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Tarar B, Batool S, Majeed S, Saleem A. Comparison Between Early Appendectomy vs. Conservative Management in Cases of Appendicular Mass. Cureus 2023; 15:e37986. [PMID: 37223186 PMCID: PMC10202446 DOI: 10.7759/cureus.37986] [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: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION At present, the treatment of choice for appendicular masses is unclear. Recent studies claimed that conservative management of appendicular masses was safe in terms of frequency of perforation. However, there is controversy in the existing literature. OBJECTIVE This research is designed to compare the results of early appendectomy versus conservative management of appendicular masses. MATERIAL AND METHODS It was a randomized controlled trial performed in the Combined Military Hospital, Lahore. The study lasted six months, from 01/03/2019 to 30/09/2019. It involved 60 patients of both genders aged between 16 and 70 years diagnosed with appendicular masses with an Alvarado score of 4-7. These patients were randomly divided into two treatment groups. In Group A patients, an early appendectomy was performed, while patients in Group B were managed conservatively. Outcome variables were the mean length of hospital stay and frequency of appendicular perforation. RESULTS The mean age of the patients was 26.8±11.9 years. There were 33 (55.0%) male and 27 (45.0%) female patients, with a male-to-female ratio of 1.2:1. The mean length of hospital stay was significantly longer in patients managed conservatively as compared to those undergoing early appendectomy (2.80±1.54 vs. 1.83±0.83; p=0.004). However, the frequency of perforation was not significantly higher in the conservative group as compared to the early appendectomy group (16.7% vs. 10.0%; p=0.448). CONCLUSION Conservative management of patients with appendicular mass was associated with prolonged hospital stays, yet it was found equally safe in terms of frequency of appendicular perforation, which advocates conservative management of patients with appendicular mass, particularly in high-risk patients.
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Affiliation(s)
- Bilal Tarar
- General Surgery, Northwick Park Hospital, London, GBR
| | - Sadaf Batool
- Surgery, Chesterfield Royal Hospital, Chesterfield, GBR
| | - Shahid Majeed
- General Surgery, Combined Military Hospital, Lahore, PAK
| | - Aimen Saleem
- Paediatric Surgery, Children's Hospital and Medical Center, Lahore, PAK
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Falih Noori Alsubsiee I, Falih Noori Alsubsiee A. Appendicectomy for Uncomplicated Simple Appendicitis: Is It Always Required? Surg Res Pract 2021; 2021:8848162. [PMID: 33791405 PMCID: PMC7984904 DOI: 10.1155/2021/8848162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although appendicectomy is still the classical and standard treatment for acute appendicitis, initial conservative antibiotic only treatment for simple uncomplicated cases has been proposed and tried as a feasible and effective approach. The objective of this study was to evaluate the efficacy and outcomes of antibiotics treatment for acute simple uncomplicated appendicitis. METHODS This is a prospective controlled nonrandomized study in which a total of 156 patients whose ages range from 16 to 54 years presenting with clinical diagnosis of acute uncomplicated appendicitis were assigned for conservative antibiotics treatment, which consists of ceftriaxone I gram twice daily and metronidazole infusions, 500 mg in 100 ml, 3 times daily for 48 to 72 hours to be converted on oral antibiotics after clinical improvement for 5 to 7 days. Patients who failed to initial conservative treatment and those who had recurring symptoms of appendicitis were presented for appendectomy. RESULTS Antibiotic treatment was successful and feasible in 138 (88.5%) patients. Progression of the signs and symptoms despite full medical treatment was observed in 11 (7%) patients during the same admission. Further 7 (4.5%) patients showed recurrence of the symptoms during follow-up period of 6-12 months after successful initial conservative treatment and also proceeded for appendicectomy. CONCLUSION Nonoperative antibiotic treatment of acute simple appendicitis is safe, feasible, and effective for properly selected cases, thus avoiding unnecessary surgery with its possible complications.
