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Tang Y, Liu J, Bai G, Cheng N, Deng Y, Cheng Y. Abdominal drainage to prevent intraperitoneal abscess after appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2025; 4:CD010168. [PMID: 40214287 PMCID: PMC11987584 DOI: 10.1002/14651858.cd010168.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
RATIONALE This is the third update of a Cochrane review first published in 2015 and last updated in 2021. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. People who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications in comparison to uncomplicated appendicitis. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES To evaluate the benefits and harms of abdominal drainage in reducing intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases, and five trials registers, together with reference checking, citation searching, and contact with study authors, to identify studies for inclusion in the review. The latest search date was 12 October 2023. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in people with complicated appendicitis comparing (1) use of drain versus no drain, (2) open drain versus closed drain, or (3) different schedules for drain removal. We excluded studies in which not all participants received antibiotics after appendectomy. OUTCOMES Our critical outcome was intraperitoneal abscess. Important outcomes were wound infection, morbidity, mortality, and hospital stay. RISK OF BIAS We used the Cochrane RoB 1 tool to assess the risk of bias in RCTs and quasi-RCTs. SYNTHESIS METHODS We synthesised the results for each outcome in a meta-analysis using the random-effects model, except for the Peto odds ratio, which only has a fixed-effect model. We planned to use the Synthesis Without Meta-analysis (SWiM) approach to report studies when it was not possible to undertake a meta-analysis of effect estimates. We used GRADE to assess the certainty of evidence for each outcome. INCLUDED STUDIES We included eight studies (five RCTs and three quasi-RCTs) with a total of 739 paediatric and adult participants, of which 370 participants were randomised to the drainage group and 369 participants to the no-drainage group. The studies were conducted in North America, Asia, and Africa and published between 1973 and 2023. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open or laparoscopic appendectomy. All studies were at overall high risk of bias. SYNTHESIS OF RESULTS Use of drain versus no drain We assessed the certainty of the evidence for 30-day mortality as moderate due to imprecision. We assessed the certainty of the evidence for all other outcomes as very low, downgraded mainly due to high risk of bias, inconsistency, and imprecision. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.55 to 2.12; 7 studies, 671 participants; very low-certainty evidence), wound infection at 30 days (RR 1.76, 95% CI 0.89 to 3.45; 7 studies, 696 participants), and morbidity at 30 days (RR 1.84, 95% CI 0.14 to 24.50; 2 studies, 124 participants) in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis. Approximately 113 (57 to 221 participants) out of 1000 participants in the drainage group developed intraperitoneal abscess, compared with 104 out of 1000 participants in the no-drainage group. There were seven deaths in the drainage group (N = 291) compared with one in the no-drainage group (N = 290); abdominal drainage probably increases the risk of 30-day mortality (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 6 studies, 581 participants; moderate-certainty evidence) in paediatric and adult participants undergoing open appendectomy for complicated appendicitis. Abdominal drainage may increase hospital stay by 1.58 days (95% CI 0.86 to 2.31; 5 studies, 516 participants; very low-certainty evidence) in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis, but the evidence is very uncertain. Open drain versus closed drain No studies compared open drain versus closed drain for complicated appendicitis. Early versus late drain removal No studies compared early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS The evidence is very uncertain whether abdominal drainage prevents intraperitoneal abscess, wound infection, or morbidity in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis. Abdominal drainage may increase hospital stay in paediatric and adult participants undergoing open or laparoscopic appendectomy for complicated appendicitis, but the evidence is very uncertain. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in people undergoing open or laparoscopic appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in paediatric and adult participants undergoing open appendectomy for complicated appendicitis. Larger studies are needed to more reliably determine the effects of drainage on mortality outcomes. FUNDING This Cochrane review was funded by the National Natural Science Foundation of China (Grant No. 81701950, 82172135), Natural Science Foundation of Chongqing (Grant No. CSTB2022NSCQ-MSX0058, cstc2021jcyj-msxmX0294), Medical Research Projects of Chongqing (Grant No. 2018MSXM132, 2023ZDXM003, 2024jstg028), and the Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University. REGISTRATION Registration: not available. Protocol and previous versions available via doi.org/10.1002/14651858.CD010168, doi.org/10.1002/14651858.CD010168.pub2, doi.org/10.1002/14651858.CD010168.pub3, and doi.org/10.1002/14651858.CD010168.pub4.
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Affiliation(s)
- Yunhao Tang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jie Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guijuan Bai
- Department of Clinical Laboratory, Community Health Center of Dingshan Street Jiangjin District Chongqing City, Jiangjin, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yilei Deng
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Salö M, Tiselius C, Rosemar A, Öst E, Sohlberg S, Andersson RE. Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children. BJS Open 2025; 9:zrae165. [PMID: 40203150 PMCID: PMC11980984 DOI: 10.1093/bjsopen/zrae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/19/2024] [Accepted: 12/15/2024] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common causes of acute abdominal pain. Differences in the management of this large group of patients has important consequences for the patients and the healthcare system. Controversies regarding the understanding of the natural course of the disease, the utility of new diagnostic methods, and alternative treatments have lead to large variations in practice patterns between centres. These national guidelines present evidence-based recommendations aiming at a uniform, safe and cost-efficient management of this large group of patients. METHOD A working group of six experts with broad clinical and research experience was formed. Additional expertise from outside was consulted during the process. A national survey revealed significant variations in the management of patients with suspicion of appendicitis. The evidence provided in published guidelines and reviews were extracted and systematically graded, according to the GRADE methodology. This was supplemented by additional more recent and more directed search of the literature. Patients treated for appendicitis were involved through interviews. The guidelines were reviewed by external experts before the final version was determined. RESULTS The guidelines cover an extensive number of issues: pathology, epidemiology, aetiology, natural history, clinical and laboratory diagnosis, diagnostic scoring systems, diagnostic imaging, treatment, nursing care, follow-up, quality registers and quality indicators, among others. Special considerations related to children and pregnant women are covered. CONCLUSION These national guidelines present an extensive and thorough review of the current knowledge base related to appendicitis, and provide up-to-date evidence-based recommendations for the management of this large group of patients.
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Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Catarina Tiselius
- Department of Surgery, Västmanland Hospital Västerås, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anders Rosemar
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Sohlberg
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Roland E Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
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Liu M, Yang P, Gou Y, Chen Q, Xu D. Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study. Front Pediatr 2024; 12:1441263. [PMID: 39735250 PMCID: PMC11671485 DOI: 10.3389/fped.2024.1441263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 12/04/2024] [Indexed: 12/31/2024] Open
Abstract
Objective The aim of this research was to develop and internally validate a nomogram for forecasting the length of hospital stay following laparoscopic appendectomy in pediatric patients diagnosed with appendicitis. Methods We developed a prediction model based on a training dataset of 415 pediatric patients with appendicitis, and hospitalization data were collected retrospectively from January 2021 and December 2022. The primary outcome measure in this study was hospital length of stay (LOS), with prolonged LOS defined as admission for a duration equal to or exceeding the 75th percentile of LOS, including the discharge day. Risk factor analysis was conducted through univariate and multivariate logistic regression analyses. Based on the regression coefficients, a nomogram prediction model was developed. The discriminative performance of the predicting model was evaluated using the C-index, and an adjusted C-index was computed through bootstrapping validation. Calibration curves were generated to assess the accuracy of the nomogram. Decision curve analysis was conducted to determine the clinical utility of the predicting model. Results Predictors contained in the prediction nomogram included Age, neutrophil-to-lymphocyte ratio, C-reactive protein level, operative time, appendiceal fecalith, and drainage tube. The C-index of the prediction nomogram was determined to be 0.873 (95% CI: 0.838-0.908), with a corrected C-index of 0.8625 obtained through bootstrapping validation (1,000 resamples), indicating the model's favorable discrimination. Calibration curves illustrated a strong agreement between predicted and observed outcomes. According to the decision curve analysis of the nomogram, the predictive model demonstrates a net benefit at threshold probabilities exceeding 2%. Conclusion This nomogram, incorporating variables such as Age, neutrophil-to-lymphocyte ratio, C-reactive protein level, operative time, appendiceal fecalith, and drainage tube, offers a convenient method for assessing the duration of hospitalization in pediatric patients with appendicitis.
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Affiliation(s)
| | - Ping Yang
- Department of Pediatric Surgery, Suining Central Hospital, Suining, Sichuan Province, China
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Wu H, Liao B, Cao T, Ji T, Luo Y, Huang J, Ma K. Advantages comparison of peritoneal drainage versus no drainage after laparoscopic appendectomy for complicated appendicitis: a meta-analysis. BMC Gastroenterol 2024; 24:411. [PMID: 39550531 PMCID: PMC11568599 DOI: 10.1186/s12876-024-03500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 11/07/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Peritoneal drainage (PD) following laparoscopic appendectomy(LA) has long been considered beneficial for appendicitis patients, especially those with complicated appendicitis. However, recent research has raised doubts about the advantages of PD, as it not only fails to reduce postoperative complications but also prolongs the operative duration and hospital stay and incurs higher medical expenses. Given this controversy, we conducted a meta-analysis to determine whether drainage is necessary after LA for complicated appendicitis. This meta-analysis had registered in PROSPERO(ID: CRD42023472382). OBJECTIVE This study assessed current evidence regarding the efficacy, safety, and potential benefits of drainage versus no drainage following LA for complicated appendicitis. METHODS We conducted a comprehensive search of PubMed, Springer, and the Cochrane Library using the search terms "appendicitis", "laparoscopic appendectomy", and "drain" or "drainage" for studies published between January 1, 2000, and December 31, 2022. We employed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria for study inclusion and exclusion. Primary outcomes included postoperative intra-abdominal abscess, postoperative intestinal obstruction, postoperative stump leakage, wound infection and postoperative visual analog scale(VAS) score, while secondary outcomes consisted of operative time, postoperative recovery time and total hospitalization duration. Studies with at least two outcomes were considered for meta-synthesis. Depending on I2 values, fixed- or random effects models were used for data synthesis. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated for outcome comparisons between PD and no peritoneal drainage (NPD). Sensitivity analysis and meta-regression were performed to assess and investigate inter-study heterogeneity. RESULTS After conducting our literature search and screening, twelve studies were analyzed, comprising 3374 cases. During the comparison of primary outcomes between PD and NPD, the incidence of wound infection and postoperative VAS score were significantly higher in the PD group(P < 0.05). While during the comparison of secondary outcomes, the operative duration, postoperative recovery time and hospitalization duration were significantly longer in the PD group than in the NPD group(P < 0.05). CONCLUSION PD following LA for complicated appendicitis not only increases the incidence wound infection and aggravate patients' postoperative pain, but also prolongs the operative duration, postoperative recovery time and hospitalization duration. Therefore, routine PD after LA for acute complicated appendicitis is not recommended.
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Affiliation(s)
- Hongsheng Wu
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China.
| | - Biling Liao
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China
| | - Tiansheng Cao
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China
| | - Tengfei Ji
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China
| | - Yumei Luo
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China
| | - Jianbin Huang
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China
| | - Keqiang Ma
- Department of Hepatobiliary Pancreatic Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou, 510800, Guangdong, PR China.
