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Feng SJ, Zhou YF, Yang JF, Shen HZ, Cui GX, Zhang XF. Is appendoscope a new option for the treatment of acute appendicitis? World J Gastroenterol 2024; 30:3386-3392. [PMID: 39091716 PMCID: PMC11290393 DOI: 10.3748/wjg.v30.i28.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
Acute appendicitis is a common surgical emergency. It is commonly caused by obstruction of the appendiceal lumen due to fecaliths, tumors, or lymphoid hyperplasia. For over a century, appendectomy has been the primary treatment for acute appendicitis. Abraham Groves performed the first open appendectomy in 1883. In 1983, Kurt Semm completed the first laparoscopic appendectomy, heralding a new era in appendectomy. However, appendectomy is associated with certain complications and a rate of negative appendectomies. Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson's disease, but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer, gallstones, and cardiovascular disease. With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic te-chnology, Liu proposed the endoscopic retrograde appendicitis therapy. It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis. Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis. This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.
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Affiliation(s)
- Shu-Jiong Feng
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Yi-Feng Zhou
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Feng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Hong-Zhang Shen
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Guang-Xing Cui
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
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Prajapat B, Chejara R, Mittal MK, S V A, Kalwaniya DS. Evaluation of Factors Predicting Successful Outcome in Patients Undergoing Expectant Management of Uncomplicated Acute Appendicitis. Cureus 2023; 15:e48687. [PMID: 38024038 PMCID: PMC10640851 DOI: 10.7759/cureus.48687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Expectant management, or non-operative management (NOM), with standalone intravenous antibiotic therapy, has emerged as an effective alternative to appendectomy for the treatment of uncomplicated acute appendicitis. Various clinical, biochemical, and radiological factors have been implicated in predicting the success or failure of outcomes. Therefore, it is important to identify patients at the onset who are likely to have successful outcomes for conservative management of uncomplicated acute appendicitis. METHODS We prospectively enrolled 85 surgical patients diagnosed with uncomplicated acute appendicitis in our study. On admission, clinical features such as duration of symptoms, pulse rate (PR), history of fever within 24 hours of admission, modified Alvarado score and adult appendicitis score, biochemical parameters such as C-reactive protein (CRP), and hematological parameters such as total leukocyte count (TLC) were recorded. Radiological imaging of patients, namely ultrasonography and contrast-enhanced CT abdomen to evaluate appendix diameter and mural enhancement, was also undertaken. The outcome of expectant management for these patients (success or failure) was recorded, and the above-mentioned factors were evaluated to find a possible correlation with successful expectant management. RESULTS We found that among 85 patients, 77.6% had a successful NOM of appendicitis, whereas 22.4% had a failed NOM of appendicitis. The duration of symptoms, pulse rate, fever within 24 hours of admission, TLC, percentage of neutrophils, CRP level, appendix diameter, modified Alvarado score, and adult appendicitis score were found to be statistically significant predictors of successful NOM of appendicitis according to univariate analysis. According to multivariable analysis, pulse rate and appendix diameter value were found to be statistically significant predictors of successful NOM of appendicitis. With each beat per minute (bpm) increase in pulse rate, there was a 0.30% decrease in the probability of a successful NOM of appendicitis. With each mm increase in appendix diameter, there was an 82% decrease in the probability of a successful NOM of appendicitis. CONCLUSION From our study, it can be concluded that patients who met the following criteria, i.e., duration of symptoms before presenting to surgical emergency less than two days, presence of fever within 24 hours of presenting to surgical emergency, pulse rate >90 bpm, TLC >12000 cells/dL, CRP >20 mg/L, appendix diameter >10 mm, modified Alvarado score ≥ 9, and adult appendicitis score ≥ 18, have a higher probability of failure of NOM and hence should be excluded from expectant management.
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Affiliation(s)
- Bhrigu Prajapat
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rajkumar Chejara
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | | | - Arya S V
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Dheer S Kalwaniya
- General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Omling E, Salö M, Saluja S, Bergbrant S, Olsson L, Björk J, Hagander L. A Nationwide Cohort Study of Outcome after Pediatric Appendicitis. Eur J Pediatr Surg 2021; 31:191-198. [PMID: 32590867 PMCID: PMC10499502 DOI: 10.1055/s-0040-1712508] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/16/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Children with appendicitis often present with complicated disease. The aim of this study was to describe the clinical management of pediatric appendicitis, and to report how disease severity and operative modality are associated with short- and long-term risks of adverse outcome. MATERIALS AND METHODS A nationwide retrospective cohort study of all Swedish children (<18 years) diagnosed with appendicitis, 2001 to 2014 (n = 38,939). Primary and secondary outcomes were length of stay, surgical site infections, readmissions, 30-day mortality, and long-term risk of surgery for small bowel obstruction (SBO). Implications of complicated disease and operative modality were assessed with adjustment for age, gender, and trends over time. RESULTS Complicated appendicitis was associated with longer hospital stay (4 vs. 2 days, p < 0.001), increased risk of surgical site infection (5.9 vs. 2.3%, adjusted odds ratio [aOR]: 2.64 [95% confidence interval, CI: 2.18-3.18], p < 0.001), readmission (5.5 vs. 1.2, aOR: 4.74 [95% CI: 4.08-5.53], p < 0.001), as well as long-term risk of surgery for SBO (0.7 vs. 0.2%, adjusted hazard ratio [aHR]: 3.89 [95% CI: 2.61-5.78], p < 0.001). Intended laparoscopic approach was associated with reduced risk of surgical site infections (2.3 vs. 3.1%, aOR: 0.74 [95% CI: 0.62-0.89], p = 0.001), but no overall reduction in risk for SBO; however, successful laparoscopic appendectomy was associated with less SBO during follow-up compared with open appendectomy (aHR: 0.27 [95% CI: 0.11-0.63], p = 0.002). CONCLUSION Children treated for complicated appendicitis are at risk of substantial short- and long-term morbidities. Fewer surgical site infections were seen after intended laparoscopic appendectomy, compared with open appendectomy, also when converted procedures were accounted for.