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Luo CC, Cheng KF, Huang CS, Lo HC, Wu SM, Huang HC, Chien WK, Chen RJ. Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. BMC Surg 2016; 16:72. [PMID: 27756361 PMCID: PMC5070137 DOI: 10.1186/s12893-016-0188-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022] Open
Abstract
Background In this study, we studied the therapeutic effectiveness of percutaneous drainage with antibiotics and the need for an interval appendectomy for treating appendiceal abscess in children with a research-oriented dataset released by the Bureau of National Health Insurance in Taiwan through the Collaboration Center for Health Information Application (CCHIA). Methods We identified 1225 patients under 18 years of age who had non-surgical treatment for an appendiceal abscess between 2007 and 2012 in a Taiwan CCHIA dataset. The treatment included percutaneous drainage with antibiotics or antibiotics alone. We also analyzed data of patient’s baseline characteristics, outcomes of percutaneous drainage, and indicating factors for performing an interval appendectomy. Results Totally, 6190 children had an appendiceal abscess, an 1225 patients received non-operative treatment. Of 1225 patients, 150 patients received treatment with percutaneous drainage and antibiotics, 78 had recurrent appendicitis, 185 went on to receive an interval appendectomy, and 10 had postoperative complications after the interval appendectomy. We found that patients treated with percutaneous drainage and antibiotics had a significantly lower rate of recurrent appendicitis (p < 0.05), a significantly smaller chance of receiving an interval appendectomy (p < 0.05), and significantly fewer postoperative complications after the interval appendectomy (p < 0.05) than those without percutaneous drainage treatment. Older children (13 ~ 18 years) patients were found to have a significantly smaller need to receive an interval appendectomy than those who were ≤ 6 years of age (odd ratio (OR) = 2.071, 95 % confidence interval (CI) = 1.34–3.19, p < 0.01), and those who were 7 ~ 12 years old (OR = 1.662, 95 % CI = 1.15–2.41, p < 0.01). In addition, those treated with percutaneous drainage were significantly less indicated to receive an interval appendectomy later (OR = 2.249, 95 % CI = 1.19 ~ 4.26, p < 0.05). In addition, those with recurrent appendicitis had a significantly increased incidence of receiving an interval appendectomy later (OR = 3.231, 95 % CI = 1.95 ~ 5.35, p < 0.001). Conclusions In this study, we used nationwide data to demonstrate therapeutic effectiveness of percutaneous drainage and antibiotics was more beneficial than only antibiotics in treating patients with an appendiceal abscess. We also found three factors that were significantly associated with receiving an interval appendectomy: recurrent appendicitis, being aged ≤ 13 years, and treatment with antibiotics only.
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Affiliation(s)
- Chih-Cheng Luo
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Medical Center, Taipei Medical University, 111 Xinglong Rd., Sect. 3, 11696, Taipei, Taiwan. .,Division of Pediatric Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St, Taipei, 11031, Taiwan.
| | - Kuang-Fu Cheng
- Biostatistics Center, Taipei Medical University, Taipei, Taiwan
| | - Chen-Sheng Huang
- Division of Pediatric Surgery, Department of Surgery, Wan Fang Medical Center, Taipei Medical University, 111 Xinglong Rd., Sect. 3, 11696, Taipei, Taiwan
| | - Hung-Chieh Lo
- Department of Traumatology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Mao Wu
- Department of Traumatology, Wan Fang Medical Center, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chang Huang
- Department of Acute Care Surgery and Traumatology, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuei Chien
- Biostatistics Center, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, 252 Wu-Xing Street, Taipei, 110, Taiwan. .,Division of Pediatric Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St, Taipei, 11031, Taiwan.