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Alabbad J, Alhamly H, Alrubaiaan A, Kabli A, Abdulraheem F. The utility of intraperitoneal drain placement after laparoscopic appendectomy for perforated appendicitis in postoperative intraperitoneal abscess prevention. Surg Endosc 2024; 38:3571-3577. [PMID: 38750172 DOI: 10.1007/s00464-024-10869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/17/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Perforated appendicitis is associated with postoperative development of intraperitoneal abscess. Intraperitoneal drain placement during appendectomy is thought to reduce the risk of developing postoperative intraperitoneal abscess. The aim of this study was to determine whether intraperitoneal drainage could reduce the incidence of intraperitoneal abscess formation after laparoscopic appendectomy for perforated appendicitis. METHODS This is a retrospective study of all patients (aged 7 and above) who were diagnosed with perforated appendicitis and subsequently underwent laparoscopic appendectomy between January 2018 and December 2022 at two government hospitals in the state of Kuwait. Demographic, clinical, and perioperative characteristics were compared between patients who underwent intraoperative intraperitoneal drain placement and those who did not. The primary outcome was the development of postoperative intraperitoneal abscess. Secondary outcomes included overall postoperative complications, superficial surgical site infection (SSI), length of stay (LOS), readmission and postoperative percutaneous drainage. RESULTS A total of 511 patients met the inclusion criteria between 2018 and 2022. Of these, 307 (60.1%) underwent intraoperative intraperitoneal drain placement. Patients with and without drains were similar regarding age, sex, and Charlson Comorbidity Index (CCI) (Table 1). The overall rate of postoperative intraperitoneal abscess was 6.1%. Postoperatively, there was no difference in postoperative intraperitoneal abscess formation between patients who underwent intraperitoneal drain placement and those who did not (6.5% vs. 5.4%, p = 0.707). Patients with intraperitoneal drains had a longer LOS (4 [4, 6] vs. 3 [2, 5] days, p < 0.001). There was no difference in the overall complication (18.6% vs. 12.3%, p = 0.065), superficial SSI (2.9% vs. 2.5%, p = 0.791) or readmission rate (4.9% vs. 4.4%, p = 0.835). CONCLUSIONS Following laparoscopic appendectomy for perforated appendicitis, intraperitoneal drain placement appears to confer no additional benefit and may prolong hospital stay.
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Affiliation(s)
- Jasim Alabbad
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
- Department of Surgery, College of Medicine, Kuwait University, P.O. Box 24923, 3110, Safat, Kuwait.
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Hubble T, Huseyin A, Kersey J, Bath MF, Nair M. Impact of intra-abdominal drains in emergency gastrointestinal surgery: a scoping review. ANZ J Surg 2024; 94:1240-1246. [PMID: 38775095 DOI: 10.1111/ans.19096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/14/2024] [Accepted: 05/07/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Intra-abdominal drains are often placed in emergency gastrointestinal surgery procedures with the aim to prevent the formation of intra-abdominal collections (IAC) and aid in their early detection. However, the evidence for this is debated. This scoping review aims to evaluate the current evidence for their use in this setting. METHODS A literature search was performed using MEDLINE via PubMed, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. Primary studies published between January 2000 and September 2023 that assessed intra-abdominal drain placement and post-operative IAC formation in emergency gastrointestinal surgery were included. RESULTS A total of 26 articles were identified. There was no strong evidence to suggest that prophylactic intra-abdominal drain placement influences the formation of IAC in emergency gastrointestinal procedures. There was a suggestion that drain placement may increase the rate of surgical site infection and length of hospital stay. However, current studies on the topic are of poor quality and high risk of bias. CONCLUSION The undifferentiated use of drains in emergency gastrointestinal surgery should not be encouraged. Drain placement should be specific to the clinical context. Higher quality research is warranted to better understand the influence drain placement has on post-operative outcomes.
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Affiliation(s)
- T Hubble
- Department of Surgery, North Middlesex University Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK
| | - A Huseyin
- Department of Surgery, North Middlesex University Hospital, London, UK
| | - J Kersey
- Department of Surgery, North Middlesex University Hospital, London, UK
| | - Michael F Bath
- Department of Surgery, North Middlesex University Hospital, London, UK
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M Nair
- Department of Surgery, North Middlesex University Hospital, London, UK
- St Georges University School of Medicine, St. George's University, St. George's, Grenada
- University College London Medical School, University College London, London, UK
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Dahiya DS, Akram H, Goyal A, Khan AM, Shahnoor S, Hassan KM, Gangwani MK, Ali H, Pinnam BSM, Alsakarneh S, Canakis A, Sheikh AB, Chandan S, Sohail AH. Controversies and Future Directions in Management of Acute Appendicitis: An Updated Comprehensive Review. J Clin Med 2024; 13:3034. [PMID: 38892745 PMCID: PMC11172822 DOI: 10.3390/jcm13113034] [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: 04/21/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Globally, acute appendicitis has an estimated lifetime risk of 7-8%. However, there are numerous controversies surrounding the management of acute appendicitis, and the best treatment approach depends on patient characteristics. Non-operative management (NOM), which involves the utilization of antibiotics and aggressive intravenous hydration, and surgical appendectomy are valid treatment options for healthy adults. NOM is also ideal for poor surgical candidates. Another important consideration is the timing of surgery, i.e., the role of interval appendectomy (IA) and the possibility of delaying surgery for a few hours on index admission. IA refers to surgical removal of the appendix 8-12 weeks after the initial diagnosis of appendicitis. It is ideal in patients with a contained appendiceal perforation on initial presentation, wherein an initial nonoperative approach is preferred. Furthermore, IA can help distinguish malignant and non-malignant causes of acute appendicitis, while reducing the risk of recurrence. On the contrary, a decision to delay appendectomy for a few hours on index admission should be made based on the patients' baseline health status and severity of appendicitis. Post-operatively, surgical drain placement may help reduce postoperative complications; however, it carries an increased risk of drain occlusion, fistula formation, and paralytic ileus. Furthermore, one of the most critical aspects of appendectomy is the closure of the appendiceal stump, which can be achieved with the help of endoclips, sutures, staples, and endoloops. In this review, we discuss different aspects of management of acute appendicitis, current controversies in management, and the potential role of endoscopic appendectomy as a future treatment option.
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Affiliation(s)
- Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Hamzah Akram
- Department of Internal Medicine, Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai 400012, India
| | - Abdul Moiz Khan
- Department of Internal Medicine, Ayub Medical College, Abbottabad 22020, Pakistan
| | - Syeda Shahnoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Khawaja M. Hassan
- Department of Internal Medicine, King Edward Medical University, Lahore 54000, Pakistan
| | - Manesh Kumar Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC 27858, USA
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
| | - Saqr Alsakarneh
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Amir Humza Sohail
- Department of Surgery, University of New Mexico, Albuquerque, NM 87131, USA
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Lamm R, Kumar SS, Collings AT, Haskins IN, Abou-Setta A, Narula N, Nepal P, Hanna NM, Athanasiadis DI, Scholz S, Bradley JF, Train AT, Pucher PH, Quinteros F, Slater B. Diagnosis and treatment of appendicitis: systematic review and meta-analysis. Surg Endosc 2023; 37:8933-8990. [PMID: 37914953 DOI: 10.1007/s00464-023-10456-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The optimal diagnosis and treatment of appendicitis remains controversial. This systematic review details the evidence and current best practices for the evaluation and management of uncomplicated and complicated appendicitis in adults and children. METHODS Eight questions regarding the diagnosis and management of appendicitis were formulated. PubMed, Embase, CINAHL, Cochrane and clinicaltrials.gov/NLM were queried for articles published from 2010 to 2022 with key words related to at least one question. Randomized and non-randomized studies were included. Two reviewers screened each publication for eligibility and then extracted data from eligible studies. Random effects meta-analyses were performed on all quantitative data. The quality of randomized and non-randomized studies was assessed using the Cochrane Risk of Bias 2.0 or Newcastle Ottawa Scale, respectively. RESULTS 2792 studies were screened and 261 were included. Most had a high risk of bias. Computerized tomography scan yielded the highest sensitivity (> 80%) and specificity (> 93%) in the adult population, although high variability existed. In adults with uncomplicated appendicitis, non-operative management resulted in higher odds of readmission (OR 6.10) and need for operation (OR 20.09), but less time to return to work/school (SMD - 1.78). In pediatric patients with uncomplicated appendicitis, non-operative management also resulted in higher odds of need for operation (OR 38.31). In adult patients with complicated appendicitis, there were higher odds of need for operation following antibiotic treatment only (OR 29.00), while pediatric patients had higher odds of abscess formation (OR 2.23). In pediatric patients undergoing appendectomy for complicated appendicitis, higher risk of reoperation at any time point was observed in patients who had drains placed at the time of operation (RR 2.04). CONCLUSIONS This review demonstrates the diagnosis and treatment of appendicitis remains nuanced. A personalized approach and appropriate patient selection remain key to treatment success. Further research on controversies in treatment would be useful for optimal management.
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Affiliation(s)
- Ryan Lamm
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Thomas Jefferson University, 1015 Walnut Street, 613 Curtis, Philadelphia, PA, 19107, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Nisha Narula
- Department of Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Pramod Nepal
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Stefan Scholz
- Division of General and Thoracic Pediatric Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel F Bradley
- Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arianne T Train
- Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Philip H Pucher
- Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Francisco Quinteros
- Division of Colorectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Bethany Slater
- Division of Pediatric Surgery, University of Chicago Medicine, Chicago, IL, USA
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Liao J, Zhou J, Wang J, Xie G, Wei H. Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis. Front Surg 2023; 9:1086877. [PMID: 36743896 PMCID: PMC9889918 DOI: 10.3389/fsurg.2022.1086877] [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] [Received: 11/01/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background To date, the value of prophylactic abdominal drainage (AD) following appendectomy in patients with complicated appendicitis (CA), including adults and children, has yet to be determined. This paper presents a meta-analysis of the effects of prophylactic AD on postoperative complications in patients with CA, with the goal of exploring the safety and effectiveness of prophylactic AD. Methods PubMed, Science Direct, Web of Science, Cochrane Library, and Embase databases were searched for relevant articles published before August 1, 2022. The primary outcomes were the complication rates [overall incidence of postoperative complications, incidence of intra-abdominal abscess (IAA), wound infection (WI), and postoperative ileus (PI), and the secondary outcome was the perioperative outcome]. The meta-analysis was performed with STATA V. 16.0A. Results A total of 2,627 articles were retrieved and 15 high-quality articles were eventually included after screening, resulting in a total of 5,123 patients, of whom 1,796 received AD and 3,327 did not. The results of this meta-analysis showed that compared with patients in the non-drainage group, patients in the drainage group had longer postoperative length of hospitalization (LOH) (SMD = 0.68, 95% CI: 0.01-1.35, P = 0.046), higher overall incidence of postoperative complications (OR = 0.50, 95% CI: 0.19-0.81, P = 0.01), higher incidence of WI (OR = 0.30, 95% CI: 0.08-0.51, P = 0.01) and PI (OR = 1.05, 95% CI: 0.57-1.54, P = 0.01), the differences were statistically significant. However, there was no significant difference in the incidence of IAA (OR = 0.10, 95% CI: -0.10 to 0.31, P = 0.31) between the two groups. The results of subgroup meta-analysis showed that in the adult subgroup, the overall incidence of postoperative complications in the drainage group was higher than that in the non-drainage group (OR = 0.67, 95% CI: 0.37-0.96, P = 0.01). However, there were no significant differences in IAA (OR = 0.18, 95% CI: -0.28 to 0.64, P = 0.45) and WI (OR = 0.13, 95% CI: (-0.40 to 0.66, P = 0.63) and PI (OR = 2.71, 95% CI: -0.29 to 5.71, P = 0.08). In the children subgroup, there were no significant differences in the incidence of IAA (OR = 0.51, 95% CI: -0.06 to 1.09, P = 0.08) between the two groups. The overall incidence of postoperative complications (OR = 0.46, 95% CI: 0.02-0.90, P = 0.04), incidences of WI (OR = 0.43, 95% CI: 0.14-0.71, P = 0.01) and PI (OR = 0.75, 95% CI: 0.10-1.39, P = 0.02) were significantly higher than those in the non-drainage group. Conclusion This meta-analysis concluded that prophylactic AD did not benefit from appendectomy, but increased the incidence of related complications, especially in children with CA. Thus, there is insufficient evidence to support the routine use of prophylactic AD following appendectomy.