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Affiliation(s)
- Erik Omling
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Martin Salö
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Saurabh Saluja
- Department of Surgery, Weill Cornell Medicine, New York, New York, United States
| | - Sanna Bergbrant
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Louise Olsson
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Björk
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Skåne, Sweden
| | - Lars Hagander
- Pediatric Unit, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
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Bertrand MM, Loubet P, Cuvillon P, Prudhomme M. Acute appendicitis management: several options. Anaesth Crit Care Pain Med 2021; 40:100798. [PMID: 33450418 DOI: 10.1016/j.accpm.2021.100798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Martin M Bertrand
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Department of Visceral Surgery, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France.
| | - Paul Loubet
- VBMI, INSERM U1047, Université de Montpellier, 34000 Montpellier, France; Department of Infectious and Tropical Diseases, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
| | - Philippe Cuvillon
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Anaesthesiology Department, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
| | - Michel Prudhomme
- EA 2992 IMAGINE, Prévention et Prise en Charge de la Défaillance Circulatoire des Patients en état de Choc, 30000 Nîmes, France; Department of Visceral Surgery, CHU Nîmes, Univ Montpellier, 30000 Nîmes, France
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Early Postoperative Small Bowel Obstruction After Appendectomy Because of Staples in Pediatric Patients. J Surg Res 2020; 254:314-317. [PMID: 32505924 DOI: 10.1016/j.jss.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/18/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
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Bajcurová K, Novák P, Korčáková E, Mírka H, Geiger J, Rajal P, Daum O, Podolcová M. Submucosal mucoid as a late complication after appendectomy-A case report. Int J Surg Case Rep 2019; 58:37-40. [PMID: 31003092 PMCID: PMC6475718 DOI: 10.1016/j.ijscr.2019.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Shortly after an operation infection, intraabdominal abscess, seroma, haemorrhage or development of paralytic ileus may occur. Postoperative adhesions, nonspecific abdominal pain without signs of obstruction, incisional hernia and appendicitis or mucocele in appendiceal stump present common late complications. We present a unique case of a late complication after appendectomy. PRESENTATION OF CASE The case report describes a unique expansion in the ascending colon of a young athlete with long-lasting abdominal pain in the lower right quadrant. Colonoscopy showed a lesion in a wall of the ascending colon. Computed tomography (CT) confirmed a cystoid formation of high content density in a wall of the caecum. A right hemicolectomy was performed. Histology showed a lesion located in the submucosa with intestinal lining and stroma rich in lymphoid cells. These are the typical attributes of the wall of the appendix. Other parts of the wall were not demonstrated, and there was no communication with the lumen of the native bowel. CONCLUSION A submucosal cavity filled with acellular matter, which were probably disintegrated epithelioid structures, and calcifications were found in the ascending colon, while no intestinal cell atypia or dysplasia was found. The case cannot be classified under any previously presented diagnosis.
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Affiliation(s)
- Kristýna Bajcurová
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic.
| | - Petr Novák
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Eva Korčáková
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Petr Rajal
- Department of Internal Medicine, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
| | - Ondřej Daum
- Pathological-anatomical Šikl Institute, Charles University Medical School in Pilsen, Teaching Hospital in Pilsen, Dr. E. Beneše 13, 305 99, Pilsen, Czech Republic
| | - Marcela Podolcová
- Radiological Department, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
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Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, De' Angelis GL, Gaiani F, Di Mario F, Tomasoni M, Catena F, Ansaloni L. Conservative treatment of acute appendicitis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:119-134. [PMID: 30561405 PMCID: PMC6502196 DOI: 10.23750/abm.v89i9-s.7905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Acute appendicitis has been considered by surgeons a progressive disease leading to perforation for more than 100 years. In the last decades the theories about this concept gained attention, especially in adults. However, appendectomy for acute appendicitis remains the most common urgent/emergent surgical procedure. At present, accumulating evidences are showing the changing in clinical practice towards the non-operative management of several cases of acute appendicitis either non-complicated or complicated. The present review aims to show the literature results regarding the non-operative management of acute appendicitis in non-complicated and in complicated cases.
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Affiliation(s)
- Federico Coccolini
- Emergency, General and Trauma Surgery dept., Bufalini hospital, Cesena, Italy.
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Rasmussen T, Fonnes S, Rosenberg J. Long-Term Complications of Appendectomy: A Systematic Review. Scand J Surg 2018; 107:189-196. [PMID: 29764306 DOI: 10.1177/1457496918772379] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Appendectomy is a common surgical procedure, but no overview of the long-term consequences exists. Our aim was to systematically review the long-term complications of appendectomy for acute appendicitis. MATERIALS AND METHODS This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42017064662). The databases PubMed and EMBASE were searched for original reports on appendectomy with n ≥ 500 and follow-up >30 days. The surgical outcomes were ileus and incisional hernia; other outcomes were inflammatory bowel disease, cancer, fertility, and mortality. RESULTS We included 37 studies. The pooled estimate of the ileus prevalence was 1.0% over a follow-up period of 4.6 (range, 0.5-15) years. Regarding incisional hernia, we found a pooled estimate of 0.7% prevalence within a follow-up period of 6.5 (range, 1.9-10) years. Ulcerative colitis had a pooled estimate of 0.15% prevalence in the appendectomy group and 0.19% in controls. The opposite pattern was found regarding Crohn's disease with a pooled estimate of 0.20% prevalence in the appendectomy group and 0.12% in controls. No clear pattern was found regarding most of the examined cancers in appendectomy groups compared with background populations. Pregnancy rates increased after appendicitis compared with controls in most studies. Mortality was low after appendectomy. CONCLUSION Appendectomy had a low prevalence of long-term surgical complications. We did not find any significant other long-term complications, though the prevalence of Crohn's disease was higher and the prevalence of ulcerative colitis was lower after appendectomy than in controls. Appendectomy did not impair fertility.
