Evaluating the benefit of incidental appendectomy

Background: Surgeons sometimes perform appendectomies during abdominopelvic surgeries for surgical conditions unrelated to the appendix. A retrospective study of the histopathological diagnoses of incidental appendectomy specimens was performed to see the value of this practice. Materials and Methods: Records of incidentally resected appendices submitted to the Histopathology Department of the University of Benin Teaching Hospital from January 2005 to December 2014 were reviewed retrospectively. Results: A total of 129 histopathological reports of incidental appendectomy were retrospectively reviewed; 67 (51.9%) of the patients were male and 62 (48.1%) were female, giving a male­female ratio of about 1.1:1. Fifty­four cases (41.9%) had histologically normal appendices, while 75 cases (58.1%) had various histopathologically demonstrable lesions ranging from acute appendicitis (the most frequent with 27%) to neoplasia (one case of mucinous adenocarcinoma). Conclusion: Significant pathology can be uncovered on histopathological examination of the clinically normal appendix. Incidental appendectomy is thus a useful procedure

Open versus laparoscopic appendicectomy in acute appendicitis: results of a district general hospital

Background:Despite multiple studies comparing the two methods, the real advantages of laparoscopic appendicectomy (LA) compared to open appendicectomy (OA) are still unclear. Purpose of the current study was to compare the results between the two techniques in a district general hospital.Methods:The electronic records of all patients who underwent OA or LA in a one year period were reviewed retrospectively. The comparative data points assessed included age, gender, overall complications, length of stay and Clavien-Dindo Classification of Surgical Complications, including the rates of the main types of complications. Results:300 patients were included in the study. 166 patients underwent OA and 134 patients LA. Postoperative complications were documented in 26 patients (8.7%). LA was employed predominantly in female patients (p = 0.004) and in older patients (p = 0.0015) and was associated with significantly more negative appendicectomies than OA (p = 0.002). No statistically significant difference was noted with regards to the length of hospital stay (p = 0.577), overall postoperative morbidity (p = 0.543) and grading of complications (p = 0.460). Finally, following comparison of the incidence of specific types of complications, only wound infections were significantly different, in favour of LA.Conclusions:LA is safe and effective, however, besides the lower incidence of wound sepsis, demonstrates no clear advantage over OA. The selection between OA and LA should thus be tailored to the clinical scenario and the surgeon's preference

Appendicectomy in private practice in Kwazulu-Natal Province, South Africa

Background. The treatment of appendicitis is regarded as a bellwether procedure that can be used to describe the delivery of essential surgical care. Little has been published on clinical outcomes in the private sector in South Africa (SA), and this study attempts to address this deficiency.Objectives. To extend our understanding of the outcomes of acute appendicitis in the public and private sectors in SA.Methods. Data on patients covered by a leading medical aid who underwent appendicectomy in 26 private hospitals in Durban and Pietermaritzburg, KwaZulu-Natal Province, during the period 2010 - 2015 were obtained and compared with existing data from a recent study of patients with appendicitis treated in the Pietermaritzburg academic complex.Results. Between January 2010 and December 2015, 397 patients covered by the medical aid underwent appendicectomy in private hospitals. Their mean age was 29.7 years (range 3.7 - 87.6), the mean length of stay 4.6 days (range 1 - 41) and the mean operation time 70.6 minutes (range 24.0 - 335.0). Of the procedures 66.5% were laparoscopic. A total of 33 patients (8.3%) required intensive care unit (ICU) admission, and 38 (9.6%) were readmitted. While there was no information on the reasons for readmission, this is a proxy marker for possible complications. The mean total event cost per patient was ZAR38 934. A total of 134 open operations were performed (33.8%). In the state sector, a total of 1 004 patients were documented. The mean patient age was 20.2 years (difference not statistically significant), mean length of stay was significantly longer at 7.3 days (p=0.02, one-tailed t-test), and 10% of patients required ICU admission. In the state hospitals only 3% of the operations were laparoscopic. None of the private sector patients but 40% of the state patients required further surgery. Conclusions. Medical aid data provide useful information on disease profiles and outcomes in private practice. The outcome of acute appendicitis in the private sector appears to be significantly better than in the state sector. Further work is required to fully elucidate the reasons for this, although late presentation in the state patients almost certainly contributes to their poor outcome. In terms of cost, SA private practice appears to be highly efficient and is relatively inexpensive in comparison with international equivalents

Unusual Histological Findings of the Appendix Following Appendectomy; a Ten Year Histopathologic Study