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Abu A, Mohamedahmed AY, Alamin A, Mohamed M, Osman M, Mohammed MJ, Abdalla H, Eltyeb HA, Ali O, Mohamad R, Hamid S, Faycal Mirghani S, Hamad Y, Mohamed HK. Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e32018. [PMID: 36600842 PMCID: PMC9799077 DOI: 10.7759/cureus.32018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.
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Affiliation(s)
- Abduelraheim Abu
- General and Colorectal Surgery, Whipps Cross Hospital, London, GBR
| | - Ali Yasen Mohamedahmed
- General Surgery, Royal Wolverhampton NHS (National Health Service) Trust, Birmingham, GBR
| | - Amin Alamin
- General and Colorectal Surgery, London North West University Healthcare NHS (National Health Service) Trust, London, GBR
| | - Mazin Mohamed
- General Surgery, University Hospitals Sussex NHS (National Health Service) Foundation Trust, Brighton, GBR
| | - Mohamed Osman
- General Surgery, Princess of Wales Hospital, Bridgend, GBR
| | | | - Hiba Abdalla
- Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, GBR
| | - Hazim A Eltyeb
- General Surgery, Health Education North East, Newcastle upon Tyne, GBR
| | - Omer Ali
- General and Colorectal Surgery, Queen Elizabeth The Queen Mother Hospital, Kent, GBR
| | - Rifat Mohamad
- General Surgery, Wirral University Teaching Hospital NHS (National Health Service) Foundation Trust, Liverpool, GBR
| | - Safaa Hamid
- General and Colorectal Surgery, Kent and Canterbury Hospital, Kent, GBR
| | | | - Yousif Hamad
- General Surgery, Surrey and Sussex Healthcare NHS (National Health Service) Trust, Leeds, GBR
| | - Hussam Khougali Mohamed
- General and Upper GI (Gastrointestinal) Surgery, University Hospital Hairmyres, Glasgow, GBR
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Human MJ, Tshifularo N, Mabitsela M. Laparoscopic appendectomy for complicated appendicitis in children: does the post-operative peritoneal drain make any difference? A pilot prospective randomised controlled trial. Pediatr Surg Int 2022; 38:1291-1296. [PMID: 35771234 PMCID: PMC9355919 DOI: 10.1007/s00383-022-05155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This was a pilot randomised, prospective study, which aimed to determine and compare the post-operative complications of paediatric patients undergoing laparoscopic appendectomy (LA) for complicated appendicitis, with and without a peritoneal drain. METHODS Patients younger than 13 years, undergoing LA for complicated appendicitis at the Dr George Mukhari Academic Hospital (DGMAH), over a 15-month period during 2019-2020 were enrolled. Randomisation was achieved by a blocked randomisation plan. Patients were randomised in a 1:1 ratio into the "drain" (D) and "no drain" (ND) groups. RESULTS Thirty-four patients were included in this study; seventeen in each group. The complication rate was 26%. Intra-abdominal collection accounted for 89% of the complications. The complication rate in the "D" group was 18% and 35% in the "ND" group, with no statistically significant difference. Complication rates were higher (38%) in patients with generalised pus when compared to localised pus (7%), although not statistically significant. The mean theatre time, hospital stay, and duration of antibiotic use did not differ significantly between the groups. CONCLUSION From our study, the post-operative peritoneal drain did not make any statistically significant difference in patient outcome. The amount of intra-abdominal contamination is more likely to contribute in the development of complications. TRIAL REGISTRATION NUMBER SMUREC/M/15/2019: PG.
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Affiliation(s)
- M J Human
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Molotlegi Road, Ga-Rankuwa, Pretoria, 0208, South Africa.
| | - N Tshifularo
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Molotlegi Road, Ga-Rankuwa, Pretoria, 0208, South Africa
| | - M Mabitsela
- Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, Molotlegi Road, Ga-Rankuwa, Pretoria, 0208, South Africa
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Arutyunyan AS, Blagovestnov DA, Levitsky VD, Yartsev PA. Diffuse Appendicular Peritonitis: Laparoscopic vs Open Access — Viewpoint From Aside. RUSSIAN SKLIFOSOVSKY JOURNAL "EMERGENCY MEDICAL CARE" 2022; 11:137-146. [DOI: 10.23934/2223-9022-2022-11-1-137-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
The perforative acute appendicitis with the development of diffuse peritonitis increases the incidence of postoperative complications to 47%, and mortality to 3%. Mortality in the case of the development of diffuse purulent peritonitis makes 4.5-58%, and it can exceed 70% in severe forms of diffuse peritonitis with the development of infectious-toxic shock and multiple organ failure. National Clinical Guidelines for acute appendicitis with diffuse peritonitis allow for appendectomy from both the median and laparoscopic access in the absence of general contraindications to the creation of pneumoperitoneum. However, despite the proven advantages of laparoscopic appendectomy, there are opponents of its use in diffuse forms of appendicular peritonitis. An increased number of postoperative abscesses with a minimally invasive approach has been reported in literature; however, recent randomized studies refute this fact. There is also evidence that the laparoscopic method for appendicular peritonitis often leads to a lengthening of the operation time and higher operating costs, but at the same time there is a decrease in postoperative pain syndrome, a reduction in the length of inpatient treatment and early social and labor rehabilitation, which leads to an overall decrease in hospital costs. Thus, to date, there is no generally accepted opinion about the advisability of laparoscopic access for appendicular peritonitis. At the moment, the presence of diffuse peritonitis is the most common intraoperative reason for refusing a minimally invasive surgical treatment. However, there is a tendency to trying to standardize indications and contraindications, which was the objective of our literature review.
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Affiliation(s)
- A. S. Arutyunyan
- Russian Medical Academy of Continuous Professional Education; N.V. Sklifosovsky Research Institute for Emergency Medicine
| | - D. A. Blagovestnov
- Russian Medical Academy of Continuous Professional Education; N.V. Sklifosovsky Research Institute for Emergency Medicine
| | - V. D. Levitsky
- N.V. Sklifosovsky Research Institute for Emergency Medicine
| | - P. A. Yartsev
- Russian Medical Academy of Continuous Professional Education; N.V. Sklifosovsky Research Institute for Emergency Medicine; Penza Institute for Advanced Doctors Training, the branch of the Russian Medical Academy of Continuous Professional Education
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13
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Liao YT, Huang J, Wu CT, Chen PC, Hsieh TT, Lai F, Chen TC, Liang JT. The necessity of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy: a retrospective cohort study. World J Emerg Surg 2022; 17:16. [PMID: 35300711 PMCID: PMC8928608 DOI: 10.1186/s13017-022-00421-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/08/2022] [Indexed: 12/17/2022] Open
Abstract
Background This study aimed to evaluate the necessity of abdominal drainage after laparoscopic appendectomy in patients with complicated appendicitis. Methods Patients with acute appendicitis undergoing laparoscopic appendectomy at two hospitals between January 2014 and December 2018 were retrospectively included. Complicated appendicitis was defined as the American Association for the Surgery of Trauma (AAST) grade ≥ II. The patients were classified according to the AAST grade and the indwelling of abdominal drainage. The postoperative surgical outcomes and recovery were compared among patient groups to evaluate the impact of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy. Results A total of 1241 patients was retrospectively included. Among them, there were 820 patients with simple appendicitis (AAST grade I) and 421 patients with complicated appendicitis (AAST grade ≥ II). For complicated appendicitis, the drainage group (N = 192) tended to harbor more overall complications, intra-abdominal abscess formation, time to resume a soft diet, and the postoperative length of hospitalization (P = 0.0000 for all). Multivariate logistic regression confirmed that abdominal drainage increased the risk of overall complications [Odds ratio (OR) 2.439; 95% confidence interval (CI) 1.597–3.726; P ≤ 0.0001] and failed to decrease the risk of intra-abdominal abscess formation (OR 1.655; 95% CI 0.487–5.616; P = 0.4193). Multivariate linear regression analysis also showed that the drainage group harbored longer postoperative length of hospitalization (Coefficients: 20.697; 95% CI 15.251–26.143; P < 0.0001) and time to resume a soft diet (Coefficients: 45.899; 95% CI 34.502–57.297; P < 0.0001). Conclusions Abdominal drainage did not prevent overall complications in patients with complicated appendicitis; paradoxically, it delayed the convalescence. Our results discourage the routine use of abdominal drainage and suggest that abdominal drainage should be performed sparingly.
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Affiliation(s)
- Yu-Tso Liao
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.,Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, ROC
| | - John Huang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
| | - Chia-Tung Wu
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC
| | - Pei-Chen Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Tsung-Ting Hsieh
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Feipei Lai
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan, ROC.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan, ROC
| | - Tzu-Chun Chen
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
| | - Jin-Tung Liang
- Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC.
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Tsai YW, Lee SY, Jiang JH, Chuang JH. Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis. BMC Surg 2021; 21:437. [PMID: 34953485 PMCID: PMC8709970 DOI: 10.1186/s12893-021-01413-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods
The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Shin-Yi Lee
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jyun-Hong Jiang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C
| | - Jiin-Haur Chuang
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, R.O.C..
