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Gomaa IA, Mirande MD, Armenia SJ, Aboelmaaty S, Dozois EJ, Perry WRG. Intestinal malrotation in the adult population: Diagnosis, management, and outcomes after laparoscopic Ladd procedure. J Gastrointest Surg 2024; 28:1339-1343. [PMID: 38825442 DOI: 10.1016/j.gassur.2024.05.024] [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] [Received: 04/09/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The Ladd procedure is the treatment of choice for patients with intestinal malrotation; however, the long-term outcomes of the laparoscopic Ladd procedure are not well documented. This study aimed to review the presentation, management, and outcomes of adult patients who underwent a laparoscopic Ladd procedure. METHODS A retrospective review was conducted to identify adult patients with malrotation who underwent a laparoscopic Ladd procedure between January 1995 and June 2022 at the Mayo Clinic in Rochester, Minnesota. Patient details and follow-up data were obtained from the electronic medical records. Patients were invited to participate in a structured phone interview to assess symptoms and quality of life (QoL). RESULTS A total of 44 patients underwent the laparoscopic Ladd procedure. Of the 44 patients, 42 (95.5 %) were symptomatic, with 7 (16.7 %) presenting with acute symptoms. Moreover, 8 laparoscopic procedures (13.6 %) required conversion to an open procedure. The median estimated blood loss was 20 mL (IQR, 10-50), operative time was 2.3 h (IQR, 1.8-2.8), and hospital length of stay was 2 days (IQR, 2-3). Postoperative ileus was the most common complication (18.0 %). The median follow-up was 8.00 years (IQR, 2.25-13.00), with more than 90.0 % of patients having partial or complete symptom resolution. Of note, 28 patients (63.6 %) completed phone interviews. Moreover, 1 patient (2.0 %) reported a postoperative volvulus. When asked to compare their current symptoms with those preoperatively, 78.6 % of patients noted that they were significantly better. Furthermore, 85.7 % of patients reported that their QoL was significantly better after surgery. Finally, 96.4 % of patients would recommend the procedure to a friend or family member with the same condition. CONCLUSION The laparoscopic Ladd procedure is a safe and effective surgical procedure for adult patients with intestinal malrotation.
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Affiliation(s)
- Ibrahim A Gomaa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Sarah J Armenia
- Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Sara Aboelmaaty
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States
| | - William R G Perry
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, United States.
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Heiranizadeh N, Mousavi Beyuki SMH, kargar S, Abadiyan A, Mohammadi HR. Alvarado or RIPASA? Which one do you use to diagnose acute appendicitis?: A cross-sectional study. Health Sci Rep 2023; 6:e1078. [PMID: 36698708 PMCID: PMC9851161 DOI: 10.1002/hsr2.1078] [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: 09/16/2022] [Revised: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Background and Aims Acute appendicitis is one of the most common causes of lower abdominal pain, which is considered a general surgical emergency worldwide. The present study aimed to compare the diagnostic value of Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado score systems in diagnosing acute appendicitis. Methods A prospective cross-sectional study was conducted at Shahid Sadoughi and Shahid Rahnemoon Hospitals in Yazd between September 2020 and February 2020. The statistical population consisted of all of the patients referred to the Accident and Emergency department with right iliac fossa (RIF) pain. All patients were scored using Alvarado and RIPASA scoring system. sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed by using SPSS statistical software. An receiver operating characteristic curve were plotted. Results In present study, one hundred suspected patients with appendicitis who underwent appendectomy were evaluated. The mean age of our study population was 25.2 ± 12.1 years, and the gender distribution was 57% males and 43% females. The sensitivity, specificity, PPV and NPV of RIPASA were 86.6%, 66.7%, 92.2%, and 52.2%, respectively. The sensitivity, specificity, PPV and NPV of Alvarado score were 67.1%, 72.2%, 91.7%, 32.5%, respectively. The diagnostic accuracy was 68% for Alvarado score and 83% for RIPASA. The area under the curve for RIPASA (0.87) was more than that for Alvarado score (0.77). Conclusion The RIPASA score system had higher sensitivity, PPV, NPV, and accuracy than the Alvarado one. It is recommended for the physician and surgeon to evaluate patients with RIF pain using the RIPASA score.
