Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to examine that premise. Two surgical groups contributed consecutively... more
Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to examine that premise. Two surgical groups contributed consecutively operated patients with a clinical diagnosis of appendicitis. One group did all appendectomies open and the other group did them laparoscopically. Hospital expenses were compared using a single billing formula. Hospital length of stay, time to return to work, and complications were analyzed. Operating room times were longer for the laparoscopic group, median 80 minutes, versus median 50 minutes for the open group. Hospital length of stay and return to work were the same, median 1 day and median 10 days, respectively. Wound complications were less common in the laparoscopic group, 0 of 30, than in the open group, 3 of 18; however, there was 1 intra-abdominal abscess in the laparoscopic group. Median cost of the laparoscopic group was $2,915 versus $1,747 for the open group. Laparoscopic appendectomy is more expensive than appendectomy but does not reduce hospital length of stay nor change the time to return to work; however, wound complications are less common.
Background: Acute appendicitis is considered one of the most frequent emergent laparotomies. The precise confirmation of acute appendicitis is a challenge. Alvarado score is used to stratify patients with clinical features of suspected... more
Background: Acute appendicitis is considered one of the most frequent emergent laparotomies. The precise confirmation of acute appendicitis is a challenge. Alvarado score is used to stratify patients with clinical features of suspected acute appendicitis. Aim: To assess the effect of implementation of Alvarado score in decreasing the incidence of negative appendectomies in a Jordanian group of patients. Methods: Our prospective, randomized and double blind investigation enrolled 174 patients, of both sexes, aged 22-64 years and presented to the emergency surgical clinic complaining of lower quadrant and right iliac fossa pain possibly of acute appendicitis, at Prince Hashem bin Abdullah II military hospital, Aqaba, JORDAN, during the period Jan-Nov 2017. Patients were divided into two groups: group I (n=114, surgical) and group II (n=60, non-surgical). In the two groups, patients were sub grouped in those with an Alvarado score of less than 6 and those with an Alvarado score of more than 7. Alvarado score (with a total score of 10 and 8 elements) was compared between all participants in both groups regarding its influence in the confirmation of diagnosis of acute appendicitis and reducing negative appendectomies. Score 1-4 requires discharge, score 5-6 requires observation and admission and score 7-10 requires surgery. The confirmation of diagnosis in group I relied on pathology examination of the excised appendix. Patients with no pathological appendicular inflammation underwent negative appendectomies. The diagnosis for each group was assessed using the Pearson chi-square test. A value of P<0.05 was considered statistically significant. Results: In group I, remarkable anticipation factors for pathology results was Alvarado score more than 7 (45.6%). In group II, Alvarado score more than 7(15%) was not a remarkable anticipator for pathology results. Normal appendix was reported in the pathology report in 8.8% in group I and in 31.7% in group II. Conclusion: There was no difference regarding anticipation confirmation of acute appendicitis between Alvarado score and abdominal ultrasound. Keywords: Abdominal ultrasound; Acute appendicitis; Alvarado score.
Mucocele of the appendix secondary to appendicular carcinoid tumour is a rare entity. It occurs exceptionally during pregnancy. The interaction between carcinoid tumour or mucocele of the appendix and pregnancy is not yet elucidated.... more
Mucocele of the appendix secondary to appendicular carcinoid tumour is a rare entity. It occurs exceptionally during pregnancy. The interaction between carcinoid tumour or mucocele of the appendix and pregnancy is not yet elucidated. Prognosis depends on the size of the carcinoid tumour and its regional invasion. We report a case of appendicular mucocele caused by a carcinoid tumour in
The aetiological importance of stressful life events and psychological characteristics was assessed amongst 280 appendicectomy patients of whom 80% were classified with &#39;acutely inflamed&#39; (organic) appendicitis and 20%... more
The aetiological importance of stressful life events and psychological characteristics was assessed amongst 280 appendicectomy patients of whom 80% were classified with &#39;acutely inflamed&#39; (organic) appendicitis and 20% with &#39;non-inflamed&#39; (non-organic) appendicitis. Patients were compared with a community comparison group. Specific characteristics of life stressors, namely severe goal frustration for organic patients and severe threat for non-organic patients, were the best predictors of patient outcome. Whilst psychological characteristics were not useful in discriminating between patients, depression in particular, was clearly associated with both conditions, with 38% of non-organic and 28% of organic patients with depression scores in the clinical range. As the patient&#39;s clinical depression status failed to modify the effect of the life stress predictors, it was concluded that life stress played an important role in the development of the patients GI symptoms, irrespective of their clinical depression status.
on behalf of the SCOTTISH SURGICAL RESEARCH GROUP Introduction: The aim of our study was to identify the most commonly employed methods and influencing factors for securing the appendiceal stump in current NHS practice.
Acute appendicitis is the most common intra-abdominal condition that requires emergency surgical intervention. Open appendicectomy (OA) was first described in 1894 and is performed through a right lower abdominal quadrant incision.1 This... more
Acute appendicitis is the most common intra-abdominal condition that requires emergency surgical intervention. Open appendicectomy (OA) was first described in 1894 and is performed through a right lower abdominal quadrant incision.1 This technique remained the golden standard until the introduction of laparoscopic appendicectomy (LA) by Semm in 1983.It is considered safe with low morbidity rate.2 Laparoscopic appendectomy has been found to have better wound healing,reduced postoperative pain,earlier resumption of daily activities and finally a better cosmetic results. Conventional open appendicectomy comes to play most importantly in patients with associated complicationssuch as appendicular mass formation or abscess. However, there are no evidences to showcase that both the methods are better for the patient.
This is a retrospective study that focuses on the outcomes in patients undergoing open appendicectomy compared with laparoscopic appendectomy
Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice... more
Background and aims Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. Methods This executive manuscript summarizes the WSES gu...
