Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis

High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia

Context

Acute appendicitis is a common surgical emergency. While clinical diagnosis is generally effective, it is not perfect, potentially leading to negative appendectomies or delayed treatment.

Aims

This study investigated the histopathological patterns of appendectomy specimens in King Khalid Hospital, Hail Province, Saudi Arabia, correlating them with preoperative clinical diagnoses to assess diagnostic accuracy and guide optimal management.

Subjects and Methods

A retrospective analysis was conducted on 198 patients who underwent appendectomies between August 2023 and July 2024. Resected appendix specimens underwent histopathological examination and were categorized as inflamed, malignant, or benign. Clinical data and histopathological findings were compared using statistical analyses, including Fisher's exact test, to assess diagnostic accuracy and explore potential associations between patient demographics, appendicitis severity, and clinical presentation.

Results

The study cohort consisted predominantly of young males (78.8%, mean age: 26 ± 9.2 years), with no pediatric cases included. The most common histopathological finding was an inflamed appendix (99.5%), with acute inflammation being most prevalent (86.9%). Perforation (10.1%) and gangrenous changes (2.5%) were also observed. A rare case of negative appendectomy (0.5%) was attributed to a perforated Meckel's diverticulum.

Conclusions

This study demonstrates a high preoperative diagnostic accuracy for acute appendicitis. However, the occurrence of negative appendectomies and complicated cases, particularly in young adult males, highlights the need for continuous vigilance and refinement of diagnostic approaches. Further research exploring age- and sex-specific risk factors for complicated appendicitis is crucial to optimizing patient management strategies and minimizing unnecessary surgical interventions.

The relationship between microRNA-155-5p and postoperative inflammatory markers in children with acute suppurative appendicitis and its role in predicting postoperative complications

BACKGROUND

The prevalence of acute suppurative appendicitis (ASA) is the highest among pediatric cases of acute abdominal conditions. This research examined the stress response linked to surgical techniques and identified potential biomarkers that could predict postoperative complications to enhance clinical treatment strategies.

METHODS

This study involved a selection of 166 ASA patients who underwent laparoscopic appendectomy (LA), and 150 patients who underwent open appendectomy (OA), based on data collected from 2020 to 2023. Comprehensive documentation of clinical and pathological characteristics, as well as postoperative complications, was conducted following patient enrollment. Quantitative polymerase chain reaction (qPCR), enzyme-linked immunosorbent assay (ELISA), and blood smear techniques were employed to assess the levels of microRNA (miR)-155-5p, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD), and malondialdehyde (MDA), as well as changes in leukocytes, neutrophils, and lymphocytes at preoperative and postoperative 0 h, and 24 h. A logistic regression model was utilized to identify risk factors associated with the development of complications. Furthermore, receiver operating characteristic (ROC) curve analysis was performed to assess the predictive capacity of miR-155-5p for the occurrence of complications.

RESULTS

The study revealed that the levels of miR-155-5p postoperatively in patients undergoing OA was significantly greater than that observed in patients undergoing LA (P.

Effects of evidence-based nursing on surgical site wound infection in patients undergoing acute appendicitis surgery: A meta-analysis

This study aimed to comprehensively evaluate the effects of evidence-based nursing (EBN) intervention on wound infection and postoperative complications in patients after appendectomy for acute appendicitis (AA), with the expectation of providing a theoretical basis for postoperative care in AA. Randomised controlled trials (RCTs) on the postoperative application of EBN in patients with AA were searched in PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure from the inception of databases to October 2023. Two authors screened and evaluated the literature based on the inclusion and exclusion criteria, and data were extracted from the final included literature. Stata software (version 17.0) was employed for data analysis. In total, 29 RCTs involving 2848 patients with AA were included, with 1424 in the EBN group and 1424 in the conventional care group. The analyses revealed that patients with AA who experienced EBN were significantly less likely to develop postoperative wound infections (odds ratio [OR] = 0.23, 95% confidence intervals [CIs]: 0.14-0.38, p < 0.001) and postoperative complications (OR = 0.20, 95% CI: 0.15-0.26, p < 0.001) as opposed to conventional care. Available evidence suggests that EBN can effectively reduce the risk of wound infection and postoperative complications in patients undergoing appendectomy for AA, thereby improving patient prognosis. This finding is worth promoting in the clinical practice.