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Affiliation(s)
| | | | - Saeed kargar
- Department of SurgeryShahid Sadoughi University of Medical SciencesYazdIran
| | - Aryana Abadiyan
- Department of SurgeryShahid Sadoughi University of Medical SciencesYazdIran
| | - Hamid Reza Mohammadi
- Student Research Committee, Department of SurgeryShahid Sadoughi University of Medical SciencesYazdIran
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Raffee L, Almasarweh SA, Mazahreh TS, Alawneh K, Alabdallah NB, Al Hamoud MA, Aburayya HA, Ayoub FS, Issa F, Ciottone G. Predicting mortality and morbidity in emergency general surgery patients in a Jordanian Tertiary Medical Center: a retrospective validation study of the Emergency Surgery Score (ESS). BMJ Open 2022; 12:e061781. [PMID: 36400729 PMCID: PMC9677020 DOI: 10.1136/bmjopen-2022-061781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The Emergency Surgery Score (ESS) is a predictive tool used to assess morbidity and mortality rates in patients undergoing emergent surgery. This study explores the ESS's predictive ability and reliability in the Jordanian surgical population. DESIGN A retrospective validation study. SETTING A tertiary hospital in Jordan. PARTICIPANTS A database was created including patients who underwent emergent surgery in King Abdullah University Hospital from January 2017 to June 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Relevant preoperative, intraoperative and postoperative variables were retrospectively and systematically gathered, and the ESS was calculated for each patient accordingly. In addition, a multivariable logistic regression analysis was performed to assess the correlations between the ESS and postoperative mortality and morbidity along with intensive care unit (ICU) admissions. RESULTS Out of total of 1452 patients evaluated, 1322 patients were enrolled based on inclusion and exclusion criteria. The mean age of the population was 47.9 years old. 91.9% of the patients were admitted to the surgical ward through the emergency department, while the rest were referred from inpatient and outpatient facilities. The mortality and postoperative complication rates were 3.9% and 13.5%, respectively. Mortality rates increased as the ESS score gradually increased, and the ESS was evaluated as a strong predictor with a c-statistic value of 0.842 (95% CI 0.743 to 0.896). The postoperative complication and ICU admission rate also increased with reciprocal rises in the ESS. They were also evaluated as accurate predictors with a c-statistic value of 0.724 (95% CI 0.682 to 0.765) and a c-statistic value of 0.825 (95% CI 0.784 to 0.866), respectively. CONCLUSION The ESS is a robust, accurate predictor of postoperative mortality and morbidity of emergency general surgery patients. Furthermore, it is an all-important tool to enhance emergency general surgery practices, in terms of mitigating risk, quality of care measures and patient counselling.