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Okuş A, Ay S, Karahan Ö, Eryılmaz MA, Sevinç B, Aksoy N. Monitoring C-reactive protein levels during medical management of acute appendicitis to predict the need for surgery. Surg Today 2014; 45:451-6. [PMID: 25542081 DOI: 10.1007/s00595-014-1099-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/01/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To clarify the role of medical treatment in the management of acute appendicitis and the value of C-reactive protein (CRP) for predicting its failure. MATERIALS AND METHODS Patients with clinically diagnosed acute appendicitis, confirmed by imaging studies, were enrolled in this study. We measured leukocyte counts and CRP levels and recorded success and recurrence rates and the efficiency of medical treatment during follow-up. The efficiency of CRP values to predict failure of medical treatment was evaluated using receiver operating characteristics (ROC) curve analysis. RESULTS The subjects comprised 193 patients (mean age 30.9 years) who received medical treatment for acute appendicitis. The mean follow-up period was 12.3 (6-24) months and the early success rate of medical treatment was 86.5 % (160/185). Fifteen (9.3 %) patients suffered recurrence during follow-up. The leukocyte and CRP levels in these two groups of patients were not significantly different at the beginning of the treatment, but the increase in the CRP value differed significantly between the two groups during the follow-up period (p < 0.001). ROC curve analysis suggested that the optimum CRP cut-off point for unsuccessful medical treatment was 80.8 mg/L, with 81.82 % sensitivity and 84.34 % specificity (p < 0.001). CONCLUSION The success rate for treating acute appendicitis medically is high, with antibiotic treatment being effective as the firstline therapy for many unselected patients. An increase in CRP levels to 80.8 mg/L and above seems to be a meaningful parameter for determining a lack of response to medical treatment.
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Affiliation(s)
- Ahmet Okuş
- Mevlana University Hospital General Surgery Clinic, Gemalmaz Mah., Dökümcü Sk No:7, Meram Merkez, 42040, Konya, Turkey,
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Malkan AD, Sandoval JA. Controversial tumors in pediatric surgical oncology. Curr Probl Surg 2014; 51:478-520. [PMID: 25524425 DOI: 10.1067/j.cpsurg.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
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Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H, Kuroiwa M, Kuwano H. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg Today 2014; 44:1400-5. [PMID: 24931545 DOI: 10.1007/s00595-014-0950-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 11/26/2012] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE To clarify the role of interval appendectomy (IA) in pediatric patients with acute appendicitis with an appendiceal inflammatory mass or abscess, we histologically analyzed the appendices removed during IA. PATIENTS AND METHODS We treated 355 consecutive pediatric patients with acute appendicitis and reviewed the admission charts of patients who started conservative management (CM). The histology of the appendix removed during IA was also examined. The relationships among the clinical features, appendicolith formation at the time of IA and histological findings were analyzed by stepwise regression analyses. RESULTS (1) CM was started in 48 patients (13.5 %). Recurrence or a remaining abscess was observed in nine patients (18.8 %). (2) Histopathological changes, particularly foreign body reaction with fibrosis and infiltration of inflammatory cells, were observed in about half of the specimens. (3) In a stepwise regression analysis, the presence of an appendicolith at IA was correlated with an appendicolith at diagnosis, foreign body reaction in the appendix and a decrease in the inflammatory reaction at diagnosis. CONCLUSION More than half the patients had strong histopathological changes in the appendix, suggesting a high possibility of recurrence. The presence of appendicolith formation at IA, which is a risk factor for recurrence, was influenced by the presence of an appendicolith at diagnosis, foreign body reaction in the appendix and the inflammatory status of patients at diagnosis. These clinical findings are indications for IA.
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Affiliation(s)
- Sayaka Otake
- Division of Pediatric Surgery, Department of General Surgical Science, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan,
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Minneci PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, Deans KJ. Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children. J Am Coll Surg 2014; 219:272-9. [PMID: 24951281 DOI: 10.1016/j.jamcollsurg.2014.02.031] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND For decades, urgent operation has been considered the only appropriate management of acute appendicitis in children. The purpose of this study was to investigate the feasibility of nonoperative management of uncomplicated acute appendicitis in children. STUDY DESIGN A prospective nonrandomized clinical trial of children with uncomplicated acute appendicitis comparing nonoperative management with urgent appendectomy was performed. The primary result was 30-day success rate of nonoperative management. Secondary outcomes included comparisons of disability days, missed school days, hospital length of stay, and measures of quality of life and health care satisfaction. RESULTS Seventy-seven patients were enrolled during October 2012 to October 2013; 30 chose nonoperative management and 47 chose surgery. There were no significant differences in demographic or clinical characteristics. The immediate and 30-day success rates of nonoperative management were 93% (28 of 30) and 90% (27 of 30). There was no evidence of progression of appendicitis to rupture at the time of surgery in the 3 patients for whom nonoperative management failed. Compared with the surgery group, the nonoperative group had fewer disability days (3 vs 17 days; p < 0.0001), returned to school more quickly (3 vs 5 days; p = 0.008), and exhibited higher quality of life scores in both the child (93 vs 88; p = 0.01) and the parent (96 vs 90; p = 0.03), but incurred a longer length of stay (38 vs 20 hours; p < 0.0001). CONCLUSIONS Nonoperative management of uncomplicated acute appendicitis in children is feasible, with a high 30-day success rate and short-term benefits that include quicker recovery and improved quality of life scores. Additional follow-up will allow for determination of longer-term success rate, safety, and cost effectiveness.