Comparative analysis of wound healing techniques in postoperative bladder cancer patients

Bladder cancer is a highly prevalent malignancy that presents significant difficulties in the management of wounds following surgery. The present study investigated the critical necessity to optimize wound healing techniques in patients undergoing bladder cancer surgery by contrasting conventional approaches with advanced modalities in order to promote recovery and mitigate complications. The study assessed the efficacy of conventional and advanced wound healing methods in these patients, taking into account the complex interaction of patient-specific factors and surgical complexities. A cross-sectional analysis was performed on 120 patients who underwent bladder cancer surgery at the first affiliated hospital of Wenzhou Medical University. In addition to medical record evaluations and direct wound assessments, patient interviews were utilized to gather information regarding demographics, surgical specifics, wound healing methodologies and postoperative results. Survival analysis and logistic regression were utilized in statistical analysis, with potential confounding variables such as age, comorbidities and type of surgery being accounted for. Advanced wound healing techniques, such as negative pressure wound therapy, tissue-engineered products, bioactive dressings and platelet-rich plasma (PRP), exhibited distinct advantage in comparison with conventional suturing. The aforementioned techniques, especially PRP, resulted in expedited wound healing, decreased rates of complications (p < 0.05) and enhanced secondary outcomes, including curtailed hospital stays and decreased rates of readmissions. PRP therapy, in particular, demonstrated significant improvements with the faster mean time to wound healing of 9 ± 2 days and lower complication incidence of 2 (6.7%) (p < 0.05), indicating its superior efficacy. A subgroup analysis revealed that younger patients, males and those undergoing laparoscopic surgery exhibited superior outcomes (p < 0.05). The results were further supported by logistic regression and Cox proportional hazards models, which further indicated that sophisticated techniques, notably PRP therapy with a hazard ratio of 3.00 (2.00-4.50) and adjusted odds ratio of 0.20 (0.09-0.43), were effective in improving postoperative recovery. The research clarified the significant advantages that advanced wound healing techniques offered in postoperative care of patients diagnosed with bladder cancer. By customizing these methods to suit the unique requirements of individual patients and specific circumstances of surgical procedures, they can significantly enhance the recuperation process after surgery and set a new standard for patient care.

Risk Factors for Post-appendectomy Surgical Site Infection in Laparoscopy and Laparotomy - Retrospective Cohort Study

Background Appendicitis is a frequent emergency condition. Surgical site infections (SSI) are a common complication of appendectomy. Despite improvements in infection control, SSIs continue to cause harm, prolonged hospital stays, and even death. Objective The objective of this study is to compare the risk of developing surgical site infections (SSIs) between open laparotomy and laparoscopic appendectomies in Al-Baha, Saudi Arabia. Methods This retrospective cohort study compared laparotomy and laparoscopy for post-operative surgical site infection among patients who underwent an appendectomy at King Fahad Hospital (KFH) in Albaha, Saudi Arabia. Medical record numbers (MRNs) of patients who met the inclusion criteria were collected to build the sampling frame. From the final sampling frame, simple random sampling using a random number generator was used to draw a representative sample. Data were collected from the surgical health records of the patients. The collected data included patients' demographics, comorbidities, presenting symptoms, ordered imaging studies, pre-operative shaving, type and duration of surgery, intraoperative findings, and signs of wound inflammation. Results The total number of patients included in the analysis was 256, who underwent surgery for acute appendicitis. Among those who underwent laparoscopy, 5.7% had to be converted to open laparotomy. Signs of surgical wound inflammation were found in 10.2% of the patients. Patients who underwent open laparotomy had a significantly higher risk of wound infection (RR=3.1, p-value=0.001). Further analysis revealed an effect modification of pre-operative shaving. Open laparotomy has a higher risk of wound infection among patients who have not had pre-operative shaving (RR=4.1 vs. RR=2.6), while both risks were statistically significant (p-value=0.033 and p-value=0.035), respectively. Complicated cases in intra-operative findings were found to have a higher risk of post-appendectomy SSI. Conclusion This study demonstrates that laparoscopic appendectomy carries a lower risk of surgical site infection (SSI) compared to open laparotomy. Additionally, pre-operative shaving of the surgical site was found to increase the incidence of SSI. Healthcare providers can use this information to enhance their practice and reduce the occurrence of surgical site infections. Whenever possible, laparoscopic appendectomy should be preferred over open laparotomy due to its substantially lower SSI risk. We also recommend vigilant monitoring of complicated appendectomy, particularly in cases of ruptured appendicitis, for signs of SSI.

Application and curative effect of laparoscopic purse-string sutures in the treatment of adult acute complicated appendicitis

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.