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Affiliation(s)
- Liqaa Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami A Almasarweh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Tagleb S Mazahreh
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khaled Alawneh
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Hamza A Aburayya
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi S Ayoub
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi Issa
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Greg Ciottone
- BIDMC Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Hoshino N, Endo H, Hida K, Kumamaru H, Hasegawa H, Ishigame T, Kitagawa Y, Kakeji Y, Miyata H, Sakai Y. Laparoscopic Surgery for Acute Diffuse Peritonitis Due to Gastrointestinal Perforation: A Nationwide Epidemiologic Study Using the National Clinical Database. Ann Gastroenterol Surg 2021; 6:430-444. [PMID: 35634193 PMCID: PMC9130886 DOI: 10.1002/ags3.12533] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nobuaki Hoshino
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
| | - Koya Hida
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
| | - Hiroshi Hasegawa
- Project Management Subcommittee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Teruhide Ishigame
- Project Management Subcommittee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yoshihiro Kakeji
- Database Committee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
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Podda M, Andersson R, Boermeester M, Coccolini F, Sartelli M, Moore EE, Sugrue M, Abu-Zidan F, Tolonen M, Damaskos D, Kluger Y, Soreide K, Pisanu A, Augustin G, Latifi R, Kelly M, Leppaniemi A, Fraga GP, Ten Broek R, Tan E, Van Goor H, Chiara O, Maier RV, Pata F, De Simone B, Ordoñez CA, Ansaloni L, Catena F, Di Saverio S. Do young patients with high clinical suspicion of appendicitis really need cross-sectional imaging? Proceedings from a highly controversial debate among the experts' panel of 2020 WSES Jerusalem guidelines. J Trauma Acute Care Surg 2021; 90:e101-e107. [PMID: 33496553 DOI: 10.1097/ta.0000000000003097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Mauro Podda
- From the Department of Emergency Surgery (M.P., A.P.), Azienda Ospedaliero-Universitaria di Cagliari, University Hospital Policlinico Duilio Casula, Cagliari, Italy; Department of Surgery (R.A.), Linkoping University, Linkoping, Sweden; Department of Surgery (M.B.), University of Amsterdam, Amsterdam, The Netherlands; General, Emergency and Trauma Surgery (F.C.), Pisa University Hospital, Pisa, Italy; Department of Surgery (M.S.), Macerata Hospital, Macerata, Italy; Denver Health System-Denver Health Medical Center (E.E.M.), Denver, Colorado; Department of Surgery (M.S.), Letterkenny Hospital, Donegal, Ireland; Department of Surgery (F.A.-Z.), College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates; Department of Abdominal Surgery (M.T., A.L.), Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Department of Upper GI Surgery (D.D.), Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Division of General Surgery (Y.K.), Rambam Health Care Campus, Haifa, Israel; Department of Gastrointestinal Surgery (K.S.), Stavanger University Hospital, Stavanger, Norway; Department of Surgery (G.A.), University Hospital Centre of Zagreb, Zagreb, Croatia; Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery (R.L.), New York Medical College, Valhalla, New York; Acute Surgical Unit (M.K.), Canberra Hospital, ACT, Canberra, Australia; Faculdade de Ciências Médicas (FCM)-Unicamp, Campinas (G.P.F.), SP, Brazil; Department of Surgery (R.T.B., E.T., H.V.G.), Radboud University Medical Center, Nijmegen, The Netherlands; Niguarda Hospital Trauma Center (O.C.), Milan, Italy; Department of Surgery (R.V.M.), University of Washington, Harborview Medical Center, Seattle, Washington; Department of Surgery (F.P.), Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University o Rome, Rome, Italy; Department of Visceral Surgery (B.D.S.), Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France; Division of Trauma and Acute Care Surgery, Department of General Surgery (C.A.O.), Fundación Valle del Lili, Cali, Colombia; Department of General Surgery and Trauma (L.A.), Bufalini Hospital, Cesena, Italy; Emergency and Trauma Surgery Department (F.C.), Maggiore Hospital of Parma, Parma, Italy; and Department of General Surgery (S.D.S.), University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy
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Al Sheikh S, Al Ali M, Kiran DS, Al Tabatabai M. How POCUS picks up a rare mimickers of acute appendicitis in the emergency department. Ultrasound J 2020; 12:2. [PMID: 31938870 PMCID: PMC6960269 DOI: 10.1186/s13089-020-0151-6] [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: 07/01/2019] [Accepted: 01/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Appendicitis is the most common surgical abdominal emergency. Punctual diagnosis and rapid operative treatment of acute appendicitis are critically important, as it reduces the risk of complications, associated with greater morbidity and cost of care. The clinical diagnosis of acute appendicitis can be difficult and confusing. Due to some typical presentation and mimic, several abdominal conditions are left undiagnosed. POCUS has comparatively acceptable sensitivity and high specificity for diagnosing acute appendicitis, and early practice POCUS has a standalone test to rule out acute appendicitis. Case presentation A 43-year-old man presented with a 3-day history of abdominal pain rated 5/10 in intensity which had localized to the right iliac fossa by the time he attended our emergency. He described the acute pain as sharp in nature, colicky without the presence of any radiation. The pain was associated with nausea, but there was no vomiting. On clinical examination, the patient was stable at first, had a normal temperature with tenderness and guarding the right iliac fossa under nearby normal laboratory investigation. Conclusion The importance of POCUS in scanning right iliac fossa for patients present with signs and symptoms that are mimicking acute appendicitis for diagnosing a rare pathology and avoiding the risk of ionizing radiation hazards and unnecessary surgical intervention.