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Mulita F, Plachouri KM, Liolis E, Kehagias D, Kehagias I. Comparison of intra-abdominal abscess formation after laparoscopic and open appendectomy for complicated and uncomplicated appendicitis: a retrospective study. Wideochir Inne Tech Maloinwazyjne 2021; 16:560-565. [PMID: 34691306 PMCID: PMC8512505 DOI: 10.5114/wiitm.2021.103942] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Acute appendicitis (AA) is one of the most common causes of acute abdominal pain seen in emergency departments and appendectomy has been the preferred treatment of this disease for decades. Postoperative intra-abdominal abscess (PIAA) complicates 3% to 25% of appendectomies and the risk is highest following complicated appendicitis. However, the risk for intra-abdominal abscess formation after appendectomy is still a matter of debate. AIM To evaluate PIAA formation after open appendectomy (OA) and laparoscopic appendectomy (LA), in particular in complicated appendicitis. MATERIAL AND METHODS From January 2003 to December 2018, records of patients who underwent appendectomy with diagnosis of appendicitis were retrieved from a computer database for analysis. RESULTS During the study period, 1809 appendectomies were performed in our institution (939 LAs and 850 OAs). Twenty conversion cases were recorded. There was no difference between the incidences of PIAA (LA, 3.73% (35/939) and OA, 3.41% (29/850); p > 0.05). The incidence of PIAA in those with complicated appendicitis was: LA, 11/212 (5.19%) vs. OA 14/198 (7.07%); p > 0.05. CONCLUSIONS This retrospective study shows that the technique of appendectomy does not appear to affect the incidence of IAAs either in uncomplicated or in complicated appendicitis. However, laparoscopic appendectomy has the advantages of laparoscopic procedures, such as lower hospital stay and earlier return to activities, and should therefore be preferred for acute appendicitis.
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Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | | | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital of Patras, Patras, Greece
| | - Dimitris Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Patras, Greece
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Li Z, Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intra-peritoneal abscess after appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2021; 8:CD010168. [PMID: 34402522 PMCID: PMC8407456 DOI: 10.1002/14651858.cd010168.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.
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Affiliation(s)
- Zhuyin Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Li
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Longshuan Zhao
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Cheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Nansheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yilei Deng
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Qian S, Vasileiou G, Pust GD, Zakrison T, Rattan R, Zielinski M, Ray-Zack M, Zeeshan M, Namias N, Yeh DD. Prophylactic Drainage after Appendectomy for Perforated Appendicitis in Adults: A Post Hoc Analysis of an EAST Multi-Center Study. Surg Infect (Larchmt) 2021; 22:780-786. [PMID: 33877912 DOI: 10.1089/sur.2019.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: We sought to assess the efficacy of prophylactic abdominal drainage to prevent complications after appendectomy for perforated appendicitis. Methods: In this post hoc analysis of a prospective multi-center study of appendicitis in adults (≥ 18 years), we included patients with perforated appendicitis diagnosed intra-operatively. The 634 subjects were divided into groups on the basis of receipt of prophylactic drains. The demographics and outcomes analyzed were surgical site infection (SSI), intra-abdominal abscess (IAA), Clavien-Dindo complications, secondary interventions, and hospital length of stay (LOS). Multivariable logistic regression for the cumulative 30-day incidence of IAA was performed controlling for age, Charlson Comorbidity Index (CCI), antibiotic duration, presence of drains, and Operative American Association for the Surgery of Trauma (AAST) Grade. Results: In comparing the Drain (n = 159) versus No-Drain (n = 475) groups, there was no difference in the frequency of male gender (61% versus 55%; p = 0.168), weight (87.9 ± 27.9 versus 83.8 ± 23.4 kg; p = 0.071), Alvarado score (7 [6-8] versus 7 [6-8]; p = 0.591), white blood cell (WBC) count (14.8 ± 4.8 versus 14.9 ± 4.5; p = 0.867), or CCI (1 [0-3] versus 1 [0-2]; p = 0.113). The Drain group was significantly older (51 ± 16 versus 48 ± 17 years; p = 0.017). Drain use increased as AAST EGS Appendicitis Operative Severity Grade increased: Grade 3 (62/311; 20%), Grade 4 (46/168; 27%), and Grade 5 (51/155; 33%); p = 0.007. For index hospitalization, the Drain group had a higher complication rate (43% versus 28%; p = 0.001) and longer LOS (4 [3-7] versus 3 [1-5] days; p < 0.001). We could not detect a difference between the groups in the incidence of SSI, IAA, or secondary interventions. There was no difference in 30-day emergency department visits, re-admissions, or secondary interventions. Multi-variable logistic regression showed that only AAST Grade (odds ratio 2.7; 95% confidence interval7 1.5-4.7; p = 0.001) was predictive of the cumulative 30-day incidence of IAA. Conclusions: Prophylactic drainage after appendectomy for perforated appendicitis in adults is not associated with fewer intra-abdominal abscesses but is associated with longer hospital LOS. Increasing AAST EGS Appendicitis Operative Grade is a strong predictor of intra-abdominal abscess.
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Affiliation(s)
- Sinong Qian
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Georgia Vasileiou
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Gerd Daniel Pust
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Tanya Zakrison
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Rishi Rattan
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | | | - Mohamed Ray-Zack
- Department if Surgery, University of Arizona College of Medicine, Tucson, Arizona USA
| | - Muhammad Zeeshan
- New York Medical College-Westchester Medical Center, Valhalla, New York, USA
| | - Nicholas Namias
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
| | - D Dante Yeh
- Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida USA
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18
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Ferguson DM, Anderson KT, Arshad SA, Garcia EI, Hebballi NB, Li LT, Kawaguchi AL, Lally KP, Tsao K. Prophylactic intraabdominal drains do not confer benefit in pediatric perforated appendicitis: Results from a quality improvement initiative. J Pediatr Surg 2021; 56:727-732. [PMID: 32709531 DOI: 10.1016/j.jpedsurg.2020.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND/PURPOSE Prophylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis. METHODS A 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (age < 18) perforated appendicitis patients. QI patients were compared to controls admitted during the preceding 8 months and following 4 months. The primary outcome was 30-day IAA rate. Univariate and multivariate analyses were performed. RESULTS Two hundred seventy QI patients were compared to 109 controls. There was 100% compliance during 21 of 27 months of the QI initiative; only 7 QI patients did not receive drains. IAA occurred in 20.0% of QI patients and 22.9% of control (p = 0.52). After adjustment, the QI initiative was not associated with reduced odds of IAA (OR 0.83, 95% CI 0.48-1.44). Median length of stay was longer in QI patients during the index admission (p = 0.03) and over 30 postoperative days (p = 0.03), but these relationships did not persist after adjustment. CONCLUSIONS A QI initiative investigating prophylactic, intraabdominal drain placement in perforated appendicitis did not reduce the IAA rate. We recommend against routine drain placement in pediatric perforated appendicitis. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dalya M Ferguson
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - K Tinsley Anderson
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Seyed A Arshad
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Elisa I Garcia
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Linda T Li
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Akemi L Kawaguchi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - Kevin P Lally
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
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19
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Podda M, Poillucci G, Gerardi C, Cillara N, Montemurro L, Russo G, Carlini M, Pisanu A. Acute Appendicitis. EMERGENCY LAPAROSCOPIC SURGERY IN THE ELDERLY AND FRAIL PATIENT 2021:111-120. [DOI: 10.1007/978-3-030-79990-8_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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20
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Perceptions and Life Experiences of Patients With Wound Healing by Secondary Intention After the Removal of Thoracic Drainage Tube: A Qualitative Study. J Wound Ostomy Continence Nurs 2020; 47:124-127. [PMID: 31977645 DOI: 10.1097/won.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to explore the perceptions and experiences of patients with wound healing by secondary intention after the removal of a thoracic drainage tube. DESIGN A qualitative phenomenological study. SUBJECTS AND SETTING After removal of the tube, patients who were attending a nursing clinic that provides WOC care to a population of around 1 million people in Suzhou, China, were invited to participate. METHODS Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analysis of data was performed using Colaizzi's 7-step thematic analysis. RESULTS Three major themes emerged from the interviews, namely, emotional stress response, impaired social function, and increased disease burden. CONCLUSION Patients with wound healing by secondary intention after the removal of the drainage tube perceived they experienced an emotional stress reaction accompanied by increased psychological and economic burden. They also experienced impaired social function. There is a critical need to develop health education plans for use during the pre- and postoperative periods to reduce emotional, social, and economic consequences associated with delayed wound healing.
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21
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Labricciosa FM, Sartelli M, Barbadoro P, Abbo LM, Ansaloni L, Coccolini F, Catena F. Epidemiology and Risk Factors for Superficial Surgical Site Infections after Appendectomy for Acute Appendicitis: A Secondary Data Analysis. Surg Infect (Larchmt) 2020; 22:227-233. [PMID: 33202156 DOI: 10.1089/sur.2020.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The identification of risk factors for superficial surgical site infections (SSSIs) associated with appendectomy is paramount in the management of patients with acute appendicitis (AA). Methods: This study was a secondary data analysis from a prospective multi-center observational study. It included all consecutive hospitalized patients with AA who underwent appendectomy and were monitored for complications at 30 days after the intervention. A case-control approach was used to evaluate risk factors associated with the occurrence of SSSI. Results: Among 2,667 patients, 156 (5.8%) developed an SSSI. The series included 1,449 males (54.3%) and 1,218 females with a median age of 29 years (interquartile range [IQR] 20-45 years). Antimicrobial therapy within the previous 30 days was reported by 170 patients (6.4%), and a C-reactive protein concentration (CRP) >50 mg/L was observed in 609 (22.8%). A total of 960 patients (36.0%) underwent open surgery, 1,699 (63.7%) laparoscopic surgery, and 8 (0.3%) another surgical intervention. In 2,575 patients (95.6%), a pathological appendix was detected during the operation. In 776 patients (29.1%), an intra-operative abdominal drain (IAD) was placed; 125 patients (4.7%) were admitted to the intensive care unit. The median hospital length of stay was 3 days (IQR 2-5 days). The overall mortality rate was 0.11%. Multinomial logistic regression analysis of risk factors demonstrated that statistically significant risk factors independently associated with the occurrence of SSSIs were antimicrobial therapy within the previous 30 days, CRP >50 mg/L, open surgical procedures, presence of IAD, and intra-operative findings of complex appendicitis. Conclusions: Knowledge of five easily recognizable variables, assessable at hospital admission or as soon as the surgical intervention is concluded, might identify patients with a greater risk of developing an SSSI.