Decision-making changes for patients and medical personnel in the management of acute appendicitis during the COVID-19 pandemic

BACKGROUND

Acute appendicitis is the most common cause of acute abdomen. During the pandemic, to contain the spread of COVID-19, there were some integral changes in the medical processes based on the pandemic prevention policy, especially regarding emergency surgery. This study was conducted to investigate whether this pandemic also impacted the decision-making for both patients and medical personnel along with the treatment outcomes.

METHODS

Patients of age 18 years or older who were diagnosed clinically and radiologically with acute appendicitis between Jan 1, 2017, and Dec 31, 202,0 were reviewed. The data of 1991 cases were collected and used for this study. Two groups were formed, one group before and the other group after the outbreak. The gathered data included gender, age, appendiceal fecalith, outcomes of treatment, and long-term outcomes of non-operation (8 months follow-up). We also collected details of surgical cases from the above two groups. This data also included age, gender, appendiceal fecalith, fever, jaundice, length of onset before presenting to an emergency department (ED), anesthesia, surgery, white cell count, pathology, complications, and length of stay. We compared the above data respectively and analyzed the differences.

RESULTS

Compared to the period before the outbreak, patient visits for acute appendicitis remarkably dropped (19.8%), but surgical cases showed no change (dropped by roughly 5%). There were significant differences (P < 0.05) in failure of non-operation(after the pandemic 8.31% vs. before pandemic 3.22%), interval appendectomy(after pandemic 6.29% vs. before pandemic 12.84%), recurrence(after pandemic 23.27% vs. before pandemic 14.46%), and outcomes of recurrence. There was a significant difference (P < 0.05) in anesthesia method, surgery way, and complications( before pandemic 4.15% vs. after pandemic9.89% P < 0.05) in patients who underwent the surgery. There was no statistical difference (P > 0.05) concerning age, gender, fever, jaundice, appendiceal fecalith, white cell count, and length of onset before presenting to the ED.

CONCLUSION

The current pandemic prevention policy is very effective, but some decision-making processes of doctor-patient have changed in the context of COVID-19 pandemic, that further influenced some treatment outcomes and might lead to a potential economic burden. It is essential to address the undue concern of everyone and optimize the treatment process.

Changes in the Emergency General Surgery Operations in the Setting of COVID-19 and Impact of Strategy of Non-Operative Management on Outcomes in Acute Appendicitis

Background: Coronavirus disease 2019 (COVID-19) has posed significant challenges to the provision of elective and emergency general surgical care. Patterns of presentation have changed and management pathways have also been adapted, moving to more non-operative management (NOM) for some conditions. We investigated how COVID-19 changed the volume of emergency general surgery operating in our district general hospital (DGH). We aimed to evaluate the impact of NOM on outcomes in acute appendicitis.

Methods: A retrospective case review of operating lists, patient handover lists, and patient notes was undertaken for patients presented between 1^st January 2020 and 3^rd June 2020. The study period was divided into two, with the period between 1^st January 2020 and 23^rd March 2020 representing the pre-COVID cohort.

Results: Some 393 emergency general surgery operations were performed in the study period. There was a clear reduction in operating volume after 23^rd March 2020. During that same period, 325 patients were assessed with right iliac fossa (RIF) pain. Median age was 21 (range 5-87) and 201 patients were female (61.8%). The rate of NOM for suspected acute appendicitis was 8.8% in the pre-COVID group, which increased to 36.4% in the COVID group. The incidence of normal histology following appendicectomy did not change with this difference in management (16.1% compared to 17.9%, p = 0.78).

Conclusions: This study summarizes the changes brought to the provision of emergency general surgery in the setting of a DGH by the COVID-19 pandemic. In particular, NOM was the preferred option for acute appendicitis but this did not alter the negative appendicectomy rate.

Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy

Purpose

This study aimed to compare the perioperative outcomes of wet gauze and conventional irrigation after laparoscopic appendectomy to determine whether wet gauze irrigation can help reduce surgical site infection (SSI).

Methods

A total of 308 patients undergoing laparoscopic appendectomy were included in this study between December 2018 and May 2020. Of these, 132 (42.9%) received gauze irrigation (group 1), and 176 patients (57.1%) received conventional irrigation (group 2). Pre-operative outcomes and complications, including SSI, were compared after propensity score matching (PSM) to adjust for baseline differences and selection bias.