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Affiliation(s)
- Shihab Al Sheikh
- Emergency Department, Rashid Hospital Trauma Center, Dubai, United Arab Emirates.
| | - Mariam Al Ali
- Emergency Department, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
| | - Dhanya Sochel Kiran
- Emergency Department, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
| | - Mohsen Al Tabatabai
- Emergency Department, Rashid Hospital Trauma Center, Dubai, United Arab Emirates
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Abstract
CLINICAL ISSUE Acute abdominal pain is a prevalent problem in the emergency department. The work-up has to include a broad spectrum of differential diagnoses, which should be narrowed down with respect to frequent diagnoses without overlooking rare but potentially even more severe pathologies. STANDARD RADIOLOGICAL METHODS The radiological method of choice for the initial work-up after sonography is computed tomography, which has demonstrated the highest sensitivity and specificity for most findings. Plain film radiographs of the abdomen rarely contribute to the final diagnosis. Magnetic resonance imaging is reserved for selected cases, which are described in this article. ASSESSMENT The clinical decision trees and recommendations, which need to be in the report depending on the diagnosis, are of relevance for every radiologist who deals with patients with acute abdominal presentations. PRACTICAL RECOMMENDATIONS Knowledge of the clinical diagnostic approach in patients with acute abdomen is an unavoidable prerequisite for optimal cooperation between clinicians and radiologists in acute situations.
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Affiliation(s)
- D Tamandl
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - T Uray
- Universitätsklinik für Notfallmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, Wien, Österreich
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Uncommon Differential Diagnosis of Acute Right-sided Abdominal Pain – Case Report. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
The appendix is a worm-like, blind-ending tube, with its base on the caecum and its tip in multiple locations. Against all odds, it plays a key role in the digestive immune system and appendectomy should therefore be cautiously considered and indicated. We report the case of a 45-year-old male with a known history of Fragile-X syndrome who presented to the emergency department with intense abdominal pain and was suspected of acute appendicitis, after a positive Dieulafoy’s triad was confirmed. The laparoscopic exploration showed no signs of inflammation of the appendix; nonetheless, its removal was carried out. Rising inflammatory laboratory parameters led to a focused identification of a pleural empyema due to a tooth inlay aspiration. Our objective is to emphasize the importance of a thorough anamnesis, even in cases of mentally impaired patients, as well as to highlight a rare differential diagnosis for appendicitis. Acute appendicitis is an emergency condition that requires a thorough assessment and appropriate therapy. Clinical examinations are important, but in this particular case, imaging methods had a much more important role in establishing the right treatment approach. Furthermore, the signs of acute appendicitis are mimicked by several medical conditions including respiratory tract infections.