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Affiliation(s)
| | | | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Lilian M Abbo
- Infectious Disease University, Miami Miller School of Medicine and Jackson Health System, Miami, Florida, USA
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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22
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Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, Boermeester M, Sartelli M, Coccolini F, Tarasconi A, De' Angelis N, Weber DG, Tolonen M, Birindelli A, Biffl W, Moore EE, Kelly M, Soreide K, Kashuk J, Ten Broek R, Gomes CA, Sugrue M, Davies RJ, Damaskos D, Leppäniemi A, Kirkpatrick A, Peitzman AB, Fraga GP, Maier RV, Coimbra R, Chiarugi M, Sganga G, Pisanu A, De' Angelis GL, Tan E, Van Goor H, Pata F, Di Carlo I, Chiara O, Litvin A, Campanile FC, Sakakushev B, Tomadze G, Demetrashvili Z, Latifi R, Abu-Zidan F, Romeo O, Segovia-Lohse H, Baiocchi G, Costa D, Rizoli S, Balogh ZJ, Bendinelli C, Scalea T, Ivatury R, Velmahos G, Andersson R, Kluger Y, Ansaloni L, Catena F. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020; 15:27. [PMID: 32295644 PMCID: PMC7386163 DOI: 10.1186/s13017-020-00306-3] [Citation(s) in RCA: 577] [Impact Index Per Article: 115.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
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 guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. CONCLUSIONS The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
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Affiliation(s)
- Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Belinda De Simone
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca, Milan, Italy
| | - Goran Augustin
- Department of Surgery, University Hospital Centre of Zagreb, Zagreb, Croatia
| | - Alice Gori
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Marja Boermeester
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Antonio Tarasconi
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris, France
| | - Dieter G Weber
- Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | - Matti Tolonen
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Arianna Birindelli
- Department of General Surgery, Azienda Socio Sanitaria Territoriale, di Valle Camonica, Italy
| | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Michael Kelly
- Acute Surgical Unit, Canberra Hospital, ACT, Canberra, Australia
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Jeffry Kashuk
- Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlos Augusto Gomes
- Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | | | - Richard Justin Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Ari Leppäniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP, Brazil
| | - Ronald V Maier
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Raul Coimbra
- UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA, USA
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Gabriele Sganga
- Department of Emergency Surgery, "A. Gemelli Hospital", Catholic University of Rome, Rome, Italy
| | - Adolfo Pisanu
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry Van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University of Rome, Rome, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | | | - Andrey Litvin
- Department of Surgery, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Fabio C Campanile
- Department of Surgery, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, TSMU, Tbilisi, Georgia
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, TSMU, Tbilisi, Georgia
| | - Rifat Latifi
- Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Fakri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Gianluca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - David Costa
- Hospital universitario de Alicante, departamento de Cirugia General, Alicante, Spain
| | - Sandro Rizoli
- Department of Surgery, St. Michael Hospital, University of Toronto, Toronto, Canada
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | | | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
| | - George Velmahos
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- Department of General Surgery and Trauma, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
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23
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Fugazzola P, Ceresoli M, Agnoletti V, Agresta F, Amato B, Carcoforo P, Catena F, Chiara O, Chiarugi M, Cobianchi L, Coccolini F, De Troia A, Di Saverio S, Fabbri A, Feo C, Gabrielli F, Gurrado A, Guttadauro A, Leone L, Marrelli D, Petruzzelli L, Portolani N, Prete FP, Puzziello A, Sartelli M, Soliani G, Testini M, Tolone S, Tomasoni M, Tugnoli G, Viale P, Zese M, Ishay OB, Kluger Y, Kirkpatrick A, Ansaloni L. The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World J Emerg Surg 2020; 15:19. [PMID: 32156296 PMCID: PMC7063712 DOI: 10.1186/s13017-020-00298-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.
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Affiliation(s)
- Paola Fugazzola
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy.
| | - Marco Ceresoli
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | | | | | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Osvaldo Chiara
- Emergency and Trauma Surgery, Niguarda Hospital, Milan, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Lorenzo Cobianchi
- Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Alessandro De Troia
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Fabbri
- Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Carlo Feo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Francesco Gabrielli
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Angela Gurrado
- Department of Biochemical Sciences and Human Oncology, University of Medical School "A. Moro" of Bari, Bari, Italy
| | - Angelo Guttadauro
- General Surgery Department, Milano-Bicocca University, School of Medicine and Surgery, Monza, Italy
| | - Leonardo Leone
- General and Oncological Surgery, Filippo Neri Hospital, Rome, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Petruzzelli
- Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Francesco Paolo Prete
- Endocrine, Digestive and Emergency Surgery Department, University of Medical School of Bari, Bari, Italy
| | | | | | - Giorgio Soliani
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Mario Testini
- Endocrine, Digestive and Emergency Surgery Department, University of Medical School of Bari, Bari, Italy
| | - Salvatore Tolone
- General, Mininvasive and Bariatric Surgery Unit, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Matteo Tomasoni
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Pierluigi Viale
- Operative Unit of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Monica Zese
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Offir Ben Ishay
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Andrew Kirkpatrick
- Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Luca Ansaloni
- General and Emergency Surgery Department, Bufalini Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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24
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Is single-incision laparoscopic appendectomy suitable for complicated appendicitis? A comparative analysis with standard multiport laparoscopic appendectomy. Asian J Surg 2019; 43:282-289. [PMID: 31130501 DOI: 10.1016/j.asjsur.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite emerging evidences on the feasibility and efficacy of single-incision laparoscopic appendectomy (SILA) for managing simple appendicitis, advancing its use for treating complicated appendicitis remains unwarranted. This study aimed to evaluate the surgical outcome of SILA compared with that of standard multiport laparoscopic appendectomy (MPLA) in the management of complicated appendicitis. METHODS Between July 2013 and September 2017, 40 patients who underwent SILA and 150 patients who underwent MPLA for the treatment of complicated appendicitis, defined as AAST grades II-V, were recruited for this study. The demographic characteristics, intraoperative and recovery parameters were retrospectively recorded. No routine drainage was placed in the SILA group. RESULTS SILA was smoothly performed without requiring conversion to MPLA. No significant difference was observed between the 2 groups in demography and preoperative severity. The operation duration was approximately 8 min shorter in the SILA group than in the MPLA group, without a statistical difference (60.03 ± 21.01 vs. 68.04 ± 32.03 min, p = 0.222). The recovery parameters, including soft diet intake and postoperative hospitalization, were more favorable in the SILA group (p < 0.001). Despite the absence of routine drainage in the SILA group, only 1 patient developed an intra-abdominal hematoma necessitating further computed tomography-guided drainage. CONCLUSION SILA is safe and feasible for the management of complicated appendicitis. SILA had non-inferior results to MPLA in terms of time to resume oral intake and postoperative hospital stay. Furthermore, this study posted a question on the concept of routine postoperative drainage in complicated appendicitis.
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Re-evaluation of purse string suture in laparoscopic appendectomy. Surg Endosc 2019; 34:779-786. [PMID: 31087172 PMCID: PMC6957542 DOI: 10.1007/s00464-019-06828-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to compare the outcomes of laparoscopic appendectomy (LA) using purse string invaginating sutures (PS) with those using intracorporeal knotting (IK) or Hem-o-lock polymeric clips (HL). METHODS A total of 882 patients who underwent laparoscopic appendectomy from January 2015 to December 2017 were studied retrospectively. Of these, 538 patients used PS, 229 patients used IK and 115 patients used HL to close the appendiceal stump. Their demographic characteristics, intraoperative findings and postoperative complications were analysed retrospectively. RESULTS There were similar percentages of complicated cases in all the groups (21.7% in PS vs. 21.4% in IK vs. 24.3% in HL, p = 0.803). The mean length of hospital stay was shorter in PS group when compared to IK or HL group (3.72 + 2.35 in PS vs. 4.41 + 2.40 in IK, 4.43 + 2.66 in HL, p < 0.05) as well as lower ASA scores (1.7 + 0.6 in PS vs. 1.8 + 0.6 in IK vs. 1.7 + 0.6 in HL, p < 0.05). The overall complication rates for the PS, the HL and the IK groups were 12.1, 8.7 and 9.2%, respectively. The rate of wound infection was higher in PS group for uncomplicated appendicitis (5.0% in PS vs. 2.8% in IK and 1.1% in HL, p = 0.129). Furthermore, there were no differences in the rate of intra-abdominal infection among the groups in both uncomplicated and complicated cases. CONCLUSIONS Based on our results, purse string suture failed to demonstrate better postoperative outcome in laparoscopic appendectomy and is no longer recommended by our institution as initial approach.
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Trauma-Induced Long-Term Alterations of Human T Cells and Monocytes-Results of an Explorative, Cross-Sectional Study. Shock 2019; 53:35-42. [PMID: 30998650 DOI: 10.1097/shk.0000000000001358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major trauma leads to complex immune reactions, known to result in a transient immunodeficiency. The long-term consequences of severe trauma on immune function and regulation as well as its clinical impact remain unclear. METHODS Six months (ranging from -12 to +5 days) after a major trauma event, 12 former trauma patients (Injury Severity Score ≥ 16) and 12 healthy volunteers were enrolled. The current clinical status and infection history since discharge were assessed by a standardized questionnaire. Immune cell subsets (cluster of differentiation (CD)4, CD8, CD14), cell surface receptor expression (programmed cell death protein 1 (PD-1), B- and T-lymphocyte attenuator (BTLA), cytotoxic T-lymphocyte-associated protein 4, toll-like receptor (TLR)-2, -4, and -5, Dectin-1, programmed death ligand 1 (PD-1L)), and human leucocyte antigen D-related receptor (HLA-DR)-expression were quantified by flow cytometry. Cytokine secretion (IL-2, -4, -6, -10, and 17A, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ) was assessed after stimulation of whole blood with LPS-, α-CD3/28, or zymosan. RESULTS Analysis of surface receptors on T cells revealed a significant elevation of PD-1 expression on CD4 T cells, whereas BTLA expression on CD4 and CD8 T cells was significantly suppressed in the trauma cohort. Monocytes showed a significantly reduced expression of TLR-2 and -4 as well as a reduced proportion of TLR-4 monocytes. HLA-DR receptor density revealed no significant changes between both cohorts. LPS-induced IL-6 and TNF-α secretion showed non-significant trends toward reduced values. No differences regarding clinical apparent infections could be detected. CONCLUSIONS Six months following major trauma, changes of cell surface receptors on CD4 and CD8 T cells as well as on CD14 monocytes were present, hinting toward an immunosuppressive phenotype. Following major trauma, although IL-6 and TNF-α release after stimulation were reduced, they did not reach statistical significance. Overall, further studies are necessary to evaluate the clinical implications of these findings. TRIAL REGISTRATION DRKS00009876, Internet Portal of the German Clinical Trials Register (DRKS), registration date 11.08.2016, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009876.
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Weiser TG, Forrester JD, Forrester JA. Tactics to Prevent Intra-Abdominal Infections in General Surgery. Surg Infect (Larchmt) 2019; 20:139-145. [PMID: 30628859 DOI: 10.1089/sur.2018.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abdominal infections following surgery have many severe consequences. Several effective, well-evaluated infection prevention and control processes exist to avoid these infections. METHODS This manuscript reviews and provides supporting evidence for common management strategies useful to avoid postoperative abdominal infection. RESULTS Prevention of abdominal infection begins with preparation of the environment using standard infection control practices. Peri-operative use of systemic antibiotics, an antibiotic bowel preparation in colorectal surgery, and effective antiseptic preparation of the surgical site all reduce infection rates. Peri-operative supplemental oxygenation, maintenance of core body temperature, and physiologic euglycemia will reduce both incisional and organ-space infections in the abdominal surgery patient. Strategic use of irrigation and drain placement may be useful in some circumstances. CONCLUSION Specific methods of prevention are documented to reduce intra-abdominal infections. Prevention requires a multi-disciplinary team including the surgeon, anesthesiologist, and all operating room personnel.