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Affiliation(s)
- T Rasmussen
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - S Fonnes
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - J Rosenberg
- Centre for Perioperative Optimization (CPO), Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
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Bolger JC, Kelly ME, Barry K. Acute Appendicitis in the Adult Population: Modelled Decision Analysis Supports a Conservative Approach. J Gastrointest Surg 2015; 19:2249-57. [PMID: 26361771 DOI: 10.1007/s11605-015-2934-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/31/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Acute appendicitis represents the commonest cause of acute intra-abdominal pathology. Appendectomy and antibiotics are the mainstay of therapy for appendicitis. Evidence is emerging that antibiotics alone may adequately treat most cases of appendicitis. Decision analysis is a quantitative method of examining alternate treatment strategies. This study describes a modelled decision analysis comparing operative and conservative management of appendicitis. METHODS The base case patient is a healthy, 23-year-old male presenting with migratory pain to the right iliac fossa (RIF) and elevated inflammatory markers. A decision tree was constructed comparing operative and conservative treatment. Rates of complications, failure of conservative therapy, recurrence and utilities were calculated via a systematic literature review. Variables were tested for sensitivity. RESULTS Overall, conservative management gives a significantly better outcome (51.51 vs 49.87 QALYs). Three variables proved sensitive. Once operative complication rates are lower than 11.5 %, surgical treatment becomes the optimal strategy. If rates of failure of conservative management exceed 12.9 %, surgery becomes optimal. If the utility assigned to a post-operative complication exceeds 0.44, surgery becomes optimal. CONCLUSIONS This decision analysis supports a conservative strategy, albeit with caveats. If operative complications are low or rates of failure of conservative management remain high, surgery is the preferable strategy.
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Affiliation(s)
- Jarlath Christopher Bolger
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland.
| | - Michael Eamon Kelly
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland
| | - Kevin Barry
- Department of Surgery, Mayo General Hospital, Saolta University Hospital Group, Castlebar, Co Mayo, Ireland.,Discipline of Surgery, National University of Ireland Galway, Galway, Ireland
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Steiner Z, Buklan G, Stackievicz R, Gutermacher M, Erez I. A role for conservative antibiotic treatment in early appendicitis in children. J Pediatr Surg 2015; 50:1566-8. [PMID: 26341885 DOI: 10.1016/j.jpedsurg.2015.04.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 03/10/2015] [Accepted: 04/20/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate whether antibiotics without surgery is sufficient treatment for children with clinically and ultrasonographically suspected acute appendicitis (AA). METHOD Children with clinical, laboratory and radiological findings suspicious for AA were evaluated prospectively. Patients with mild clinical signs, without peritonitis were considered for IV followed by oral antibiotics without surgery. RESULTS From 1 November 2013 through 30 June 2014, 45 children were diagnosed with early, acute appendicitis. Ages ranged from 4 to 15 years (mean 9.3) and 32 (75%) were boys. All had routine, clinical laboratory and ultrasound workup. Forty-two improved with antibiotic treatment and were discharged home within 3-5 days, without surgery. Three of them were operated on within 24 hours, another two underwent appendectomy for recurrent appendicitis: one at 2 weeks and the other 2 months after discharge. There was no more recurrent appendicitis in 6-14-month follow-up. CONCLUSION Our series of patients with AA treated with antibiotics only are a product of the observation that some children improve with antibiotics alone at a stage in which surgery is still debatable. These results (89% success rate) support the conservative approach in cases of early appendicitis, without increased morbidity in failed cases.
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Affiliation(s)
- Zvi Steiner
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Genady Buklan
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Rodica Stackievicz
- Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Michael Gutermacher
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Ilan Erez
- Department of Pediatric Surgery, Meir Medical Center, Kfar Saba, Israel; Tel Aviv University, Tel Aviv, Israel
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Jiang TH, Sun XJ, Chen Y, Cheng HQ, Fang SM, Jiang HS, Cao Y, Liu BY, Wu SQ, Mao AW. Percutaneous needle decompression in treatment of malignant small bowel obstruction. World J Gastroenterol 2015; 21:2467-2474. [PMID: 25741156 PMCID: PMC4342925 DOI: 10.3748/wjg.v21.i8.2467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/29/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and safety of percutaneous needle decompression in the treatment of malignant small bowel obstruction (MSBO).
METHODS: A prospective analysis of the clinical data of 52 MSBO patients undergoing percutaneous needle decompression was performed.
RESULTS: Percutaneous needle decompression was successful in all 52 patients. Statistically significant differences were observed in symptoms such as vomiting, abdominal distension and abdominal pain before and after treatment (81.6% vs 26.5%, 100% vs 8.2%, and 85.7% vs 46.9%, respectively; all P < 0.05). The overall significantly improved rate was 19.2% (11/52) and the response rate was 94.2% (49/52) using decompression combined with nasal tube placement, local arterial infusion of chemotherapy and nutritional support. During the one-month follow-up period, puncture-related complications were acceptable.