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Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials. Int J Surg 2018; 56:307-314. [PMID: 30017607 DOI: 10.1016/j.ijsu.2018.07.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/09/2018] [Accepted: 07/06/2018] [Indexed: 12/13/2022]
Abstract
BACKROUND The electronic diagnostic tools of acute appendicitis present serious disadvantages, thus some clinical scores have been formed in order to reach the diagnosis easily and safely. Alvarado and RIPASA scores are the most commonly used and the purpose of this meta-analysis is to compare the diagnostic accuracy of these two scoring systems. METHOD We searched MEDLINE (1966-2017), Scopus (2004-2017), ClinicalTrials.gov (2008-2017), Google Scholar (2004-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. We selected all observational cohort studies that reported diagnostic parameters of Alvarado and RIPASA diagnostic scores on patients with clinical status of acute appendicitis. Statistical meta-analysis was performed with Meta Disc 1.4 software. RESULTS Twelve studies were included in our meta-analysis which enrolled 2161 patients. The sensitivity of RIPASA score was 94% (95% CI, 92%-95%) and the specificity was 55% (95% CI, 51%-55%). In addition, the area under the Roc Curve (AUC) was 0.9431 and the diagnostic Odds Ratio was 24.66 (95% CI, 8.06 to 75.43). The sensitivity of Alvarado score was 69% (95% CI, 67%-71%) and the specificity was 77% (95% CI, 74%-80%). Moreover, the AUC was 0.7944 and the diagnostic Odds Ratio was 7.99 (95% CI, 4.75 to 13.43). CONCLUSION RIPASA scoring system is more sensitive than Alvarado one, but the low specificity forms the need of a supplementary mean to provide the accurate diagnosis. Nevertheless, the wide and safe use of both tests is recommended in health systems that lack electronic diagnostic tests, such us developing countries or rural hospitals.
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Ma L, Cai XJ, Wang HH, Yu YL, Huang DY, Ge GJ, Hu HY, Yu SC. Laparoscopic colonic anastomosis using a degradable stent in a porcine model. World J Gastroenterol 2016; 22:4707-4715. [PMID: 27217702 PMCID: PMC4870077 DOI: 10.3748/wjg.v22.i19.4707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.
METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group (n = 10) and control group (hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference (AC).
RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group (P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups (P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumference in the control group (P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing.
CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.
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Floras T, Philippou A, Bardakostas D, Mantas D, Koutsilieris M. The growth endocrine axis and inflammatory responses after laparoscopic cholecystectomy. HORMONES 2016. [DOI: 10.1007/bf03401405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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BEKTASOGLU HUSEYINKAZIM, CIPE GOKHAN, YARDIMCI ERKAN, ARICI DILEKSEMA, HASBAHCECI MUSTAFA, KARATEPE OGUZHAN, MUSLUMANOGLU MAHMUT. Metachronous metastatic paraganglioma in jejunum as a rare entity: A case report. Oncol Lett 2015; 9:1278-1280. [PMID: 25663897 PMCID: PMC4314967 DOI: 10.3892/ol.2015.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/19/2014] [Indexed: 11/05/2022] Open
Abstract
Pheochromocytomas and paragangliomas are neuroendocrine tumors that arise from chromaffin cells of adrenal medulla and extra-adrenal paraganglia, respectively. The recurrence of these neuroendocrine tumors as a jejunal mass causing obstruction in the small intestine is an exceptional entity. The present study reports the case of a 70-year-old male who presented to the Emergency Department of Bezmialem Vakif University Hospital with abdominal pain and vomiting. The patient possessed a history of left nephrectomy due to malignant pheochromocytoma that had invaded into the left kidney eight months prior to presentation. Bowel obstruction was diagnosed and the patient underwent a laparoscopic procedure. Partial resection of the jejunum was performed and immunohistochemical studies revealed the lesion to be malignant paraganglioma. The majority of paragangliomas are chemo- and radioresistant. Surgical excision remains the primary treatment. Metachronous paraganglioma arising from the small intestine is an extremely rare entity and may be a relevant consideration in patients presenting with bowel obstruction.
