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Alkhalifah HA, Aljehani KM, Algethami SR, Alyahya SA, Alzubide AA, Alharbi RM, Khafaji HA, Althoubaity FK. Surgical and Pre-surgical Factors Affecting Appendectomy Outcomes in Jeddah, Saudi Arabia: A Retrospective Record Review. Cureus 2024; 16:e62960. [PMID: 39044866 PMCID: PMC11265513 DOI: 10.7759/cureus.62960] [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: 06/21/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Appendectomy is the preferred treatment for acute uncomplicated appendicitis and the most common emergency abdominal surgery. While previous studies have investigated variables affecting post-appendectomy complications, local research is limited, and data on complication rates are scarce. Therefore, this study aimed to investigate appendectomy outcomes and the factors influencing them. METHODS This retrospective record review included all patients who underwent appendectomies at our center between 2013 and 2023, excluding those who underwent appendectomies as part of other procedures. Data were retrieved from the hospital database and recorded on predesigned Google Forms. RESULTS A total of 556 patients were included. Complications occurred in 60 patients (10.8%); the most common included intra-abdominal collections (n=19, 3.4%), postoperative fever (n=13, 2.3%), and surgical site infections (n=11, 2.0%). The most frequently documented histopathological diagnoses included acute appendicitis (n=402, 72.3%), perforated appendicitis (n=109, 19.6%), and gangrenous appendicitis (n=19, 4.4%). Surgical site infection rates were higher after open appendectomies (6.0% vs. 0.9%, P=0.006), while intra-abdominal collections were more frequent after laparoscopic appendectomies (4.1% vs. 0.0%, P=0.095). Additionally, histopathology results showing complicated or chronic appendicitis were associated with higher complication rates (P<0.001, odds ratio=3.793, 95% confidence interval=1.957-7.350). CONCLUSION To the best of our knowledge, this is the largest retrospective review of appendectomy cases in Saudi Arabia. However, this study was conducted in a tertiary care center, which may have caused the rates of complications to appear lower than those in primary centers. We recommend a multi-center study be conducted to establish more accurate results.
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Affiliation(s)
| | | | | | - Saud A Alyahya
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Koroth A, Basheer S, Abdul Rasheed MF, Ali Usman A, Sadanandan A. Association Between Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring and Pathological Severity of Acute Appendicitis: A Cross-Sectional Study. Cureus 2024; 16:e56166. [PMID: 38618466 PMCID: PMC11015883 DOI: 10.7759/cureus.56166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed. A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over 12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted with the histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.
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Affiliation(s)
- Arshad Koroth
- Department of General Surgery, Kasturba Medical College, Manipal, Manipal, IND
| | - Shiraz Basheer
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Muhamed Fawas Abdul Rasheed
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Azif Ali Usman
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
| | - Arjun Sadanandan
- Department of General Surgery, Muslim Educational Society (MES) Academy of Medical Sciences, Perinthalmanna, IND
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Song SR, Liu YY, Guan YT, Li RJ, Song L, Dong J, Wang PG. Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis. World J Gastrointest Surg 2023; 15:2320-2330. [PMID: 37969709 PMCID: PMC10642468 DOI: 10.4240/wjgs.v15.i10.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 08/21/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Intra-abdominal infections (IAIs) is the most common type of surgical infection, with high associated morbidity and mortality rates. In recent years, due to the use of antibiotics, various drug-resistant bacteria have emerged, making the treatment of abdominal infections more challenging. Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications. However, available evidence regarding the optimal timing of IAI surgery is still weak. In study, we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery. AIM To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI, in terms of overall mortality. METHODS A systematic literature search was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and ScienceDirect. The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Based on the timing of the surgical operation, we divided the literature into two groups: Early surgery and delayed surgery. For the early and delayed surgery groups, the intervention was performed with and after 12 h of the initial surgical intervention, respectively. The main outcome measure was the mortality rate. The literature search was performed from May 5 to 20, 2021. We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20, 2021, for ongoing trials. This study was registered with the International Prospective Register of Systematic Reviews. RESULTS We identified nine eligible trial comparisons. Early surgical exploration of patients with IAIs (performed within 12 h) has significantly reduced the mortality and complications of patients, improved the survival rate, and shortened the hospital stay. CONCLUSION Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.
