 2020, more patients were managed conservatively (2019=7.1%, 2020=35.1%, p < 0.05). Among those who were managed operatively, 75% underwent open appendicectomy in 2020, compared to 7.7% (including cases converted to open from laparoscopic) in 2019. Patients managed operatively during the COVID-19 pandemic had significantly more post-operative complications (2019=17.3%, 2020=50%, p < 0.05). Common post-operative complications in 2020 were abdominal collections (16.7%) and wound infections (12.5%). Median duration of admission was similar (2019=3 days, 2020=2 days) and there was no significant difference in 30-day readmissions (2019=8.9%, 2020=13.5%, p = 0.48). Conclusions AA patients in the COVID-19 pandemic were more likely to present later and were more likely to be managed conservatively or with open appendicectomy. There was a higher rate of post-operative complications for patients in 2020. Duration of stay and readmission rates were similar.


2021 ◽  
Vol 8 ◽  
Author(s):  
Jia Zhang ◽  
Miye Wang ◽  
Zechang Xin ◽  
Ping Li ◽  
Qingbo Feng

To explore the updated evaluation about the obstetrical and perioperative outcomes of laparoscopic appendicectomy (LA) for pregnancy appendicitis compared with open appendicectomy (OA). Two reviewers independently searched the PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science databases to screen eligible studies up to December 2020. Only clinical researches, no < 10 cases for LA and OA group were included. Twenty retrospective studies with 7,248 pregnant women, evaluating LA and OA in surgical and obstetrical outcomes, were included. The weighted mean difference (WMD) with 95% CI and odds ratio (OR) was used to compare continuous and dichotomous variables. It seems LA was connected with significantly shorter hospital time and lower wound infection [mean difference (MD), −0.57 days; 95% CI, −0.96 to −0.18; p = 0.004 and OR, 0.34; 95% CI, 0.18 to 0.62; p = 0.0005, respectively]. The incidence of fetal loss after LA was higher than OA (OR,1.93; 95% CI, 1.39–2.69; p < 0.0001). It was almost similar in the rate of preterm delivery (OR, 0.80; 95% CI, 0.48 to 1.34; p = 0.40) and other perioperative and obstetrical complications (p > 0.05). Our results indicated that the occurrence of fetal loss after LA should not be ignored. Caution, skillful operation, and thoroughly informed consent about the advantages and disadvantages of laparoscopy are necessary.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42021233150.


Author(s):  
Johnathon Harris ◽  
Christina A. Fleming ◽  
Paul N. Stassen ◽  
Daniel Mullen ◽  
Helen Mohan ◽  
...  

Abstract Background Appendicitis is a common general surgical emergency. The role of removing a normal appendix is debated. However, this relies on accurate intra-operative diagnosis of a normal appendix by the operating surgeon. This study aimed to compare surgeon’s intra-operative assessment to final histological result acute appendicitis in paediatric and adult patients. Methods All patients who underwent appendicectomy over a 14-year period in a general surgical department were identified using the prospective Lothian Surgical Audit system and pathology reports retrieved to identify final histological diagnosis. Open appendicectomy was selected to examine, as the routine practise at our institution is to remove a normal appendix at open appendicectomy. Results A total of 1035 open appendicectomies were performed for clinically suspected appendicitis. Sensitivity of intra-operative diagnosis of appendicitis with operating surgeon was high at 95.13% with no difference between trainee and consultant surgeon or between adult and paediatric cases. Specificity of intra-operative diagnosis was lower in the paediatric group (32.58%) than in the adult group (40.58%). Women had a higher rate of negative appendicectomy than men. Conclusion The results of this study highlight some discordance between histological evidence of acute appendicitis and intra-operative impression. Therefore other clinical variables and not just macroscopic appearance alone should be used when deciding to perform appendicectomy.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Karagiannidis ◽  
O Toma ◽  
E Mallidis ◽  
F Youssef

Abstract Aim The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow. Method Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020. Results During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period. Conclusions The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Carlile

Abstract Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.


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