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Affiliation(s)
- Thomas G Weiser
- Department of Surgery, Section of Trauma & Critical Care, Stanford University Stanford, California
| | - Joseph D Forrester
- Department of Surgery, Section of Trauma & Critical Care, Stanford University Stanford, California
| | - Jared A Forrester
- Department of Surgery, Section of Trauma & Critical Care, Stanford University Stanford, California
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Kohga A, Yajima K, Okumura T, Yamashita K, Isogaki J, Suzuki K, Muramatsu K, Komiyama A, Kawabe A. Are Preoperative CT Findings Useful for Predicting Postoperative Intraabdominal Abscess in the Patients with Acute Appendicitis? ACTA ACUST UNITED AC 2019; 55:medicina55010006. [PMID: 30621222 PMCID: PMC6359716 DOI: 10.3390/medicina55010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/28/2018] [Accepted: 12/31/2018] [Indexed: 11/16/2022]
Abstract
Background and objective: In patients with acute appendicitis (AA), preoperative computed tomography (CT) findings suggesting development of intraabdominal abscess (IAA) had not been widely used. The aim of this study was to investigate the preoperative clinical and radiological factors that predict the development of a postoperative IAA in patients with AA who were treated by laparoscopic appendectomy (LA). Methods: Two hundred and sixteen patients with pathologically proven AA underwent LA between January 2013 and March 2018 in our department. Medical records and preoperative CT images of these 216 patients were retrospectively reviewed and the predictive factors of postoperative IAA were investigated. In addition, patients were divided into complicated appendicitis (CA) and simple appendicitis (SA) and perioperative factors of two groups were compared. Results: One hundred and forty-seven patients were diagnosed with CA, while the other 69 patients were diagnosed with SA. Sixteen patients developed postoperative IAA in the CA group, while no patients in the SA group did. The univariate analysis revealed that time from onset to surgery more than 3 days (p = 0.011), the preoperative CT finding of periappendiceal fluid (p = 0.003), abscess (p < 0.001), and free air (p < 0.001), operation time more than 120 min (p = 0.023) and placement of a drainage tube (p < 0.001) were significantly associated with the development of IAA. Multivariate analysis revealed that the preoperative CT finding of free air was independently associated with the development of IAA (p = 0.007, odds ratio = 5.427, 95% CI: 1.586⁻18.57). Conclusions: IAA developed predominantly in patients with CA. Preoperative CT findings of free air was found to be an independent predictor for the development of IAA. Surgeons should be meticulous in managing the postoperative course of patients with this finding.
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Affiliation(s)
- Atsushi Kohga
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Kiyoshige Yajima
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Takuya Okumura
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Kimihiro Yamashita
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Jun Isogaki
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Kenji Suzuki
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Katsuaki Muramatsu
- Division of Radiology, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Akira Komiyama
- Division of Pathology, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
| | - Akihiro Kawabe
- Division of Surgery, Fujinomiya City General Hospital, Nishiki-cho, Fujinomiya, Shizuoka 4180076, Japan.
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Abdulhamid AK, Sarker SJ. Is abdominal drainage after open emergency appendectomy for complicated appendicitis beneficial or waste of money? A single centre retrospective cohort study. Ann Med Surg (Lond) 2018; 36:168-172. [PMID: 30505435 PMCID: PMC6247409 DOI: 10.1016/j.amsu.2018.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 02/08/2023] Open
Abstract
Background Appendicitis is a medical condition that causes painful inflammation of the appendix. For acute appendicitis, appendectomy is immediately required as any delay may lead to serious complications such as gangrenous or perforated appendicitis with or without localized abscess formation. Patients who had appendectomy for complicated appendicitis are more prone to develop post-operative complications such as peritoneal abscess or wound infection. Sometimes, abdominal drainage is used to reduce these complications. However, the advantage of the abdominal drainage to minimize post-operative complications is not clear. Therefore, the aim of this study was to investigate whether the use of abdominal drainage after open emergency appendectomy for complicated appendicitis (perforated appendicitis with localized abscess formation only) can prevent or significantly reduce post-operative complications such as intra-peritoneal abscess formation or wound infection. Methods In this retrospective cohort study, files and notes were reviewed retrospectively for patients who had open emergency appendectomy for complicated appendicitis (perforated appendicitis with localized abscess formation only) and who had already been admitted and discharged from the surgical wards of Kerbala medical university/Imam Hussein medical city hospital/Kerbala/Iraq. Patients were selected according to specific inclusion and exclusion criteria. Patients were divided into two groups; drainage and non-drainage groups. The drainage group had intra-abdominal drain inserted after the surgery, while the non-drainage group had no drain placed post-operatively. A comparison between both groups was done in terms of these parameters; (i) the development of post operative intra-peritoneal abscess and or wound infection. (ii) The length and cost of hospital stay. (iii) The mortality outcomes. Statistical analysis was done using Pearson Chi-square test, Independent sample t-test and Mann-Whitney U Test. Results Of 227 patients with open emergency appendectomy for complicated appendicitis, 114 had received abdominal drain after the surgery. Fifty out of 114 patients (43.9%) with abdominal drainage developed post-operative intra-peritoneal abscess (abdominal or pelvic) while 53 out of 113 patients (46.9%) without drainage developed the same complication (P = 0.65). It was also revealed that for patients with drainage, 42 patients (36.8%) had post-operative wound infection, whereas this number was 38 (33.6%) for patients without drainage (P = 0.61). On the other hand, the patients with drain had significantly longer length of hospital stay (mean length of stay: 4.99 days versus 2.12 days, P < 0.001) and significantly higher cost (median cost per patient: $120 versus $60, P < 0.001). Conclusion Installation of abdominal drainage after open emergency appendectomy for complicated appendicitis did not bring any considerable advantage in terms of prevention or significant reduction of post-operative intra-peritoneal abscess and wound infection. Rather, it lengthened the hospital stay and doubled the cost of operation.
The use of abdominal drain after open appendectomy for complicated appendicitis does not bring any considerable advantage in terms of prevention or significant reduction of post-operative intra-peritoneal abscess and wound infection. Insertion of drain lengthens hospital stay and doubles the cost of operation. No mortality complications had been identified in both drain and non drain groups.
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Affiliation(s)
- Ahmed Kamel Abdulhamid
- Department of Surgery, Imam Hussein Medical City Hospital, Kerbala Medical University, Kerbala, Iraq
| | - Shah-Jalal Sarker
- UCL Medical School, UCL, Research Department of Medical Education, Room GF/664, Royal Free Campus, Hampstead, London, NW3 2PR, UK
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Bhatt NR, Dunne E, Faraz M, Gillis AE, Conlon KC, Paran S, Ridgway PF. Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey. World J Surg 2018; 42:3792-3802. [PMID: 29855686 DOI: 10.1007/s00268-018-4688-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls. METHODS A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons. RESULTS Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg. CONCLUSION The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.
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Affiliation(s)
- N R Bhatt
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - E Dunne
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - M Faraz
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - A E Gillis
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - K C Conlon
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - S Paran
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - P F Ridgway
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
- Department of Surgery, Trinity College Dublin, Tallaght University Hospital, Dublin 24, Ireland.
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Hornor MA, Liu JY, Hu QL, Ko CY, Wick E, Maggard-Gibbons M. Surgical Technical Evidence Review for Acute Appendectomy Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. J Am Coll Surg 2018; 227:605-617.e2. [PMID: 30316962 DOI: 10.1016/j.jamcollsurg.2018.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Melissa A Hornor
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH; American College of Surgeons, Chicago, IL.
| | - Jessica Y Liu
- American College of Surgeons, Chicago, IL; Department of Surgery, Emory University, Atlanta, GA
| | - Q Lina Hu
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Clifford Y Ko
- American College of Surgeons, Chicago, IL; Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Elizabeth Wick
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Risk factors for intraabdominal abscess formation after laparoscopic appendectomy - results from the Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study. Wideochir Inne Tech Maloinwazyjne 2018; 14:70-78. [PMID: 30766631 PMCID: PMC6372867 DOI: 10.5114/wiitm.2018.77272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/04/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction According to meta-analyses laparoscopic appendectomy is associated with many benefits. However, in comparison to open surgery an increased rate of intraabdominal abscesses (IAA) has been reported. Identification of predictive factors for this complication may help to identify patients with higher risk of IAA. Aim To identify potential risk factors for intraabdominal abscess after laparoscopic appendectomy (LA). Material and methods Eighteen surgical units in Poland and Germany submitted data of patients undergoing LA to the online web-based database created by the Polish Videosurgery Society of the Association of Polish Surgeons. It comprised 31 elements related to the pre-, intra- and postoperative period. Surgical outcomes were compared among the groups according to occurrence of IAA. Univariate and multivariate logistic regression models were used to identify potential risk factors for IAA. Results 4618 patients were included in the analysis. IAA were found in 51 (1.10%) cases. Although several risk factors were found in univariate analysis, in the multivariate model, only the presence of complicated appendicitis was statistically significant (OR = 2.98, 95% CI: 1.11–8.04). Moreover, IAA has a significant influence on postoperative reintervention rate (OR = 126.95, 95% CI: 67.98–237.06), prolonged length of stay > 8 days (OR = 41.32, 95% CI: 22.86–74.72) and readmission rate (OR = 33.89, 95% CI: 18.60–34.73). Conclusions Intraabdominal abscesses occurs relatively rarely after LA. It is strongly associated with complicated appendicitis. Occurrence of this complication has a great influence on the postoperative period and due to the nature of its treatment is associated with the need for reintervention, prolonged length of stay and by extension possible readmission.
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Li Z, Zhao L, Cheng Y, Cheng N, Deng Y, Cochrane Colorectal Cancer Group. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2018; 5:CD010168. [PMID: 29741752 PMCID: PMC6494575 DOI: 10.1002/14651858.cd010168.pub3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial.This is an update of the review first published in 2015. OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 6), Ovid MEDLINE (1946 to 30 June 2017), Ovid Embase (1974 to 30 June 2017), Science Citation Index Expanded (1900 to 30 June 2017), World Health Organization International Clinical Trials Registry Platform (30 June 2017), ClinicalTrials.gov (30 June 2017) and Chinese Biomedical Literature Database (CBM) (1978 to 30 June 2017). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in people undergoing emergency open appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). We used GRADE to rate the quality of evidence. MAIN RESULTS We included six RCTs (521 participants), comparing abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia and Africa. The majority of the participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was at low risk of bias.There was insufficient evidence to determine the effects of abdominal drainage and no drainage on intra-peritoneal abscess at 14 days (RR 1.23, 95% CI 0.47 to 3.21; 5 RCTs; 453 participants; very low-quality evidence) or for wound infection at 14 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-quality evidence). The increased risk of 30-day overall complication rate (morbidity) in the drainage group was rated as very low-quality evidence (RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants). There were seven deaths in the drainage group (N = 183) compared to one in the no drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio (OR) 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; moderate-quality evidence). There is 'very low-quality' evidence that drainage increases hospital stay compared to the no drainage group by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants).Other outlined outcomes, hospital costs, pain, and quality of life, were not reported in any of the included studies. AUTHORS' CONCLUSIONS The quality of the current evidence is very low. The effect of abdominal drainage on the prevention of intra-peritoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to no drainage group is also subject to great uncertainty. Thus, there is no evidence for any clinical improvement by using abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 people recruited to the studies. Larger studies are needed to determine the effects of drainage on morbidity and mortality outcomes more reliably.