CONCLUSION: Percutaneous needle intestinal decompression is a safe and effective palliative treatment for MSBO.
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Endoscopic retrograde appendicitis therapy (ERAT) : a multicenter retrospective study in China. Surg Endosc 2014; 29:905-9. [PMID: 25106722 DOI: 10.1007/s00464-014-3750-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 07/11/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Endoscopic retrograde appendicitis therapy (ERAT) is a new procedure for the treatment of acute uncomplicated appendicitis. The aim of the study was to review the clinical outcomes of ERAT and further examine its effectiveness and safety. METHODS The study was performed on patients who underwent ERAT for acute uncomplicated appendicitis at three tertiary hospitals in China from December 2009 to May 2013. Patient demographics, technique aspects of the ERAT procedures, clinical success (resolution of symptoms and normalization of laboratory tests), time until resumption of diet, and hospital stay were analyzed, and complications and recurrence were followed up. RESULTS Forty-one patients were entered, among which 34 patients were definitely diagnosed as having acute uncomplicated appendicitis; in 7 patients, acute appendicitis was excluded by endoscopic retrograde appendicography. Thirty-three patients completed ERAT except one patient who failed appendiceal cannulation. Abdominal pain resolved immediately in 32 patients, and clinical success rate was 97 %. There was one failure case (3 %) that complicated perforation after 48 h received emergency appendectomy. The median follow-up period was 12 months (IQR = 9-23 months). During follow-up, there were no long-term complication; 2 patients (6.2 %) had recurrent abdominal pain and received appendectomy (one had a histologically normal appendix). CONCLUSIONS ERAT is an effective method to diagnose and treat acute uncomplicated appendicitis. Multicenter prospective clinical trials are needed to confirm its utility and place in the management of suspected acute appendicitis.
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Long-term follow-up for adhesive small bowel obstruction after open versus laparoscopic surgery for suspected appendicitis. Ann Surg 2014; 259:1173-7. [PMID: 24374517 DOI: 10.1097/sla.0000000000000322] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the present study was to compare the frequency of readmissions due to small bowel obstruction (SBO) after open versus laparoscopic surgery performed for suspected acute appendicitis. BACKGROUND Appendicitis is a common disease, with a lifetime risk of approximately 7%. Appendectomy is the treatment of choice for most patients. Postoperative adhesions are common after abdominal surgery, including appendectomy. MATERIALS AND METHODS Consecutive patients, 16 years or older, operated on because of suspected appendicitis at 2 university hospitals between 1992 and 2007 were included. The prime approach was open at one hospital and laparoscopic at the other hospital. Open and laparoscopic procedures were compared retrospectively, reviewing the patients' charts until the middle of 2012. Hospitalization for SBO after index surgery was registered. RESULTS A total of 2333 patients in the open group and 2372 patients in the laparoscopic group were included. The frequency of hospitalization for SBO was low in both groups, although a difference between the groups was identified (1.0% in the open group and 0.4% in the laparoscopic group) (P = 0.015). CONCLUSIONS Hospitalization due to SBO, between open and laparoscopic procedures, in patients operated on because of suspected appendicitis demonstrated a significant difference, favoring the laparoscopic approach. The frequency of SBO after the index surgery was, though, low in both groups.
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Posaric-Bauden M, Isaksson K, Akerberg D, Andersson R, Tingstedt B. Novel anti-adhesive barrier Biobarrier reduces growth of colon cancer cells. J Surg Res 2014; 191:196-202. [PMID: 24801543 DOI: 10.1016/j.jss.2014.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 03/08/2014] [Accepted: 04/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative peritoneal carcinomatosis together with adhesion formation are considered as two major clinical complications after resection of malignant abdominal tumors, jeopardizing the beneficial effect of the curative surgery. Biobarrier is a novel anti-adhesive barrier fulfilling the criteria for a good adhesion preventive agent, possessing biochemical properties that may enable it to function as a dual efficient device, reducing both adhesion and tumor development. This study aims to evaluate the effect of novel anti-adhesive device Biobarrier on intra-abdominal tumor progression. MATERIALS AND METHODS Cells from cancer cell line BN7005H1D2 were treated with Biobarrier to determine the effect of Biobarrier on cell attachment and viability in vitro. For the in vivo experiments, bilateral peritoneal trauma was inflicted in a reproducible syngeneic rat model. To mimic the clinical situation, the animals received an intraperitoneal injection of BN7005H1D2 cancer cells at the end of surgery, resembling perioperative tumor spill after intraperitoneal instillation of Biobarrier. Animals without given anti-adhesive treatment were used as control. RESULTS Biobarrier applied in vitro hindered cells from attachment to the wells. In vivo treatment with Biobarrier significantly reduced tumor growth at both sites of surgical trauma (P = 0.001 and 0.015) and other non-traumatized intraperitoneal sites (P = 0.021). CONCLUSIONS Biobarrier maybe effective in reducing intra-abdominal tumor cell implantation with subsequent tumor development in conjunction with peritoneal trauma in a syngeneic rat model.