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Affiliation(s)
- HUSEYIN KAZIM BEKTASOGLU
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - GOKHAN CIPE
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - ERKAN YARDIMCI
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - DILEK SEMA ARICI
- Department of Pathology, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - MUSTAFA HASBAHCECI
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - OGUZHAN KARATEPE
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
| | - MAHMUT MUSLUMANOGLU
- Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34093, Turkey
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Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg 2015; 32:23-31. [PMID: 25659265 DOI: 10.1159/000371583] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 12/15/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. METHODS All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. DEFINITION Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination.
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Affiliation(s)
- Sarah L Gans
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Conversion of laparoscopic surgery for perforated peptic ulcer: a single-center study. Surg Today 2015; 45:1421-8. [PMID: 25576012 DOI: 10.1007/s00595-015-1112-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 12/25/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE A perforated peptic ulcer can be managed laparoscopically in selected patients. The purpose of this study was to evaluate whether conversion of emergency laparoscopy is inferior to primary median laparotomy in terms of postoperative morbidity and mortality. METHODS We analyzed patients who underwent laparoscopic or open surgery for a perforated peptic ulcer at the Department of Surgery, University of Schleswig-Holstein, Campus Luebeck between January, 1996 and December, 2010. Perforations were graded according to the Boey classification, a preoperative risk-scoring system. RESULTS Conversion to laparotomy was necessary in 20 of the 45 patients who underwent laparoscopic surgery (CG); therefore, laparoscopic operations were completed in 25 patients (LG). The third patient cohort comprised 139 patients who underwent primary laparotomy (OG). Overall minor morbidity was significantly lower (p = 0.048) in the LG patients than in the OG patients, whereas no significant differences were found in major morbidity and mortality, particularly between the OG and CG. CONCLUSION Patients' suitability for laparoscopic management should be decided on according to Boey's clinical scoring system. Our findings demonstrated that conversion from laparoscopy to laparotomy was not associated with elevated postoperative morbidity or mortality versus initial laparotomy. Therefore, emergency operations may be commenced laparoscopically in selected patients, especially considering the postoperative advantages of this approach.
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Koenraadt A, Stegen L, Bosmans T, Van Goethem B. Laparoscopic treatment of persistent inguinal haemorrhage after prescrotal orchiectomy in a dog. J Small Anim Pract 2014; 55:427-30. [PMID: 24697691 DOI: 10.1111/jsap.12220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 11/30/2022]
Abstract
A one-year-old male Jack Russell terrier developed a prescrotal haematoma after elective orchiectomy. When surgical exploration failed to locate the responsible vessel and conservative therapy (applying a pressure bandage) was not successful in stabilising the dog, abdominal laparoscopy was performed. The haemorrhage originated from the spermatic cord in the inguinal canal bilaterally. After retracting the spermatic cord into the abdomen, haemostasis was performed using a vessel-sealing device. The prescrotal haematoma was removed and the dog made an uncomplicated recovery.
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Affiliation(s)
- A Koenraadt
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, B-9820, Merelbeke, Belgium
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Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg 2013; 101:e51-64. [PMID: 24338777 DOI: 10.1002/bjs.9368] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. METHODS PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. RESULTS Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence. CONCLUSION Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Sista F, Schietroma M, Santis GD, Mattei A, Cecilia EM, Piccione F, Leardi S, Carlei F, Amicucci G. Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis. World J Gastrointest Surg 2013; 5:73-82. [PMID: 23717743 PMCID: PMC3664294 DOI: 10.4240/wjgs.v5.i4.73] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach.
METHODS: From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 °C, leukocytosis greater than 10 × 109/L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis, complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-op day 6.
RESULTS: The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC group at all intra-operative sampling times, but reached significance only when the gallbladder was removed (OC group = 36.81 ± 6.4 ρg/mL vs LC group = 16.74 ± 4.1 ρg/mL, P < 0.05). One hour after surgery, microbiological analysis of blood cultures detected 7 different bacterial species after laparotomy, and 4 species after laparoscopy (P < 0.05).