Lesions of the appendix are common. The appendix is however exposed to other uncommon but deleterious lesions which if not detected early and prompt attention given immediately; may result in morbidity and mortality.Materials and methods This was a retrospective study which involved 1171 respondents aged between 2 and 80 years. Demographic data were obtained from the archives of the histopathology department of University of Benin Teaching Hospital. Results were analysed with chi square test and results presented in frequencies tables.Results A total of 1171 samples were analysed out of which 17 were miscellaneous findings. This included 7 diagnosed for chronic granulomatous. Parasitic infestations were observed in only two female and 1 male case respectively and their ages ranged between 21 and 50 years. One case each was seen in Carcinoid; intestinal necrosis; intestinal infarction; chronic HPV; haemorrhagic appendix (which was found in a patient between 70 and 80 year age range).ConclusionsThis study has further emphasised the need for routine histopathologic analysis of all appendices following appendectomies regardless of the macroscopic appearance

Nerfs ilioinguinal et oliohypogastrique. Bases anatomiques de prévention des névralgies résiduelles après appendicectomies; cure de hernies inguinales; césariennes

But : Determiner des zones a risque en evaluant le trajet des deux nerfs par rapport aux incisions parietales abdominales classiques. Materiel et methodes : Le trajet des nerfs ilioinguinal et iliohypogastrique a ete etudie chez 37 sujets anatomiques adultes; non embaumes; de mort recente; par dissection des regions inguinales. Les points d'emergence des nerfs au niveau du muscle oblique interne et les points de terminaison ont ete determines. Ont ete mesurees les distances de ces points d'emergence et de terminaison par rapport a l'epine iliaque antero-superieure; a la ligne mediane et au bord superieur de la symphyse pubienne. Ont ete egalement mesurees les distances entre les epines iliaques antero-superieures; entre les epines iliaques antero-superieures et l'ombilic; entre le bord superieur de la symphyse pubienne et l'ombilic. Sur un schema etabli a partir des diffe- rents reperes anatomiques et mesures moyennes; le trajet standard des deux nerfs etait compare aux incisions parietales abdominales classiques. Resultats : Le nerf ilioinguinal etait retrouve dans 67 cas; le nerf iliohypogastrique dans 64 cas. Le trajet de ces nerfs etait extremement variable. L'emergence du nerf ilioinguinal au niveau du muscle oblique interne etait situee a 3;30 cm en dedans et a 3;27 cm en dessous de l'epine iliaque anterosuperieure. La terminaison du nerf ilioinguinal etait situee a 2;50 cm en dehors de la ligne mediane et a 1;92 cm au-dessus de la symphyse pubienne. L'emergence du nerf iliohypogastrique au niveau du muscle oblique interne etait situee a 2;30 cm en dedans et a 1;20 cm en dessous de l'epine iliaque antero-superieure. La terminaison du nerf iliohypogastrique etait situee a 3;10 cm en dehors de la ligne mediane et a 4;80 cm au-dessus de la symphyse pubienne. Conclusion : Les incisions chirurgicales faites dans la region hypogastrique; au-dessous de la ligne biiliaque comportent un risque eleve de lesion des nerfs ilioinguinal et iliohypogastrique

Fournier's Gangrene Secondary to Appendicectomy

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the scrotum. Case report: A 33-year-old male presented in the accident and Emergency department of Living Word Mission Hospital with a few days history of painful scrotum with desquamation of the epithelium of the scrotal skin. He gave a history of an appendicectomy for a ruptured appendix carried out 8 days earlier at another hospital. Examination revealed a dehisced appendicectomy wound and a de-epithelialized distal scrotal skin. A diagnosis of Fournier's gangrene was made. He was commenced on potent antibiotics and had debridement of the scrotal wound. The wound improved with healthy granulation tissue and it was then covered with a split skin graft. Lesson: When the appendix is found to be ruptured at operation; potent antibiotics are required to forestall the spread of the infection in the peritoneum or along the fascial planes causing necrotising fasciitis

Laparoscopy-assisted appendectomy via the patent umbilical ring (umbilical hernia): a case report

Umbilical hernia aswell as acute appendicitis are two of the most common problems seen by paediatric surgeons; although rarely simultaneously. When detected the operative approach is adjusted. We perform the a laparoscopically assisted appendectomy trough through the an excised umbilical hernia sac opening. The operative technique is presented. The most important advantages are single general anesthesia for the two surgical procedures and the use of present openingpatent umbilical ring as an access to inflamed appendix; what is the essence of a minimally invasive surgery;. Evaluating the results of the appendectomy superior cosmetic end result; minimal scaring and lower stress index are the advantages in comparisoncompared to the conventional open surgery. Shorter procedure and reduced costs are the advantages in comparison to the three port laparoscopic appendectomy. Efficacy and safety are the same as in single umbilical hernia repair