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Affiliation(s)
- Zhe Li
- The First Affiliated Hospital of Zhengzhou UniversityDepartment of Hepatopancreatobiliary SurgeryNo. 1, Jianshe East RoadZhengzhouHenan ProvinceChina450000
| | - Longshuan Zhao
- The First Affiliated Hospital of Zhengzhou UniversityDepartment of Hepatopancreatobiliary SurgeryNo. 1, Jianshe East RoadZhengzhouHenan ProvinceChina450000
| | - Yao Cheng
- The Second Affiliated Hospital, Chongqing Medical UniversityDepartment of Hepatobiliary SurgeryChongqingChina
| | - Nansheng Cheng
- West China Hospital, Sichuan UniversityDepartment of Bile Duct SurgeryNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Yilei Deng
- The First Affiliated Hospital of Zhengzhou UniversityDepartment of Hepatopancreatobiliary SurgeryNo. 1, Jianshe East RoadZhengzhouHenan ProvinceChina450000
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Lee W, Park SJ, Park MS, Lee KY. Impact of Resident-Performed Laparoscopic Appendectomy on Patient Outcomes and Safety. J Laparoendosc Adv Surg Tech A 2018; 28:41-46. [PMID: 29016218 DOI: 10.1089/lap.2017.0357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Wonkyeong Lee
- Department of Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sun Jin Park
- Department of Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min-Su Park
- Department of Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kil Yeon Lee
- Department of Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Risk factors for intra-abdominal abscess post laparoscopic appendicectomy for gangrenous or perforated appendicitis: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Stoyanov GS, Tsocheva D, Marinova K, Dobrev E, Nenkov R. Drainage after Modified Radical Mastectomy - A Methodological Mini-Review. Cureus 2017; 9:e1454. [PMID: 28929038 PMCID: PMC5590707 DOI: 10.7759/cureus.1454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer is a socially relevant group of malignant conditions of the mammary gland, affecting both males and females. Most commonly the surgical approach of choice is a modified radical mastectomy (MRM), due to it allowing for both the removal of the main tumor mass and adjacent glandular tissue, which are suspected of infiltration and multifocality of the process, and a sentinel axillary lymph node removal. Most common post-surgical complications following MRM are the formation of a hematoma, the infection of the surgical wound and the formation of a seroma. These post-surgical complications can, at least in part, be attributed to the drainage of the surgical wound. However, the lack of modern and official guidelines provides an ample scope for innovation, but also leads to a need for a randomized comparison of the results. We compared different approaches to wound drainage after MRM, reviewed based on the armamentarium, number of drains, location, type of drainage system, timing of drain removal and no drainage alternatives. Currently, based on the general results, scientific and comparative discussions, seemingly the most affordable methodology with the best patient outcome, with regards to hospital stay and post-operative complications, is the placement of one medial to lateral (pectoro-axillary) drain with low negative pressure. Ideally, the drain should be removed on the second or third postoperative day or when the amount of drained fluid in the last 24 hours reaches below 50 milliliters.
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Affiliation(s)
- George S Stoyanov
- Department of General and Clinical Pathology, Forensic Medicine and Deontology, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Dragostina Tsocheva
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Katerina Marinova
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Emil Dobrev
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
| | - Rumen Nenkov
- Department of Surgery, Division of Thoracic Surgery, Faculty of Medicine, Medical University - Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria
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Maffi M, Lima M. Acute Appendicitis. PEDIATRIC DIGESTIVE SURGERY 2017:279-290. [DOI: 10.1007/978-3-319-40525-4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Wu X, Tian W, Kubilay NZ, Ren J, Li J. Is It Necessary To Place Prophylactically an Abdominal Drain To Prevent Surgical Site Infection in Abdominal Operations? A Systematic Meta-Review. Surg Infect (Larchmt) 2016; 17:730-738. [PMID: 27513842 DOI: 10.1089/sur.2016.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Xiuwen Wu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weiliang Tian
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Nejla Zeynep Kubilay
- Infection Prevention and Control Unit, Department of Service Delivery & Safety, World Health Organization, Geneva, Switzerland
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Schlottmann F, Reino R, Sadava EE, Campos Arbulú A, Rotholtz NA. Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies. Int J Surg 2016; 36:40-43. [PMID: 27743898 DOI: 10.1016/j.ijsu.2016.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Complicated appendicitis (CA) may be a risk factor for postoperative intra-abdominal abscess formation (IAA). In addition, several publications have shown an increased risk of postoperative collection after laparoscopic appendectomy. Most surgeons prefer to place a drain to collect contaminated abdominal fluid to prevent consequent abscess formation. We aimed to evaluate the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis. MATERIAL AND METHODS From January 2005 to June 2015 all charts of consecutive patients who underwent laparoscopic appendectomy for CA were revised. CA was defined as a perforated appendix with associated peritonitis. The sample was divided into two groups, G1: intra-abdominal drain and G2: no drain. Demographics, operative factors and 30-day postoperative complications were analyzed. RESULTS In the study period 1300 laparoscopic appendectomies were performed. Laparoscopic findings showed that 17.3% of the surgeries were for complicated acute appendicitis (225 patients). Fifty-six patients (25%) were in G1 and 169 patients (75%) in G2. No significant differences in clinical presentation and demographics were found (p: NS). G1 had an increased conversion rate (G1: 19.6% vs. G2: 7.1%; p: 0.007). No differences were found in the overall morbidity (G1: 32.1% vs. G2: 21.3%, p: NS). The rate of postoperative IAA was 14.2% in G1 and 8.9% in G2 (p: NS). Length of stay was higher in G1 (G1: 5.2 days vs. G2 2.9 days, p: 0.001). There was no mortality in either group. CONCLUSION The placement of intra-abdominal drain in complicated acute appendicitis may not present benefits and may even lengthen hospital stay. These observations suggest that there is no need of using a drain in laparoscopic appendectomy for complicated acute appendicitis.
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Affiliation(s)
| | - Romina Reino
- Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Emmanuel E Sadava
- Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Ana Campos Arbulú
- Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of General Surgery, Hospital Alemán of Buenos Aires, Argentina
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40
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Gorter RR, Eker HH, Gorter-Stam MAW, Abis GSA, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AMK, van den Helder RS, Iordache F, Ket JCF, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Diagnosis and management of acute appendicitis. EAES consensus development conference 2015. Surg Endosc 2016; 30:4668-4690. [PMID: 27660247 PMCID: PMC5082605 DOI: 10.1007/s00464-016-5245-7] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023]
Abstract
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
- Department of Pediatric Surgery, VU University Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Hasan H Eker
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Gabor S A Abis
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Amish Acharya
- Department of Surgery, St Mary's Hospital, London, UK
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Stavros A Antoniou
- Department of Surgery, Center for Minimally Invasive Surgery, Neuwerk Hospital, Mönchengladbach, Germany
- Department of Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Simone Arolfo
- Department of Surgery, University of Torino, Torino, Italy
| | - Benjamin Babic
- Department of Surgery, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Luigi Boni
- Department of Surgery, Minimally Invasive Surgery Research Center, University of Insubria, Varese, Italy
| | - Marlieke Bruntink
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | | | - Barbara Defoort
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - Charlotte L Deijen
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Borja DeLacy
- Department of Surgery, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Peter Mnyh Go
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Florin Iordache
- Department of Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Filip E Muysoms
- Department of Surgery, Maria Middelares Ghent, Ghent, Belgium
| | - M Mahir Ozmen
- Department of Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Michail Papoulas
- Department of Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Michael Rhodes
- Department of Surgery, Stepping Hill Hospital, Stockport, UK
| | - Jennifer Straatman
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark Tenhagen
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Victor Turrado
- Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andras Vereczkei
- Department of Surgery, Medical School University of Pécs, Pecs, Hungary
| | - Ramon Vilallonga
- Department of Surgery, University Hospital Vall Hebrón, Barcelona, Spain
| | - Jort D Deelder
- Department of Surgery, Noordwest Clinics Alkmaar, Alkmaar, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, Sugrue M, De Moya M, Gomes CA, Bhangu A, Agresta F, Moore EE, Soreide K, Griffiths E, De Castro S, Kashuk J, Kluger Y, Leppaniemi A, Ansaloni L, Andersson M, Coccolini F, Coimbra R, Gurusamy KS, Campanile FC, Biffl W, Chiara O, Moore F, Peitzman AB, Fraga GP, Costa D, Maier RV, Rizoli S, Balogh ZJ, Bendinelli C, Cirocchi R, Tonini V, Piccinini A, Tugnoli G, Jovine E, Persiani R, Biondi A, Scalea T, Stahel P, Ivatury R, Velmahos G, Andersson R. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World J Emerg Surg 2016; 11:34. [PMID: 27437029 PMCID: PMC4949879 DOI: 10.1186/s13017-016-0090-5] [Citation(s) in RCA: 245] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023] Open
Abstract
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.
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Affiliation(s)
| | - Arianna Birindelli
- />S. Orsola Malpighi University Hospital – University of Bologna, Bologna, Italy
| | - Micheal D. Kelly
- />Locum Surgeon, Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - Fausto Catena
- />Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Dieter G. Weber
- />Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | | | | | - Mark De Moya
- />Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Carlos Augusto Gomes
- />Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | - Aneel Bhangu
- />Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | | | - Ernest E. Moore
- />Denver Health System – Denver Health Medical Center, Denver, USA
| | - Kjetil Soreide
- />Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Ewen Griffiths
- />University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital, Birmingham, UK
| | | | - Jeffry Kashuk
- />Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Yoram Kluger
- />Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ari Leppaniemi
- />Abdominal Center, University of Helsinki, Helsinki, Finland
| | - Luca Ansaloni
- />General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Manne Andersson
- />Department of Surgery, Linkoping University, Linkoping, Sweden
| | | | - Raul Coimbra
- />UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA USA
| | | | | | - Walter Biffl
- />Queen’s Medical Center, University of Hawaii, Honolulu, HI USA
| | | | - Fred Moore
- />University of Florida, Gainesville, USA
| | - Andrew B. Peitzman
- />Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P. Fraga
- />Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP Brazil
| | | | - Ronald V. Maier
- />Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA
| | | | - Zsolt J Balogh
- />Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Cino Bendinelli
- />Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - Roberto Cirocchi
- />Department of Surgery, Terni Hospital, University of Perugia, Terni, Italy
| | - Valeria Tonini
- />S. Orsola Malpighi University Hospital – University of Bologna, Bologna, Italy
| | - Alice Piccinini
- />Trauma Surgery Unit - Maggiore Hospital AUSL, Bologna, Italy
| | | | - Elio Jovine
- />Department of Surgery, Maggiore Hospital AUSL, Bologna, Italy
| | - Roberto Persiani
- />Catholic University, A. Gemelli University Hospital, Rome, Italy
| | - Antonio Biondi
- />Department of Surgery, University of Catania, Catania, Italy
| | | | - Philip Stahel
- />Denver Health System – Denver Health Medical Center, Denver, USA
| | - Rao Ivatury
- />Professor Emeritus Virginia Commonwealth University, Richmond, VA USA
| | - George Velmahos
- />Harvard Medical School - Chief of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, USA
| | - Roland Andersson
- />Department of Surgery, Linkoping University, Linkoping, Sweden
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42
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Kim JK, Kang J, Kim WR, Park EJ, Baik SH, Lee KY. Does Conversion Adversely Impact the Clinical Outcomes for Patients with Complicated Appendicitis? J Laparoendosc Adv Surg Tech A 2016; 26:635-40. [PMID: 27258692 DOI: 10.1089/lap.2016.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although the feasibility of laparoscopic appendectomy (LA) in complicated appendicitis (CA) has been demonstrated, LA is typically underused in CA due to its high conversion rate. However, little is known regarding the clinical course of conversion in CA. MATERIALS AND METHODS Between January 2005 and April 2012, 1699 patients older than 16 years underwent an appendectomy at our institution. Of these, 207 were confirmed to have CA, which was defined as operative findings of gangrenous or perforated appendix, with or without abscess formation. Patients were divided into the following three groups: open group (OG), laparoscopy group (LG), and converted group (CG). Perioperative outcomes were compared between the three groups. RESULTS Thirty-eight patients underwent open surgery. Among the 169 patients for whom laparoscopic surgery was originally attempted, 20 (11.8%) were converted. Operation time was significantly longer and estimated blood loss was higher in the CG than in the other groups. Fewer overall complications were observed and the length of hospital stay (LOH) was shorter in the LG than in the OG and CG. However, no significant differences were observed between the OG and CG regarding the overall complication rate or LOH. Operation method was the only factor associated with postoperative morbidity in multivariate analysis. CONCLUSION While completion by laparoscopy was associated with better outcomes than the other two procedures at all levels, open conversion did not increase the overall morbidity or LOH compared with open appendectomy. Laparoscopic approach could be a viable option even in the management of CA.