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Affiliation(s)
- Monika Posaric-Bauden
- Department of Surgery, Skåne University Hospital at Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karolin Isaksson
- Department of Surgery, Skåne University Hospital at Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Akerberg
- Department of Surgery, Skåne University Hospital at Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Roland Andersson
- Department of Surgery, Skåne University Hospital at Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Skåne University Hospital at Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
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Hansson J, Khorram-Manesh A, Alwindawe A, Lundholm K. A model to select patients who may benefit from antibiotic therapy as the first line treatment of acute appendicitis at high probability. J Gastrointest Surg 2014; 18:961-7. [PMID: 24263678 DOI: 10.1007/s11605-013-2413-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/04/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Randomized studies indicated that 88-95% of patients with acute appendicitis recover on antibiotics without surgery, although it is unclear which patient would benefit with high probability on antibiotics. We hypothesized that patients with phlegmonous appendicitis should be a group where antibiotics may be a sufficient treatment. Accordingly, our aim was to propose a model to support treatment application for unselected patients with acute appendicitis. METHODS Retrospective analyses of preoperative clinical and laboratory variables in 384 consecutive adult patients, who underwent appendectomy with histological examination of the appendix, were evaluated by logistic regressions. The proposed mathematical model was then evaluated on a prospectively collected population based material of 581 consecutive patients offered antibiotics as their first line treatment of acute appendicitis. RESULTS Patients with assumed appendicitis who fulfilled all criteria with CRP <60 g/L, WCC <12 × 10(9)/L, and age <60 years had 89% probability to have phlegmonous appendicitis. When these criteria were applied retrospectively on a prospective material, 88% of operated patients had phlegmonous inflammation and 89% had recovered on antibiotics without surgery. CONCLUSION Standard clinical and laboratory tests are individually weak predictors of phlegmonous appendicitis, but can be used in combinations as a bedside instrument to select patients suitable for antibiotic therapy.
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Affiliation(s)
- Jeanette Hansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Torres K, Trębacz H, Bącik-Donica M, Atras A, Torres A, Plewa Z. Does thermodynamic stability of peritoneal collagen change during laparoscopic cholecystectomies? A differential scanning calorimetry (DSC) study. Surg Endosc 2014; 28:2623-6. [PMID: 24687418 PMCID: PMC4124257 DOI: 10.1007/s00464-014-3513-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
Background Carbon dioxide pneumoperitoneum used during laparoscopic surgeries alters the integrity of the peritoneum and results in denudation of the basal lamina that might cause altered immune response, inhibited fibrinolysis, hypoxia, and acidosis. The changes in the structure of pneumoperitoneum were described as bulging of mesothelial cells, irregular cell junction’s cell membrane degradation, and mesodermal edema. As denaturation of peritoneal proteins reflects overall condition of its structure and interactions with the surrounding molecules, the physical status of collagen was assessed on the basis of parameters of thermal denaturation measured by DSC method. Methods Twenty-four female patients operated on due to cholelithiasis were enrolled in this study. Laparoscopic cholecystectomy was performed using standard four-trocar technique, and standard values of insufflated carbon dioxide pneumoperitoneum were used. After trocar placement, the first collection of peritoneal sample (sample A) was performed. The second peritoneal sample (sample B) was collected after the removal of gall bladder. Differential scanning calorimetry (Q200 calorimeter, TA Instruments) was performed on samples defrosted at room temperature. Results In all samples of peritoneum, a nonreversible endothermal process recognized as denaturation was observed. Sample B obtained at the end of surgery did not differ from sample A obtained at the beginning in terms of all parameters under study. Temperature of denaturation in A and B was correlated only marginally, but enthalpy and specific heat were significantly correlated. The analysis of data from DSC measurements did not reveal differences in physical stability of collagen in peritoneal samples obtained at the beginning and at the end of surgery. Significant negative correlations between duration of CO2 pneumoperitoneum and enthalpy of denaturation in sample B were found. Conclusions Differences in enthalpy of denaturation may reflect a quantitative relation between amount of native collagen molecules in the sample and other, non-collagenous components or impaired collagen.
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Affiliation(s)
- Kamil Torres
- Human Anatomy Department, Laboratory of Medical Simulation, Medical University of Lublin, Jaczewskiego 4, 20-094, Lublin, Poland,
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Ditzel M, van Ginhoven TM, van der Wal JBC, Hop W, Coene PPLO, Lange JF, van der Harst E. What patients and surgeons should know about the consequences of appendectomy for acute appendicitis after long-term follow-up: factors influencing the incidence of chronic abdominal complaints. J Gastrointest Surg 2013; 17:1471-6. [PMID: 23733362 DOI: 10.1007/s11605-013-2235-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 05/13/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Abscess formation and perforation are complications of acute appendicitis that lead to localized or generalized peritonitis. The long-term implications of complicated appendectomy remain largely unknown. MATERIALS AND METHODS In the present study, it was investigated whether patients with complicated appendicitis experienced more abdominal complaints after long-term follow-up when compared to uncomplicated cases. In addition, the influence of operation technique (open versus laparoscopic) was studied. A retrospective analysis of 1,481 appendectomies for acute appendicitis was performed in two centers from January 2000 until January 2006. Demographic data, operative reports, intraoperatively adhesions and complications, abdominal pain, and satisfaction were monitored. In total, 1,433 patients were invited to fill out a questionnaire with a median follow-up of 7.1 years. Questionnaires of 526 (37 %) patients were suitable for analysis. RESULTS Perforation, abdominal abscesses, or adhesions at initial operation did not result in more abdominal complaints when compared to appendectomy for uncomplicated acute appendicitis. Additionally, no significant differences in abdominal complaints were seen between laparoscopic and open techniques. CONCLUSION In conclusion, the results of our study show that after follow-up of 7 years, the incidence of abdominal complaints was not influenced by operative technique or whether acute appendicitis was complicated or not. This finding does not support a causative role for adhesions with regard to chronic abdominal complaints. Our data enables surgeons to inform their patients about the long-term results of appendectomy, whether it was complicated or not.
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Affiliation(s)
- M Ditzel
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, 3015, Rotterdam, The Netherlands.