Local anaesthesia for appendicectomy: one surgeon's experience

Background: Appendicectomy can be performed under general; regional and local anaesthesia but the anaesthetic risks are least with the later. Where it is appropriate to perform a procedure under local anaesthesia therefore; this method should be readily utilized. This report aims to share one surgeon's experience with local anaesthesia for appendicectomy. Method: A prospective study was carried out at the Mile One Hospital; a private clinic in Port Harcourt; Nigeria. Patients with acute appendicitis admitted for appendicectomy between July 1999 and December 2002 were assessed and recruited into the study based on criteria such as weight less than 70 kg and option for local anaesthesia. Lignocaine (0.5) in a dose of 3-4mg/kg body weight was infiltrated in the line of incision (Lanz) superficially and then into deeper planes. Those who would not tolerate lignocaine alone were sedated with 10mg of diazepam and 30mg of pentazocine. Patients who still would not tolerate the procedure were converted to general anaesthesia with ketamine. The appendix was removed with the stump unburied. Results: Out of 78 patients with acute appendicitis 35 (44.85) were considered suitable for local anaesthesia. Only 31 eventually tolerated the procedure; 7 of these patients requiring sedation. General anaesthesia was resorted to in 4 patients who failed to tolerate local anaesthesia with sedation. Five patients (16.13) developed surgical site infections; 10 (32.26) had nausea intra-operatively while 7 (22.58) had subcutaneous emphysema in the immediate postoperative period. The mean operative time was 39minutes. There was no mortality

Fournier's gangrene secondary to appendicectomy

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the scrotum. Case report: A 33-year-old male presented in the Accident and Emergency department of Living Word Mission Hospital with a few days history of painful scrotum with desquamation of the epithelium of the scrotal skin. He gave a history of an appendicectomy for a ruptured appendix carried out 8 days earlier at another hospital. Examination revealed a dehisced appendicectomy wound and a de-epithelialized distal scrotal skin. A diagnosis of Fournier's gangrene was made. He was commenced on potent antibiotics and had debridement of the scrotal wound. The wound improved with healthy granulation tissue and it was then covered with a split skin graft. Lesson: When the appendix is found to be ruptured at operation; potent antibiotics are required to forestall the spread of the infection in the peritoneum or along the fascial planes causing necrotising fasciitis

Acute appendicitis in children in Kumasi, Ghana: macroscopic findings at laparotomy

Background A lot has been written about acute appendicitis in children in the developed countries but very little is written about this condition among children in the sub Saharan region. It used to be said that acute appendicitis is rare in Africa but this is no longer the case. We are unable to find, in the literature, any reference to acute appendicitis in children in Ghana. We, therefore, reviewed our experience with this pathology, especially the operative findings, in children using the Kumasi metropolitan area.Patients and Methods Ninety-six children admitted and treated for acute appendicitis from January 2001 to December 2003 were considered. The macroscopic findings at laparotomy were meticulously noted down and these form the basis for the analysis. Appendicectomy was carried out in all the 96 children.Results In all there were 67 boys and 29 girls, a boy to girl ratio of 2.2:1. the ages ranged from 1.8 years to 14.0 years with a mean age of 10.1 ± 2.8 years. Macroscopically, simple acute appendicitis (uncomplicated) was found in 13 (13.5%) and obstructive appendicitis (complicated) in 83 (86.5%) children. Postoperative complications consisted of superficial surgical site infection in 4, deep surgical site infection in 3 and incomplete wound dehiscence in 2. there was one death in the series- a mortality rate of 1.0%.Conclusion Acute appendicitis is no more a rarity in the sub-saharan setting as more and more people live affluently and adopt the western style of life. As a result of prehospital delay and also delays in diagnosis, complicated appendicitis was common among our group of patients

Les appendicites en Afrique tropicale

Les appendicites representent le 1/3 des activites d'un Service de Chirurgie Generale dans les regions Ouest-Africaines. Elles ont les memes etiologies que partout ailleurs. Les formes aigues sont plus frequentes (1143/1392 soit 82 pour cent). Le pronostic vital d'une appendicectomie est bon (0;25 pour cent de mortalite). Les complications sont essentiellement dues aux peritonites dont la forme la plus grave; la mortelle et la moins frequente est la peritonite generalisee

Traitement du plastron appendiculaire .[Lettre]

Soixante-quinze patients porteurs d'un plastron appendiculaire ont ete traites au cours d'une seule hospitalisation. Le traitement medical reposant sur une double antibiotherapie (Cefuroxime et Metronidazole) faisant place a l'appendicectomie des la disparition clinique de la masse. Un abces appendiculaire est survenu au cours du traitement medical soit 1;3 pour cent d'echec. La disparition clinique de la masse a eu lieu en 11 jours en moyenne. Le traitement chirurgical a ete entrepris en moyenne apres 24 jours d'hospitalisation. La mortalite operatoire a ete nulle. La morbidite; representee exclusivement par des abces de paroi sans gravite; a ete de 8 pour cent. Le traitement chirurgical des plastrons appendiculaires ''refroidis'' peut donc etre realise de facon efficace et en toute securite au bout de trois semaines

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant en Afrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant enAfrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)