CONCLUSION: OC increased the incidence of bacteraemia, endotoxaemia and systemic inflammation compared with LC and caused lower transient immunological defense, leading to enhanced sepsis in the patients examined.
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McGowan DR, Sims HM, Zia K, Uheba M, Shaikh IA. The value of biochemical markers in predicting a perforation in acute appendicitis. ANZ J Surg 2012; 83:79-83. [DOI: 10.1111/ans.12032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- David Ross McGowan
- Gloucestershire Hospitals NHS Foundation Trust; Gloucester; Gloucestershire; UK
| | - Helen M. Sims
- Gloucestershire Hospitals NHS Foundation Trust; Gloucester; Gloucestershire; UK
| | - Khawaja Zia
- Brighton and Sussex University Hospitals NHS Trust; Brighton; East Sussex; UK
| | - Mokthar Uheba
- Brighton and Sussex University Hospitals NHS Trust; Brighton; East Sussex; UK
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Tschuor C, Raptis DA, Limani P, Bächler T, Oberkofler CE, Breitenstein S, Graf R. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain. BMC Gastroenterol 2012; 12:154. [PMID: 23098130 PMCID: PMC3503734 DOI: 10.1186/1471-230x-12-154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/12/2012] [Indexed: 12/15/2022] Open
Abstract
Background Pancreatic Stone Protein (PSP) is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein) in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendicitis at the emergency room. Methods/design The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. 245 patients will be prospectively recruited. Interim analysis will be performed once 123 patients are recruited. The primary endpoint of the study concerns the diagnostic accuracy of PSP in predicting acute appendicitis and therefore the evidence of appendicitis on the histopathological specimen after appendectomy. Discussion The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. Trial registration ClinicalTrials.gov: NCT01610193; Institution Ethical Board Approval ID: KEKZH- Nr. 2011–0501
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Affiliation(s)
- Christoph Tschuor
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-2164. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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Morino M, Famiglietti F. Nonspecific Abdominal Pain. THE ROLE OF LAPAROSCOPY IN EMERGENCY ABDOMINAL SURGERY 2012:153-161. [DOI: 10.1007/978-88-470-2327-7_11] [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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Park HC, Kim BS, Lee BH. Efficacy of Short-Term Antibiotic Therapy for Consecutive Patients with Mild Appendicitis. Am Surg 2011. [DOI: 10.1177/000313481107700633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although antibiotic therapy seemed to be a safe treatment option for acute appendicitis, indications of this treatment have not been fully evaluated. We hypothesized that clinical and radiologic mild appendicitis may be a candidate for short-term antibiotic therapy. The purpose of present study was to examine the efficacy and the recurrence rate of short-term antibiotic therapy for consecutive patients with mild appendicitis. A prospective observational study was conducted over 3 years. The mild appendicitis was defined as the intermediate Alvarado score (4-8) and dilated appendix from 6 mm to 10 mm in radiologic study. All patients received initial antibiotics administration with clinical observation during 48 hours. The failure to respond to therapy and the incidence of recurrence were assessed. There were 107 enrolled patients with the mean Alvarado score of 6 ± 1 and the mean appendiceal diameter of 7.4 ± 1 mm. Of these, 97 (91%) exhibited improved symptoms and were discharged. The remaining 10 patients underwent surgery because of clinical aggravation, and pathology revealed true appendicitis in six of them. Of the 97 patients in whom the initial treatment was successful, five patients (5%) exhibited recurrent symptoms during a median follow-up period of 18 months. Of these five patients, three were treated with surgery (all true appendicitis), and the remaining two were once again treated with antibiotics. Patients with suspected appendicitis, those in whom mild appendicitis was diagnosed after clinical and radiologic evaluations, were found to benefit from short-term antibiotic therapy.
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Affiliation(s)
- Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Byoung-Seup Kim
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Bong Hwa Lee
- Department of Surgery, Hallym University College of Medicine, Anyang, Korea
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