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Affiliation(s)
- Shu-Rui Song
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yang-Yang Liu
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Yu-Ting Guan
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Ruo-Jing Li
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Lei Song
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jing Dong
- Medical Complex Building, Qingdao University, Qingdao 266071, Shandong Province, China
| | - Pei-Ge Wang
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part II. Wideochir Inne Tech Maloinwazyjne 2023; 18:379-400. [PMID: 37868279 PMCID: PMC10585467 DOI: 10.5114/wiitm.2023.127884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
| | - the Expert Group: Prof. Tomasz Banasiewicz, Prof. Andrzej Budzyński, Prof. Adam Dziki, Prof. Michał Grąt, Prof. Marek Jackowski, Prof. Wojciech Kielan, Prof. Andrzej Matyja, Prof. Krzysztof Paśnik, Prof. Piotr Richter, Prof. Antoni Szczepanik, Prof. Mirosław Szura, Prof. Wiesław Tarnowski, Prof. Krzysztof Zieniewicz
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Nguyen HV, Tran LH, Ly TH, Pham QT, Pham VQ, Tran HN, Trinh LT, Dinh TT, Pham DT, Mai Phan TA. Impact of the COVID-19 Pandemic on the Severity and Early Postoperative Outcomes of Acute Appendicitis. Cureus 2023; 15:e42923. [PMID: 37546691 PMCID: PMC10400342 DOI: 10.7759/cureus.42923] [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: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.
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Affiliation(s)
- Hai V Nguyen
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Loc H Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Tuan H Ly
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Quang T Pham
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, VNM
| | - Vu Q Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Ha N Tran
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Loc T Trinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Thien T Dinh
- Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VNM
| | - Dinh T Pham
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
| | - Tuong Anh Mai Phan
- Department of Digestive Surgery, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City, VNM
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Akrida I, Verras GI, Bouchagier K, Kehagias D, Kaplanis C, Tasios K, Antzoulas A, Samaras A, Benetatos N, Maroulis I, Mulita F. The impact of the COVID-19 pandemic on the number of patients presenting with appendicitis to the emergency department. PRZEGLAD GASTROENTEROLOGICZNY 2023; 19:194-197. [PMID: 38939065 PMCID: PMC11200070 DOI: 10.5114/pg.2023.129495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 06/29/2024]
Abstract
Introduction The COVID-19 pandemic has had an influence on the number of patients presenting to the emergency department (ED) with surgical conditions. Aim To evaluate the number of patients presenting with acute appendicitis (AA) and the percentage of complicated appendicitis before and after the COVID-19 disease outbreak. Material and methods This is a retrospective study based on the data of all patients presenting with AA to the ED of a tertiary COVID referral university hospital in Greece. We analysed the number of patients treated with AA, patient characteristics, and the proportion of patients with complicated appendicitis, and we compared the 2 groups of patients treated 12 months before and 12 months after COVID-19 onset in Greece. Results A total of 152 patients were included in this study. There was a significant decrease in the number of patients presenting with AA after COVID-19 onset in Greece. Respectively, 91 and 61 patients were subjected to appendectomy 12 months before and after COVID-19 onset. Comparing the 2 groups of patients, there was a statistically significant increase in the operation time (p = 0.01) after COVID-19 onset, whereas the percentage of complicated appendicitis, the duration of symptoms before presenting to the ED (< 24 h, > 24 h), and the type of operation (laparoscopic, open, converted) did not differ significantly between the 2 groups of patients. Conclusions The number of patients presenting to the ED with AA decreased after COVID-19 onset, most likely because patients hesitated to seek help in a COVID-19 referral hospital.
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Affiliation(s)
- Ioanna Akrida
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Angelos Samaras
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Nikolaos Benetatos
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Maroulis
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Erginel B, Karadeniz MS, Yuksel S, Ciftci HS, Izgi D, Ersavas C, Keskin E, Soysal FG. Can serum soluble urokinase plasminogen activator receptor be an effective biomarker in comparing the inflammatory response between laparoscopic and open appendectomy? Wideochir Inne Tech Maloinwazyjne 2023; 18:351-357. [PMID: 37680731 PMCID: PMC10481438 DOI: 10.5114/wiitm.2023.128681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/07/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction The inflammatory response after laparoscopy and laparotomy has been compared in studies in adults, but only a few studies have compared the immune response between laparoscopy and laparotomy in children. Aim To compare open and laparoscopic appendectomies regarding a new biomarker, suPAR, to evaluate the inflammatory response. Material and methods Patients between 3 and 17 years of age who were admitted to the pediatric surgery department and scheduled for appendectomy due to appendicitis were enrolled in the investigation. The patients were randomized to receive either laparoscopic (n = 20) or conventional open appendectomy (n = 20). The primary outcome was a change in preoperative and postoperative suPAR levels. The secondary outcomes were the white blood cell count, lymphocytes, neutrophils, platelets, C-reactive protein level, appendix diameter, symptoms, symptom duration, surgical complications, operative time, rescue analgesics, hospital stay, and family satisfaction. Results The mean age of the patients undergoing laparoscopic appendectomy was 10.55 ±2.743 (3-17) years. The mean age of the patients undergoing open appendectomy was 11.40 ±3.515 (3-17) years. A statistically significant difference was found when the postoperative suPAR values between the two groups were compared (p = 0.048). The operative time and hospital stay in the laparoscopic group were significantly shorter than those in the open group (p = 0.001, p = 0.047). Conclusions Laparoscopic appendectomy is associated with a shorter operative time, a shorter hospital stay, and a smaller inflammatory response caused by surgical stress than open appendectomy. suPAR is an effective marker for comparing postoperative inflammatory stress between open and closed appendectomies.