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Affiliation(s)
- Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH.
| | - Jason P Sulkowski
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Kristine M Nacion
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Justin B Mahida
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - R Lawrence Moss
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Nationwide Children's Hospital, Columbus, OH
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Svensson JF, Johansson R, Kaiser S, Wester T. Recurrence of acute appendicitis after non-operative treatment of appendiceal abscess in children: a single-centre experience. Pediatr Surg Int 2014; 30:413-6. [PMID: 24557154 DOI: 10.1007/s00383-014-3484-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the incidence of recurrence of acute appendicitis after initial successful non-operative treatment of appendiceal abscess in children. METHODS This study was an observational cohort study of children treated non-operatively for appendiceal abscess at a large tertiary referral centre from 2006 to 2010. The primary outcome was recurrence of acute appendicitis. Secondary outcome variables were re-admission and interval appendectomy. RESULTS Eighty-nine patients were discharged after successful non-operative treatment of appendiceal abscess. The median age was 10.1 (1.3-16.3) years. Nine patients underwent surgery during the follow-up period. Five patients were re-admitted with ongoing symptoms leading to an appendectomy. They all returned shortly after discharge and are considered failures of initial treatment. Two of 82 patients returned with a new episode of acute appendicitis during the trial period. Hence, the recurrence rate was 2.4 % during 5.1 years of follow-up. CONCLUSION Our data support the strategy of not performing an interval appendectomy after successful non-operative treatment with antibiotics of an appendiceal abscess in children.
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Affiliation(s)
- Jan F Svensson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden,
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de Castro SMM, Joosse P, Unlü C, Steller EP. Henoch-Schönlein disease localized in the appendix. Indian J Pediatr 2013; 80:1047-9. [PMID: 23275184 DOI: 10.1007/s12098-012-0927-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 11/22/2012] [Indexed: 11/25/2022]
Abstract
A 16-y-old boy presented with complaints of acute abdomen. Ultrasonography showed an enlarged and tender appendix suggestive of acute appendicitis. The patient underwent surgery and during surgery the appendix was found with a red vasculitis-like distal end, not typical for acute appendicitis. Further per operative examination of the intestines revealed a circular, vasculitis-like red band in terminal ileum. Four days after surgery, the patient developed skin purpura and complained of joint pain classical of Henoch-Schönlein disease. Pathological evaluation of the appendix and a skin biopsy confirmed the diagnosis and the patient was managed accordingly.
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Affiliation(s)
- S M M de Castro
- Department of Surgery, Saint Lucas Andreas Hospital, Amsterdam, The Netherlands,
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Laparoscopic interval appendectomy versus open interval appendectomy: a prospective randomized controlled trial. Surg Laparosc Endosc Percutan Tech 2013; 23:93-6. [PMID: 23386160 DOI: 10.1097/sle.0b013e318277df6a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This was a prospective randomized controlled study designed to compare laparoscopic and open interval appendectomy and involved 100 patients of appendicular phlegmon. After initial conservative management, patients were divided into 2 groups of 50 each and interval appendectomy was performed by laparoscopy in one of the groups and by open method in the other. Mean operative time in open surgery was 33.9 minutes and that in laparoscopic surgery was 57.64 minutes (P < 0.05). Concomitant pathology was observed in 16% and 2% of patients in the laparoscopic and open groups, respectively. Mean pain scores on the first postoperative day were 5.14 in the laparoscopic group and 6.01 in the open group (P < 0.05). Patients in the laparoscopic group had a shorter duration of ileus, postoperative stay, and returned to work earlier (P < 0.05). We conclude that laparoscopy offers a number of advantages over open interval appendectomy.