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Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg 2013; 50:54-86. [PMID: 23374326 DOI: 10.1067/j.cpsurg.2012.10.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hansson J, Körner U, Ludwigs K, Johnsson E, Jönsson C, Lundholm K. Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice. World J Surg 2012; 36:2028-36. [PMID: 22569747 DOI: 10.1007/s00268-012-1641-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application. METHODS All patients with acute appendicitis at Sahlgrenska University Hospital (May 2009 and February 2010) were offered intravenous piperacillin plus tazobactam according to our previous experience, followed by 9 days out-hospital oral ciprofloxacin plus metronidazole. Endpoints were treatment efficacy and complications. Efficient antibiotic treatment was defined as recovery without the need of surgery beyond 1 year of follow-up. RESULTS A total of 558 consecutive patients were hospitalized and treated due to acute appendicitis. Seventy-nine percent (n = 442) received antibiotics as first-line therapy and 20 % (n = 111) had primary surgery as the second-line therapy. Seventy-seven percent of patients on primary antibiotics recovered while 23 % (n = 100) had subsequent appendectomy due to failed initial treatment on antibiotics. Thirty-eight patients (11 %) of the 342 had experienced recurrent appendicitis at 1-year follow-up. Primary antibiotic treatment had fewer complications compared to primary surgery. CONCLUSIONS This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
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Affiliation(s)
- Jeanette Hansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 416 85 Goteborg, Sweden
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Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg 2012; 49:642-717. [PMID: 23057861 DOI: 10.1067/j.cpsurg.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Merril T Dayton
- Department of Surgery, SUNY Buffalo, Kaleida Health System, Buffalo, NY, USA
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Fitzmaurice GJ, McWilliams B, Hurreiz H, Epanomeritakis E. Antibiotics versus appendectomy in the management of acute appendicitis: a review of the current evidence. Can J Surg 2011; 54:307-14. [PMID: 21651835 DOI: 10.1503/cjs.006610] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute appendicitis remains the most common cause of the acute abdomen in young adults, and the mainstay of treatment in most centres is an appendectomy. However, treatment for other intra-abdominal inflammatory processes, such as diverticulitis, consists initially of conservative management with antibiotics. The aim of this study was to determine the role of antibiotics in the management of acute appendicitis and to assess if appendectomy remains the gold standard of care. METHODS A literature search using MEDLINE and the Cochrane Library identified studies published between 1999 and 2009, and we reviewed all relevant articles. The articles were critiqued using the Public Health Resource Unit (2006) appraisal tools. RESULTS Our search yielded 41 papers, and we identified a total of 13 papers within the criteria specified. All of these papers, while posing pertinent questions and demonstrating the role of antibiotics as a bridge to surgery, failed to adequately justify their findings that antibiotics could be used as a definitive treatment of acute appendicitis. CONCLUSION Appendectomy remains the gold standard of treatment for acute appendicitis based on the current evidence.
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Affiliation(s)
- Gerard J Fitzmaurice
- Department of General Surgery, Craigavon Area Hospital, Portadown, Northern Ireland.
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Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 2011; 17:4545-53. [PMID: 22147959 PMCID: PMC3225091 DOI: 10.3748/wjg.v17.i41.4545] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/26/2011] [Accepted: 09/03/2011] [Indexed: 02/06/2023] Open
Abstract
Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.
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Abstract
BACKGROUND Clinical advantages of laparoscopic appendectomy have been shown in numerous trials and reviews. Most of these advantages are small and of limited clinical relevance, while laparoscopic operation costs are reported to be higher. The present study compares short- and long-term results of conventional appendectomy with or without diagnostic laparoscopy (OA), and laparoscopic appendectomy (LA). METHODS All adult patients who underwent appendectomy in our institution from 1995 to 2005 were included retrospectively. Patient data were retrieved from medical records, questionnaires sent by mail, and records of general practitioners. Primary outcome parameters were long-term complications, readmissions, and reinterventions (>30 days postoperatively). Secondary outcome parameters were short-term complications, readmissions, and reinterventions (≤30 days postoperatively). RESULTS A total of 755 patients were included, 545 of whom underwent OA, with the remaining 210 undergoing LA. In the long term there were few complications noted, and there were no significant differences in complications between the two groups. Within 30 days postoperatively, LA was associated with a significantly higher incidence of abdominal abscesses with consequent diagnostic investigations, interventions, and readmissions. CONCLUSIONS Although laparoscopic appendectomy is known to deliver clinical advantages, it is associated with a higher incidence of abdominal abscesses. Because the procedure is about to become the standard of care, future research must be directed at solving this issue. The expected lower incidence of incisional hernia and small bowel obstruction after laparoscopic appendectomy was not shown in the present study.
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Isaksson K, Weber E, Andersson R, Tingstedt B. Small bowel obstruction: early parameters predicting the need for surgical intervention. Eur J Trauma Emerg Surg 2011; 37:155-9. [PMID: 26814954 DOI: 10.1007/s00068-010-0033-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
AIM To study and identify early clinical and radiological findings that could help to predict operative intervention for small bowel obstruction. MATERIALS AND METHODS One hundred and nine consecutive patients with small bowel obstruction who underwent small bowel follow-through examination with Gastrografin(®) during 2005-2006. The patients were divided into an operative group and a non-operative group, n = 44 and 65, respectively. Findings primarily noted were those which were possible to register within 1-4 h from hospital arrival. RESULTS In univariate analyses, factors found to be significantly associated with surgical intervention were no prior abdominal surgery, the presence of radiological differential air fluid levels, and absence of flatulence 24 h prior to admission, CRP > 10 mg/L and dehydration at admission. In multivariate analyses, the presence of dehydration and radiological differentiated air fluid levels were independent predictive factors of significance. Absence of all factors significantly favored non-operative treatment, while operative treatment was significantly favored when two or more factors were present. CONCLUSIONS The presence of two or more early predictive factors as defined above, available at admission, significantly correlates with a likelihood of complete obstruction and the need of surgical intervention.