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Affiliation(s)
- Basak Erginel
- Department of Pediatric Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Meltem Savran Karadeniz
- Department of Anesthesiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Secil Yuksel
- Department of Pediatric Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Demet Izgi
- Department of Biology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cenk Ersavas
- Department of General Surgery, Arel University, Istanbul, Turkey
| | - Erbug Keskin
- Department of Pediatric Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Feryal Gun Soysal
- Department of Pediatric Surgery, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Bao W, Wang J, Tang D, Li L, Meng X. Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis. BMC Surg 2023; 23:1. [PMID: 36600246 DOI: 10.1186/s12893-022-01884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. METHODS The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. RESULTS There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). CONCLUSION Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.
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Affiliation(s)
- Wenzhong Bao
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China.
| | - Jie Wang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Dawei Tang
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Liang Li
- Department of Surgery, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Guangde Road, Yaohai District, Hefei, 230011, Anhui, China
| | - Xiangling Meng
- Department of Surgery, The First Affiliated Hospital Anhui Medical University, Hefei, 230031, Anhui, China
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Muacevic A, Adler JR, Avramovic J, Palamuthusingam P. Routine Computed Tomography Versus Selective Imaging: An Audit of Negative Appendicectomy Rates in Two Hospitals. Cureus 2022; 14:e32389. [PMID: 36632248 PMCID: PMC9830005 DOI: 10.7759/cureus.32389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction There are a variety of conflicting recommendations in the literature for pre-operative imaging in acute appendicitis. There is debate over what the ideal imaging protocol is to lower the negative appendicectomy rate (NAR) without increasing missed appendicitis. The aim of this study is to compare the audited NAR between two groups with different imaging approaches: (i) mandatory pre-operative computed tomography (CT) imaging and (ii) selective imaging with CT, ultrasound (US), or no imaging prior to appendicectomy. Materials and methods A retrospective chart audit was conducted of 400 patients who underwent an appendicectomy at two hospitals with different approaches to pre-operative imaging (hospital A and hospital B). The primary outcome measure was histologically confirmed appendicitis. It was also documented whether there was radiological (CT or US) evidence of appendicitis. Results At hospital A, all 200 patients underwent CT imaging prior to appendicectomy. The total histologically confirmed NAR for this group was 9.5% (19/200). At hospital B, 97 (48.5%) patients underwent CT, 41 (25.5%) underwent US, 10 (5%) had both US and CT, and 52 (26%) had no imaging. The total NAR was 11.5% (23/200). Conclusion There was no statistically significant difference (p=0.62) in audited NARs when comparing clinician-guided selective imaging versus routine CT imaging for all patients undergoing appendicectomy.
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Rasuli SF, Naz J, Azizi N, Hussain N, Qureshi PNAA, Swarnakari KM, Dost W, Zafar S, Qadar LT, Talpur AS. Laparoscopic Versus Open Appendectomy for Patients With Perforated Appendicitis. Cureus 2022; 14:e26265. [PMID: 35911350 PMCID: PMC9312283 DOI: 10.7759/cureus.26265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute appendicitis can lead to perforation which can be lethal. The present study assessed the outcomes of laparoscopic appendectomy versus open appendectomy in patients with perforated appendicitis. Methodology A comparative study was conducted at the Department of Surgery, Liaquat University of Medical & Health Sciences (LUMHS), between March 2, 2019 and July 7, 2020. The inclusion criteria consisted of a diagnosis of perforated appendicitis. Exclusion criteria consisted of intellectual disability hindering the procurement of informed consent, pediatric patients < 15 years of age, patients with an appendicular mass or abscess unsuited for laparoscopic appendectomy, severe sepsis or septic shock on presentation, and pregnant women. Patients were allocated to either open appendectomy (Group A) or laparoscopic appendectomy (Group B). The data gathering proforma recorded demographics, surgical findings, operating room (OR) time, length of inpatient care, requirement of analgesic, and any adverse events following surgery. All of the surgeries were conducted by an experienced surgical consultant with an experience of at least five years. Results A total of 85 patients were included in the laparoscopic appendectomy group, while 101 cases were included in the open appendectomy group. The use of analgesics thrice a day to manage the postoperative pain was significantly associated with the open appendectomy (p < 0.0001). Moreover, the postoperative length of hospitalization was substantially greater in patients who underwent open appendectomy than those who underwent laparoscopic procedure (p < 0.0001). Wound-related complications were considerably lower in patients who had laparoscopic appendectomy as compared to those who had open appendectomy (23.53% versus 40.5%; p = 0.013). Conclusion The length of stay was significantly lower in patients who underwent laparoscopic appendectomy. Moreover, laparoscopic appendectomy was also associated with a lower rate of wound infection postoperatively, thus giving the former an edge over the latter. Despite the finding that the postoperative pain was not considerably different between the two groups, patients who underwent open appendectomy group required significantly more painkillers to manage the postoperative pain.
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