Results

After 1:1 PSM, 92 well-matched patients in each group were evaluated. Regarding perioperative outcomes between groups 1 and 2, the rate of severe complications (Clavien-Dindo Classification grades III, IV, and V), operative time, and readmission rate did not differ between the groups. Superficial/deep SSIs were observed more frequently in group 2 (8/92 cases) than in group 1 (1/92 cases; p = 0.017). The organ/space SSIs rate was not significantly different between the two groups (1/92 group 1 and 0/92 group 2, p = 0.316). However, post-operative hospital stay was significantly longer in group 2 (2.8 ± 1.3 days) than in group 1 (1.6 ± 1.2 days; p < 0.001). In the univariate analyses, wound irrigation using wet gauze was an independent protective factor for superficial or deep SSI (p = 0.044).

Conclusions

Wound irrigation using wet gauze after fascia closure has a significant beneficial effect on reducing post-operative superficial/deep SSI following laparoscopic appendectomy.

Acute appendicitis-advances and controversies

Being one of the most common causes of the acute abdomen, acute appendicitis (AA) forms the bread and butter of any general surgeon's practice. With the recent advancements in AA's management, much controversy in diagnostic algorithms, possible differential diagnoses, and weighing the management options has been generated, with no absolute consensus in the literature. Since Alvarado described his eponymous clinical scoring system in 1986 to stratify AA risk, there has been a burgeoning of additional scores for guiding downstream management and mortality assessment. Furthermore, advancing literature on the role of antibiotics, variations in appendicectomy, and its adjuncts have expanded the surgeon's repertoire of management options. Owing to the varied presentation, diagnostic tools, and management of AA have also been proposed in special groups such as pregnant patients, the elderly, and the immunocompromised. This article seeks to raise the critical debates about what is currently known about the above aspects of AA and explore the latest controversies in the field. Considering the ever-evolving coronavirus disease 2019 situation worldwide, we also discuss the pandemic's repercussions on patients and how surgeons' practices have evolved in the context of AA.

Complicated appendicitis are common during the epidemic period of 2019 novel coronavirus (2019-nCoV)

Objectives

To assess the prevalence of complicated appendicitis (including gangrene, abscess and perforation) after the outbreak of the 2019-nCoV epidemic and to identify the risk factors associated with complicated appendicitis.

Methods

Two groups were established in the study consisting of: one group for cases of acute appendicitis before the 2019-nCoV epidemic (before January 1, 2020; pre-epidemic group) and another group for those after the epidemic outbreak (after January 1, 2020; epidemic group). These two groups were compared in terms of demographic and clinical characteristics, prevalence of complicated appendicitis, and treatment intention. A multivariate analysis model using binary logistic regression was constructed.

Results

A total of 163 patients were included in this study, with 105 in the pre-epidemic group and 58 in the epidemic group. In the epidemic group, the interval from the onset of symptoms to admission was 65.0 h, which is significantly longer than the 17.3 h interval noted in the pre-epidemic group (P < 0.001). The prevalence of complicated appendicitis after the epidemic outbreak was significantly higher than before the outbreak (51.7% vs. 12.4%, P < 0.001). In addition, the epidemic group had a lower score of patient’s intention to seek treatment than the pre-epidemic group (9.5 ± 2.7 vs. 3.4 ± 2.6, P < 0.001). Based on the multivariate analysis, the risk factors for complicated appendicitis included the time from symptoms onset to admission (OR = 1.075) and the patients’ intention to receive treatment (OR = 0.541).

Conclusion

Complicated appendicitis was more common in patients with acute appendicitis after the outbreak of the 2019-nCoV epidemic.

Comparison of laparoscopic and open appendectomy on wound infection and healing in complicated appendicitis

The aim of this study was to investigate the effects of laparoscopic and open surgery on the development of postoperative surgical wound infection and wound healing between complicated appendicitis patients. Patients with complicated appendicitis were divided into those underwent laparoscopic and open surgical procedures according to the surgical method. Patients were followed up with regard to development of any postoperative wound infection, and medical, radiological, and surgical treatment methods and results were recorded. A total of 363 patients who underwent appendectomy were examined, of which 103 (28.4%) had complicated appendicitis. Postoperative wound infection rate in patients who underwent open surgery was 15.9%, while it was 6.8% in the laparoscopic surgery group. There was no statistically significant difference between the two groups in terms of infection development rates (P > .05). The rate of surgical drainage use and rehospitalisation was significantly higher in the group with wound infection than in the group without wound infection. (P < .05). We suggest that in terms of wound infection and wound healing, laparoscopic surgery should be the method of choice for patients with complicated appendicitis. In order to reduce the frequency of wound infection, drains should not be kept for a long time in patients undergoing appendectomy.