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Affiliation(s)
- K Isaksson
- Department of Surgery, University of Lund, University Hospital of Lund, 221 85, Lund, Sweden.
| | - E Weber
- Department of Surgery, University of Lund, University Hospital of Lund, 221 85, Lund, Sweden
| | - R Andersson
- Department of Surgery, University of Lund, University Hospital of Lund, 221 85, Lund, Sweden
| | - B Tingstedt
- Department of Surgery, University of Lund, University Hospital of Lund, 221 85, Lund, Sweden
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Schnüriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D. Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg 2011; 201:111-21. [PMID: 20817145 DOI: 10.1016/j.amjsurg.2010.02.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND postoperative adhesions are a significant health problem with major implications on quality of life and health care expenses. The purpose of this review was to investigate the efficacy of preventative techniques and adhesion barriers and identify those patients who are most likely to benefit from these strategies. METHODS the National Library of Medicine, Medline, Embase, and Cochrane databases were used to identify articles related to postoperative adhesions. RESULTS ileal pouch-anal anastomosis, open colectomy, and open gynecologic procedures are associated with the highest risk of adhesive small-bowel obstruction (class I evidence). Based on expert opinion (class III evidence) intraoperative preventative principles, such as meticulous hemostasis, avoiding excessive tissue dissection and ischemia, and reducing remaining surgical material have been published. Laparoscopic techniques, with the exception of appendicitis, result in fewer adhesions than open techniques (class I evidence). Available bioabsorbable barriers, such as hyaluronic acid/carboxymethylcellulose and icodextrin 4% solution, have been shown to reduce adhesions (class I evidence). CONCLUSIONS postoperative adhesions are a significant health problem with major implications on quality of life and health care. General intraoperative preventative techniques, laparoscopic techniques, and the use of bioabsorbable mechanical barriers in the appropriate cases reduce the incidence and severity of peritoneal adhesions.
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Affiliation(s)
- Beat Schnüriger
- Los Angeles County Medical Center, University of Southern California, Department of Surgery, Division of Acute Care Surgery, Trauma, Emergency Surgery and Surgical Critical Care, LAC + USC Medical Center, Room 1105, 1200 North State St, Los Angeles, CA, USA
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Barmparas G, Branco BC, Schnüriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 2010; 14:1619-28. [PMID: 20352368 DOI: 10.1007/s11605-010-1189-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/23/2010] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The purpose of this review was to assess the incidence and risk factors for adhesive small bowel obstruction (SBO) following laparotomy. METHODS The PubMed database was systematically reviewed to identify studies in the English literature delineating the incidence of adhesive SBO and reporting risk factors for the development of this morbidity. RESULTS A total of 446,331 abdominal operations were eligible for inclusion in this analysis. The overall incidence of SBO was 4.6%. The risk of SBO was highly influenced by the type of procedure, with ileal pouch-anal anastomosis being associated with the highest incidence of SBO (1,018 out of 5,268 cases or 19.3%), followed by open colectomy (11,491 out of 121,085 cases or 9.5%). Gynecological procedures were associated with an overall incidence of 11.1% (4,297 out of 38,751 cases) and ranged from 23.9% in open adnexal surgery, to 0.1% after cesarean section. The technique of the procedure (open vs. laparoscopic) also played a major role in the development of adhesive SBO. The incidence was 7.1% in open cholecystectomies vs. 0.2% in laparoscopic; 15.6% in open total abdominal hysterectomies vs. 0.0% in laparoscopic; and 23.9% in open adnexal operations vs. 0.0% in laparoscopic. There was no difference in SBO following laparoscopic or open appendectomies (1.4% vs. 1.3%). Separate closure of the peritoneum, spillage and retention of gallstones during cholecystectomy, and the use of starched gloves all increase the risk for adhesion formation. There is not enough evidence regarding the role of age, gender, and presence of cancer in adhesion formation. CONCLUSION Adhesion-related morbidity comprises a significant burden on healthcare resources and prevention is of major importance, especially in high-risk patients. Preventive techniques and special barriers should be considered in high-risk cases.
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Affiliation(s)
- Galinos Barmparas
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Los Angeles County Medical Center-University of Southern California, 1200 North State Street, Inpatient Tower (C)-Room C5L100, Los Angeles, CA 90033, USA
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Bowel Obstruction Following Appendectomy: A Protective Role Implied for Laparoscopy? Ann Surg 2010; 251:1190-1; author reply 1191. [DOI: 10.1097/sla.0b013e3181e01534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diana M, Paroz A, Demartines N, Schäfer M. Retroperitoneal abscess with concomitant hepatic portal venous gas and rectal perforation: a rare triad of complications of acute appendicitis. A case report. World J Emerg Surg 2010; 5:3. [PMID: 20205816 PMCID: PMC2824631 DOI: 10.1186/1749-7922-5-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/28/2010] [Indexed: 11/18/2022] Open
Abstract
Background While retroperitoneal abscess is a known complication, hepatic portal venous gas and rectal perforation have not been reported as a concomitant sequelae of acute appendicitis. Here we report a case of a patient with a perforated appendicitis that was associated with these triad of complications. Materials and Methods In addition to report our case, we carefully reviewed the literature in order to detect similar cases and the causes of such rare conditions. Results Only 26 cases (including our patient) of acute appendicitis complicated by retroperitoneal abscesses have been published in the English literature between 1955 and 2008. There was one case having hepatic portal venous gas, and one further case with a rectal perforation associated with acute appendicitis. All patients with retroperitoneal abscess presented with non specific clinic symptoms that not revealed any suspicion for such a complicated disease. Hence, delayed diagnosis and treatment are not uncommon. Conclusions So far, no patient has been described with such a triad of rare complications related to acute appendicitis. We want to emphasize the insidious onset of retroperitoneal abscess formation, and the need of prompt recognition and adequate treatment to avoid deleterious outcome.