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Affiliation(s)
- Jin Kyong Kim
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, Korea
| | - Jeonghyun Kang
- 2 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Woo Ram Kim
- 3 Department of Surgery, CHA Bundang Medical Center, CHA University , Seongnam, Korea
| | - Eun Jung Park
- 4 Division of Colon and Rectal Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Hyuk Baik
- 2 Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Kang Young Lee
- 1 Department of Surgery, Yonsei University College of Medicine , Seoul, Korea
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43
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Frongia G, Mehrabi A, Ziebell L, Schenk JP, Günther P. Predicting Postoperative Complications After Pediatric Perforated Appendicitis. J INVEST SURG 2016; 29:185-94. [PMID: 26822038 DOI: 10.3109/08941939.2015.1114690] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Assessment of risk factors for postoperative complications following surgical treatment of pediatric perforated appendicitis (PA) is necessary to identify those patients in need of closer monitoring. In this study, we have investigated the impact of different risk factors on the occurrence of complications after an appendectomy in children with PA. MATERIAL AND METHODS The study was a retrospective, single-centre analysis of all pediatric PA conducted over a 10-year period. Preoperative clinical and laboratory results, intraoperative findings, and postoperative complications were analyzed. Risk factors were defined and a risk score was determined for postoperative complications and reinterventions. RESULTS Surgical treatment for appendicitis was performed in 840 pediatric patients during the observation period. 163 of the included patients were diagnosed with PA (mean age 8.9 ± 3.6 years). 19 (11.7%) patients developed postoperative complications, 17 (10.4%) of which required complication-related intervention. We identified five predictors of postoperative complications: the C-related protein value at admission, purulent peritonitis, open appendectomy (primary, secondary, or converted), placement of an abdominal drain, and administration of antibiotics not compliant to results from the subsequent antibiogram. The determined risk score was significantly higher in the complication group (p < .0001) and reintervention group (p < .001). CONCLUSIONS Postoperative complications following pediatric PA can be predicted using specific preoperative, intraoperative, and postoperative risk factors. In the high-risk group, an active prevention, detection, and intervention of any occurring complication is necessary and we present a new specific pediatric risk score to define patients at risk for complications.
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Affiliation(s)
- G Frongia
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - A Mehrabi
- b Department of General , Visceral and Transplantation Surgery
| | - L Ziebell
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
| | - J P Schenk
- c Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology , University Hospital of Heidelberg , Heidelberg , Germany
| | - P Günther
- a Division of Pediatric Surgery, Department of General , Visceral and Transplantation Surgery
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Cho J, Lee J, Sung K. Risk factors for post-operative intra-abdominal abscess after laparoscopic appendectomy: a case-control study. Intensive Care Med Exp 2015. [PMCID: PMC4798218 DOI: 10.1186/2197-425x-3-s1-a121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Taguchi Y, Komatsu S, Sakamoto E, Norimizu S, Shingu Y, Hasegawa H. Laparoscopic versus open surgery for complicated appendicitis in adults: a randomized controlled trial. Surg Endosc 2015; 30:1705-12. [PMID: 26275544 DOI: 10.1007/s00464-015-4453-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to assess whether laparoscopic appendectomy (LA) for complicated appendicitis (CA) effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with open appendectomy (OA). METHODS This single-center, randomized controlled trial was performed in the Nagoya Daini Red Cross Hospital. Patients diagnosed as having CA with peritonitis or abscess formation were eligible to participate and were randomly assigned to an LA group or an OA group. The primary study outcome was development of infectious complications, especially surgical site infection (SSI), within 30 days of surgery. RESULTS Between October 2008 and August 2014, 81 patients were enrolled and randomly assigned with a 1:1 allocation ratio (42, LA; 39, OA). All were eligible for study of the primary endpoint. Groups were well balanced in terms of patient characteristics and preoperative levels of C-reactive protein. SSI occurred in 14 LA group patients (33.3 %) and in 10 OA group patients (25.6 %) (OR 1.450, 95 % CI 0.553-3.800; p = 0.476). Overall, the rate of postoperative complications, including incisional or organ/space SSI and stump leakage, did not differ significantly between groups. No significant differences between groups were found in hospital stay, duration of drainage, analgesic use, or parameters for postoperative recovery except days to walking. CONCLUSION These results suggested that LA for CA is safe and feasible, while the distinguishing benefit of LA was not validated in this clinical trial.
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Affiliation(s)
- Yoshiro Taguchi
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
| | - Shunichiro Komatsu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.,Department of Gastroenterological Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Eiji Sakamoto
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Shinji Norimizu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yuji Shingu
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Hiroshi Hasegawa
- Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
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46
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Cheng Y, Zhou S, Zhou R, Lu J, Wu S, Xiong X, Ye H, Lin Y, Wu T, Cheng N. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev 2015:CD010168. [PMID: 25914903 DOI: 10.1002/14651858.cd010168.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer from postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES To assess the safety and efficacy of abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. SEARCH METHODS We searched The Cochrane Library (Issue 1, 2014), MEDLINE (1950 to February 2014), EMBASE (1974 to February 2014), Science Citation Index Expanded (1900 to February 2014), and Chinese Biomedical Literature Database (CBM) (1978 to February 2014). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared abdominal drainage and no drainage in patients undergoing emergency open appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS Two review authors identified the trials for inclusion, collected the data, and assessed the risk of bias independently. We performed the meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes (or a Peto odds ratio for very rare outcomes), and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). MAIN RESULTS We included five trials involving 453 patients with complicated appendicitis who were randomised to the drainage group (n = 228) and the no drainage group (n = 225) after emergency open appendectomies. All of the trials were at a high risk of bias. There were no significant differences between the two groups in the rates of intra-peritoneal abscess or wound infection. The hospital stay was longer in the drainage group than in the no drainage group (MD 2.04 days; 95% CI 1.46 to 2.62) (34.4% increase of an 'average' hospital stay). AUTHORS' CONCLUSIONS The quality of the current evidence is very low. It is not clear whether routine abdominal drainage has any effect on the prevention of intra-peritoneal abscess after open appendectomy for complicated appendicitis. Abdominal drainage after an emergency open appendectomy may be associated with delayed hospital discharge for patients with complicated appendicitis.
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Affiliation(s)
- Yao Cheng
- Department of BileDuct Surgery,WestChinaHospital, SichuanUniversity,Chengdu,China
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[Perioperative CRP quantification for appendectomy: Clinically useful or a waste of money?]. Chirurg 2015; 86:881-8. [PMID: 25616746 DOI: 10.1007/s00104-014-2913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Appendectomy is the most frequently performed non-elective surgical procedure in general surgery. Despite the questionable benefit, inflammatory markers, such as leukocyte count and C-related protein (CRP) are often determined before and after the surgical procedure. Clinicians are not infrequently confronted with the question whether a patient can be discharged despite an increase in inflammatory laboratory parameters. OBJECTIVES The aim of the current study was to retrospectively evaluate the clinical course of patients after appendectomy and the correlation with inflammatory laboratory findings. MATERIAL AND METHODS A total of 969 patients underwent a surgical procedure due to clinically suspected acute appendicitis. All clinical, laboratory and histopathological data were obtained from the patient records and a quality control database. Laboratory results were correlated with clinical and histopathological data (e.g. t-test, χ (2)-test, regression analysis and ROC curves). RESULTS In patients without acute appendicitis operative trauma caused an increase in CRP up to a median of 31 mg/dl on the first postoperative day and up to 47 mg/dl on postoperative day 2. The overall morbidity was 6.2%. The strongest predictive parameter for complications was a CRP of more than 108 mg/l on the first postoperative day with an odds ratio of 16.6 (96% CI 6.4/42.8, p < 0.001, specificity 88% and sensitivity 69%). Patients with CRP values below the threshold suffered from complications in 1.1 % of cases in contrast to patients above the threshold in 16.8% of cases (p < 0.001). CONCLUSION A moderate postoperative elevation of CRP values is not a general contraindication for discharge; however, postoperative determination of CRP serum values after appendectomy might be an effective predictor for complications and should therefore be measured in the clinical routine.
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48
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Determinants of postoperative abscess occurrence and percutaneous drainage in children with perforated appendicitis. Pediatr Surg Int 2014; 30:1265-71. [PMID: 25362478 DOI: 10.1007/s00383-014-3617-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE Postoperative abscesses after perforated appendicitis have no clear risk factors or indications for percutaneous drainage. Our study addressed these two issues. METHODS A logistic regression model was used to delineate risk factors for postoperative abscess in children with perforated appendicitis treated during a recent 5-year period. Drainage of abscess was compared to antibiotic treatment. RESULTS Postoperative abscess occurred in 42 (14.8%) of 284 patients. Higher WBC count, presence of bowel obstruction at presentation, diffuse peritonitis with a dominant abscess at surgery, and one specific surgeon were significantly associated with postoperative abscess, while fever or pain requiring narcotics at the time of abscess diagnosis was significantly associated with drainage. Compared to non-drainage, those drained had longer hospital stay including readmissions (15.9 ± 5.3 vs. 12.2 ± 4.6 days, p < 0.005) and less readmissions (9.5 vs. 33.3%, p = 0.06). Over the 5-year period, there was no increased trend in abscess occurrence (p = 0.56), but there was an increased trend in the use of percutaneous drainage (p = 0.02). CONCLUSIONS The risk of a postoperative abscess can be predicted by specific clinical characteristics, surgical findings, and treatment-related factors. Percutaneous drainage was associated with longer hospital stays, but less readmissions.
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Lin HF, Lai HS, Lai IR. Laparoscopic treatment of perforated appendicitis. World J Gastroenterol 2014; 20:14338-14347. [PMID: 25339821 PMCID: PMC4202363 DOI: 10.3748/wjg.v20.i39.14338] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/18/2013] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.
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The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis: prospective randomized trial. Surg Endosc 2014; 29:453-7. [DOI: 10.1007/s00464-014-3685-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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