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Interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates? J Surg Res 2012; 177:127-30. [PMID: 22482752 DOI: 10.1016/j.jss.2012.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 02/22/2012] [Accepted: 03/08/2012] [Indexed: 01/20/2023]
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Khan RA, Ghani I, Chana RS. Routine histopathological examination of appendectomy specimens in children: is there any rationale? Pediatr Surg Int 2011; 27:1313-5. [PMID: 21614465 DOI: 10.1007/s00383-011-2926-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Primary carcinoma of the bowel is a rare malignancy in pediatric age group. The aim of the study was to assess the incidence of appendicular malignancies in children and the possibility of reducing the need for routine histopathological examination of appendix. MATERIALS AND METHODS In last 15 years, all the cases of appendectomies in children were analyzed. Retrospective analysis of the data was done to document the clinical presentation, diagnosis, outcome and histopathology reports of the specimen. The case files and operation notes were studied thoroughly in cases where HPR was positive for malignancy. RESULTS From July 1995 to June 2010, 595 appendectomies were done in children. Three cases of carcinoid tumor were detected. All were less than 1 cm and were on the tip of the appendix. There was no preoperative or intraoperative suspicion. CONCLUSION Routine histopathological analysis did not help in the management of any of the cases. Therefore, selective utilization of the already burdened histopathology section of the hospital would be more cost effective without affecting the patient outcome.
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Affiliation(s)
- Rizwan A Khan
- Unit of Pediatric Surgery, Department of Surgery, J. N. Medical College, AMU, Aligarh, India.
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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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Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review. J Pediatr Surg 2011; 46:767-771. [PMID: 21496553 DOI: 10.1016/j.jpedsurg.2011.01.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 01/07/2011] [Accepted: 01/18/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND/PURPOSE Interval appendicectomy (IA) is commonly performed after successful nonoperative treatment of appendix mass (AM); although, this approach has recently been challenged. We systematically reviewed the pediatric literature with regard to the justification for this practice. METHODS Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed. RESULTS Three studies (127 cases) reporting routine nonsurgical treatment were identified; all were retrospective. There was marked interstudy heterogeneity and variable follow-up. After successful nonoperative treatment of AM, the risk of recurrent appendicitis is 20.5% (95% confidence interval [CI], 14.3%-28.4%). The incidence of complications after IA (23 studies, n = 1247) is 3.4% (95% CI, 2.2-5.1), and the incidence of carcinoid tumor found at IA (15 studies, n = 955) is 0.9% (95% CI, 0.5-1.8). No reports compared costs. Mean length of stay for IA was 3 days (range, 1-30 days). CONCLUSIONS Prospective studies comparing routine IA with nonoperative treatment without IA in children are lacking. Available data suggest that 80% of children with AM may not need IA. A prospective study to evaluate the natural history of this condition compared with the morbidity and costs of IA is warranted.
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Gosain A, Williams RF, Blakely ML. Distinguishing acute from ruptured appendicitis preoperatively in the pediatric patient. Adv Surg 2010; 44:73-85. [PMID: 20919515 DOI: 10.1016/j.yasu.2010.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Sciences Center, 777 Washington Avenue, Suite P220, Memphis, TN 38105, USA
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Ait Ali Slimane M, Montupet P. [The pediatric surgeon and acute appendicitis]. JOURNAL DE CHIRURGIE 2009; 146 Spec No 1:32-35. [PMID: 19846095 DOI: 10.1016/j.jchir.2009.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The management of acute appendicitis in the pediatric patient has undergone radical rethinking in recent years. It has been shown that simple uncomplicated acute appendicitis can be successfully managed with antibiotic therapy and may not even require interval appendectomy. Appendicitis complicated by perforation, abscess, or inflammatory phlegmon can be successfully treated by initial antibiotic therapy (with or without percutaneous drainage) and delayed interval appendectomy. While the laparoscopic approach has proved to be well-adapted to many other pediatric surgical procedures, its utility in the treatment of uncomplicated acute appendicitis remains open to debate; compared to standard open appendectomy, it offers only minimal advantages with regard to post-operative care, length of hospital stay, and complications. Children can be managed either by general surgeons or pediatric surgeons depending on the organization of the emergency service; there may be a higher incidence of removal of a normal appendix in non-specialized services.