Appendicitis is the leading cause of surgical emergency admission in most hospitals in Nigeria. It accounts for about 15-40% of all emergency surgery done in most centers in the country. All age groups can develop the disease including... more
Appendicitis is the leading cause of surgical emergency admission in most hospitals in Nigeria. It accounts for about 15-40% of all emergency surgery done in most centers in the country. All age groups can develop the disease including the fetus in utero, but the incidence is higher in the second and third decade of life. Majority of patients in Nigeria present late with complicated disease. Surgery is the treatment of choice for appendicitis. However, patients must be adequately resuscitated before the procedure. Prognosis is excellent. High morbidities and occasional mortalities seen are usually due to late presentation and delay in treatments. Fear of surgery and cost of treatment are the main reason for late presentation. Mass education should be done to enlighten the populace on the evil of late presentation. The government should be implored to make widely available social support facilities that patients can make use of, at least in emergency situations.
BACKGROUND: Surgery for pain in the right lower quadrant of the abdomen remains a clinical dilemma. Acute appendicitis is considered one of the commonest surgical emergencies. Correct diagnosis and prompt treatment are required to reduce... more
BACKGROUND: Surgery for pain in the right lower quadrant of the abdomen remains a clinical dilemma. Acute appendicitis is considered one of the commonest surgical emergencies. Correct diagnosis and prompt treatment are required to reduce the development of complications. Ultrasound has been shown to be of value in the diagnosis of acute appendicitis with sensitivity varying from one study to another. METHODS: One hundred-and-three adult patients with suspected acute appendicitis who underwent preoperative ultrasound scan of the abdomen and subsequently appendectomy; had the histopathology reports compared with their operative findings. RESULTS: 103 patients whose ages ranged from 15 to 65 years with a mean age of 30.6±18 were retrospectively reviewed. Male to female ratio was 1.5:1. Seventy-five patients had ultrasound diagnosis of acute appendicitis, 68 of which correlated with histopathology. There were 16 patients with equivocal ultrasound findings while ten patients had normal scans and two patients had a misdiagnosis of ovarian cyst. Of the ten, eight had histopathological features of acute appendicitis. Sensitivity of ultrasound in this study was 90.2% while specificity was 85.6%.CONCLUSION: Ultrasound scan in patients with suspected acute appendicitis provides a high sensitivity and specificity in the diagnosis and therefore a formidable tool for diagnosing acute appendicitis in low resource center.
Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by... more
Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. Results One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). Conclusions The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.
The emergence of laparoscopy in the late 1980's as a credible therapeutic intervention heralded a new surgical age. Demonstrable reduction of wound complications, post-operative pain, hospital stay and costs in treating gallbladder... more
The emergence of laparoscopy in the late 1980's as a credible therapeutic intervention heralded a new surgical age. Demonstrable reduction of wound complications, post-operative pain, hospital stay and costs in treating gallbladder disease [1] and gynaecological conditions such as ...
Many dangerous surgical complications like intestinal obstruction, acute appendicitis with perforation, ileal perforation in a typhoid patient, Meckel’s diverticulitis, disruption of post operative intestinal anastomosis, volvulus, and... more
Many dangerous surgical complications like intestinal obstruction, acute appendicitis with perforation, ileal perforation in a typhoid patient, Meckel’s diverticulitis, disruption of post operative intestinal anastomosis, volvulus, and intussusception are known to occur due to ascariasis, with considerable morbidity and mortality. In this retrospective study of 250 cases of gastrointestinal ascariasis admitted in paediatric surgical wards of Govt. Medical College, Jabalpur (MP), the authors analysed the results of conservative (especially the use of hypertonic saline enema-given just like an ordinary soap water enema but substituting freshly made hypertonic saline in place of soap water) and surgical treatment. The success rate of conservative treatment was 95.6%. Hypertonic saline passes through the incompetent ileo-caecal valve (present in 80% of children) and irritates the worm bolus commonly situated in the terminal ileum, causing it to disintegrate. It also helps to increase the intestinal motility and passage of worms into the colon. The use of hypertonic saline enema is safe and effective in the conservative treatment of gastrointestinal ascariasis. Authors feel that it is the most grossly under utilized part of conservative treatment and deserves to be known and used on wider scale.
Background Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high-and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly... more
Background Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high-and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle and nd high-Human Development Index (HDI) countries worldwide. Methods This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countr...
Meckel's diverticulum (MD ) is the most common congenital anomaly of the gastrointestinal tract. We revalued clinical records of patients discharged from Unit of Urgent and General Surgery of Highly Specialized Hospital "A.O.R.N.... more
Meckel's diverticulum (MD ) is the most common congenital anomaly of the gastrointestinal tract. We revalued clinical records of patients discharged from Unit of Urgent and General Surgery of Highly Specialized Hospital "A.O.R.N. Antonio Cardarelli" of Naples with diagnosis of acute pathology associated to complicated MD from 1(st) January 2011 to 30(th) November 2012. Seven consecutive cases have been chosen: five males (71,4%) and two females (28,6%). The age ranges over from 13 to 50 years with a 28 years average. Four of them were submitted to emergency surgical intervention for hemorrhage from gastro-enteric tract (57%), two for bowel obstruction (29%) and one for acute appendicitis (14%). In all cases sample was send to histological examination. Two samples showed normal epithelial mucosa. Four of them showed ectopic mucosa inside the diverticulum: three gastric and one pancreatic ectopic mucosa focal areas. The last case showed normal epithelial cells but with u...
Background Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high-and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly... more
Background Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high-and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle and nd high-Human Development Index (HDI) countries worldwide. Methods This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countr...