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Affiliation(s)
- Michele Diana
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, University Hospital, Lausanne, Switzerland.
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Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 2009; 96:473-81. [PMID: 19358184 DOI: 10.1002/bjs.6482] [Citation(s) in RCA: 340] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Background
A trial in selected men suggested that antibiotic therapy could be an alternative to appendicectomy in appendicitis. This study aimed to evaluate antibiotic therapy in unselected men and women with acute appendicitis.
Methods
Consecutive patients were allocated to study (antibiotics) or control (surgery) groups according to date of birth. Study patients received intravenous antibiotics for 24 h and continued at home with oral antibiotics for 10 days. Control patients had a standard appendicectomy. Follow-up at 1 and 12 months was carried out according to intention and per protocol.
Results
Study and control patients were comparable at inclusion; 106 (52·5 per cent) of 202 patients allocated to antibiotics completed the treatment and 154 (92·2 per cent) of 167 patients allocated to appendicectomy had surgery. Treatment efficacy was 90·8 per cent for antibiotic therapy and 89·2 per cent for surgery. Recurrent appendicitis occurred in 15 patients (13·9 per cent) after a median of 1 year. A third of recurrences appeared within 10 days and two-thirds between 3 and 16 months after hospital discharge. Minor complications were similar between the groups. Major complications were threefold higher in patients who had an appendicectomy (P < 0·050).
Conclusion
Antibiotic treatment appears to be a safe first-line therapy in unselected patients with acute appendicitis. Registration number: NCT00469430 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Hansson
- Department of Surgery, Sahlgrenska, Gothenburg, Sweden
| | - U Körner
- Department of Surgery, Sahlgrenska, Gothenburg, Sweden
| | | | - A Solberg
- Department of Surgery, ¨︁Ostra University Hospitals, Gothenburg, Sweden
| | - K Lundholm
- Department of Surgery, Sahlgrenska, Gothenburg, Sweden
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Konstantinidis KM, Anastasakou KA, Vorias MN, Sambalis GH, Georgiou MK, Xiarchos AG. A Decade of Laparoscopic Appendectomy: Presentation of 1026 Patients with Suspected Appendicitis Treated in a Single Surgical Department. J Laparoendosc Adv Surg Tech A 2008; 18:248-58. [PMID: 18373452 DOI: 10.1089/lap.2006.0209] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - Kornilia A. Anastasakou
- Department of General, Laparoscopic, and Robotic Surgery, Athens Medical Center, Athens, Greece
| | - Michael N. Vorias
- Department of General, Laparoscopic, and Robotic Surgery, Athens Medical Center, Athens, Greece
| | - George H. Sambalis
- Department of General, Laparoscopic, and Robotic Surgery, Athens Medical Center, Athens, Greece
| | - Michael K. Georgiou
- Department of General, Laparoscopic, and Robotic Surgery, Athens Medical Center, Athens, Greece
| | - Anastasios G. Xiarchos
- Department of General, Laparoscopic, and Robotic Surgery, Athens Medical Center, Athens, Greece
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Cosnes J, Seksik P, Nion-Larmurier I, Beaugerie L, Gendre JP. Prior appendectomy and the phenotype and course of Crohn's disease. World J Gastroenterol 2006; 12:1235-42. [PMID: 16534877 PMCID: PMC4124435 DOI: 10.3748/wjg.v12.i8.1235] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Revised: 10/15/2005] [Accepted: 10/26/2005] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether prior appendectomy modifies the phenotype and severity of Crohn's disease. METHODS Appendectomy status and smoking habits were specified by direct interview in 2838 patients consecutively seen between 1995 and 2004. Occurrence of complications and therapeutic needs were reviewed retrospectively. Additionally, annual disease activity was assessed prospectively between 1995 and 2004 in patients who had not had ileocecal resection and of a matched control group. RESULTS Compared to 1770 non-appendectomized patients, appendectomized patients more than 5 years before Crohn's disease diagnosis (n=716) were more often females, smokers, with ileal disease. Cox regression showed that prior appendectomy was positively related to the risk of intestinal stricture (adjusted hazard ratio, 1.24; 95% confidence interval, 1.13 to 1.36; P=0.02) and inversely related to the risk of perianal fistulization (adjusted hazard ratio, 0.75; 95% confidence interval, 0.68 to 0.83; P=0.002). No difference was observed between the two groups regarding the therapeutic needs, except for an increased risk of surgery in appendectomized patients, attributable to the increased prevalence of ileal disease. Between 1995 and 2004, Crohn's disease was active during 50% of years in appendectomized patients (1318 out of 2637 patient-years) and 51% in non-appendectomized patients (1454 out of 2841 patient-years; NS). CONCLUSION Prior appendectomy is associated with a more proximal disease and has an increased risk of stricture and a lesser risk of anal fistulization. However, the severity of the disease is unaffected.
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Affiliation(s)
- Jacques Cosnes
- Service de Gastroentérologie et Nutrition, hôpital St-Antoine, 184 rue du Faubourg St-Antoine, 75571 Paris cedex 12, France.
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