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Affiliation(s)
- M Ait Ali Slimane
- Clinique chirurgicale de Boulogne-Billancourt, 105, avenue Victor-Hugo, 92100 Boulogne-Billancourt, France.
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Lugo JZ, Avgerinos DV, Lefkowitz AJ, Seigerman ME, Zahir IS, Lo AY, Surick B, Leitman IM. Can interval appendectomy be justified following conservative treatment of perforated acute appendicitis? J Surg Res 2009; 164:91-4. [PMID: 19691990 DOI: 10.1016/j.jss.2009.05.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 04/23/2009] [Accepted: 05/12/2009] [Indexed: 12/15/2022]
Abstract
BACKGROUND There continues to be controversy about the necessity of interval appendectomy for delayed presentation of acute appendicitis. While recent studies suggest that the risk of recurrent disease is small, the risk of interval appendectomy is also small and does provide histologic identification and usually definitive treatment of the right lower quadrant inflammatory process. METHODS A retrospective analysis of medical records gathered from 2002 to 2007 at a major teaching hospital of 986 adult patients over the age of 13 with appendicitis were analyzed. Forty-six patients (5%) were found to have right lower quadrant abscess or phlegmon, and were managed with intravenous antibiotics. Some patients also underwent percutaneous drainage. These patients were then readmitted 6 to 26 wk later for an elective laparoscopic interval appendectomy. RESULTS There were 19 males and 27 females with an average age of 43 y. Ninety-four percent of the appendectomies were completed laparoscopically; 16% of patients were found to have a normal or obliterated appendix on pathologic evaluation and likely did not benefit from interval appendectomy. On the other hand, 84% of patients had persistent acute appendicitis, chronic appendicitis, evidence of inflammatory bowel disease, or neoplasm identified, and likely benefited from surgical appendectomy. CONCLUSIONS Interval appendectomy provides diagnostic and therapeutic benefit to patients who present with a right lower quadrant abdominal inflammatory focus, and should be carefully considered in all adult patients.
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Affiliation(s)
- Joannele Z Lugo
- Department of Surgery, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA
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Freitas MS, Glick PL. Interval appendectomy for acute appendicitis. J Pediatr Surg 2009; 44:1056-8. [PMID: 19433198 DOI: 10.1016/j.jpedsurg.2008.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 12/30/2008] [Indexed: 12/29/2022]
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Whyte C, Tran E, Lopez ME, Harris BH. Outpatient interval appendectomy after perforated appendicitis. J Pediatr Surg 2008; 43:1970-2. [PMID: 18970926 DOI: 10.1016/j.jpedsurg.2008.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 04/05/2008] [Accepted: 04/07/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND Interval appendectomy may be advisable after successful nonoperative treatment of perforated appendicitis. To reduce the perceived morbidity of interval appendectomy, we sought to determine if the operation could be done on an outpatient basis. This study is focused on patient comfort and safety after laparoscopic interval appendectomy (LIA). METHODS This is a retrospective review of the clinical course and length of stay of 24 children who had LIA during a 4-year period. RESULTS Of the 24 patients, 12 were discharged on the evening of surgery without incident. Nine additional patients were observed for the first postoperative night-2 for short episodes of temperature elevation, 3 for pain treated within the first 4 hours of recovery and requiring no further treatment, and 4 because the idea of outpatient appendectomy had yet to become popular. None of these patients was febrile overnight, none required narcotic or parenteral analgesics after leaving the recovery room, and all accepted feedings without nausea or vomiting. It is likely that all 9 of these patients could have been discharged on the day of operation. Three other patients stayed in the hospital for treatment of pain, low-grade fever, or slow resumption of feeding. CONCLUSION Of 24 patients, 21(88%) were or could have been discharged on the day of operation. When interval appendectomy is indicated, LIA can be performed safely as an outpatient surgical procedure in most children.
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Affiliation(s)
- Christine Whyte
- Division of Pediatric Surgery, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10467, USA.
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