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Objective:To investigate the diagnostic and therapeutic value of one-time biliopancreatic-duct-imaging-system (eyeMax)-assisted endoscopic retrograde appendicitis therapy (ERAT) for children.Methods:A total of 11 children who were diagnosed as having uncomplicated acute appendicitis by imaging in Xi′an Children′s Hospital from August to November 2022 were enrolled. All patients received subscope-assisted ERAT. Subscope was intubated into the appendix cavity to observe the mucosa directly. Appendicitis was treated through cleansing, fecalith extraction, stent drainage. The clinical manifestations under subscope were recorded, as well as the treatment success rate, intubation success rate, the effective rate, complication incidence during and after the operation.Results:The age of 11 children was 7.93±2.67 years old. Appendix intubation was successful in all patients. Congestion and swelling of the mucosa in appendiceal orifice and appendix cavity were seen under the subscope in 11 children. There were 6 cases with appendiceal fecaliths, 8 cases with pus and 6 cases with luminal distortion or stenosis. Perforation was observed in 1 case during the operation and no other complication occurred. All patients were treated under subscope, including flushing appendiceal cavity (11 cases), fecalith extraction with extraction basket (3 cases), and appendiceal drainage with stenting (2 cases). The symptoms and signs were relieved after the operation, and the effective rate within 48 hours was 10/11. There were no procedure-related complications or recurrence during postoperative follow-up for 1 week to 4 months.Conclusion:Acute appendicitis could be diagnosed by observing the appendix cavity directly under one-time biliopancreatic-duct-imaging-system-assisted ERAT, and also could be treated with the system, where appendix could be preserved and radiation damage could be avoided with safety and effectiveness.
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OBJECTIVES@#To study the clinical efficacy of ultrasound-guided endoscopic retrograde appendicitis therapy in children with appendix-related chronic abdominal pain.@*METHODS@#A retrospective analysis was performed on the medical data of 30 children with the chief complaint of chronic abdominal pain who were admitted from August 2019 to May 2021. All the children were found to have inflammation of the appendix or intracavitary stool and fecalith by ultrasound and underwent ultrasound-guided endoscopic retrograde appendicitis therapy. The medical data for analysis included clinical manifestations, endoscopic findings, white blood cell count, neutrophil percentage, length of hospital stay, and cure rate.@*RESULTS@#Among the 30 children with chronic abdominal pain, there were 13 boys (43%) and 17 girls (57%), with a mean age of (9±3) years (range 3-15 years) at diagnosis. The median duration of the disease was 12 months, and the median length of hospital stay was 3 days. The children had a median white blood cell count of 6.7×109/L and a neutrophil percentage of 50%±13%. Fecalith and a large amount of feces were flushed out of the appendix cavity for 21 children (70%) during surgery. The follow-up rate was 97% (29/30), and the median follow-up time was 11 months (range 5-26 months). Of the 29 children, abdominal pain completely disappeared in 27 children (93%).@*CONCLUSIONS@#Ultrasound-guided endoscopic retrograde appendicitis therapy is effective in children with chronic abdominal pain caused by feces or fecalith in the appendix cavity.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Abdominal Pain/etiology , Appendicitis/surgery , Appendix/surgery , Fecal Impaction , Retrospective Studies , Ultrasonography, InterventionalABSTRACT
RESUMEN Introducción: La apendicitis aguda es una de las causas más frecuentes de abdomen agudo. Objetivo: Describir las tendencias actuales en el tratamiento de la apendicitis aguda en adultos. Métodos: Se realizó una revisión no sistemática de la literatura en las bases de datos: Biblioteca Virtual de Salud, PubMed, SciELO y Google académico. Se incluyeron metanálisis y trabajos originales disponibles a texto completo publicados desde 2016 hasta marzo de 2021, en idiomas inglés y español. Resultados: El más aceptado tratamiento a nivel mundial es la apendicectomía laparoscópica para el tratamiento de las formas complicadas y no complicadas de apendicitis aguda siempre y cuando existan las condiciones materiales y humanas para su realización, es preferible la ligadura simple del muñón apendicular a la invaginación. El uso sistemático de drenajes abdominales no es beneficioso. Los protectores de los bordes de la incisión son útiles en la prevención de la infección del sitio quirúrgico. El cierre primario de la piel mediante una sutura intradérmica tiene mejores resultados. Es necesario clasificar de manera uniforme la enfermedad para un mejor manejo. Los antimicrobianos profilácticos son suficientes en las formas no complicadas, en complicados, un curso corto de antibióticos es efectivo. El tratamiento conservador puede ser considerado seguro y efectivo en pacientes seleccionados con apendicitis aguda no complicada. Conclusiones: La apendicectomía laparoscópica es el abordaje más aceptado, con tendencia al uso de protocolos de tratamiento ambulatorio y menor duración de los antimicrobianos.
ABSTRACT Introduction: Acute appendicitis is one of the most common causes of acute abdominal pain. Objective: To describe currents trends in treatment of acute appendicitis in adults. Methods: A non-systematic review of the literature was made using Virtual Health Library, PubMed, SciELO and Scholar Google databases. Meta-analysis and original articles, in Spanish and English, published from 2016 to March 2021, were included. Results: Laparoscopic appendectomy is the most accepted treatment for complicated and uncomplicated forms of acute appendicitis, were human and materials resources exists. Simple ligation is preferable to stump invagination. The systematic use of abdominal drainage is not recommended. Wounds edge protectors are useful in prevention of surgical site infection. Primary skin closure with an intradermal suture, has better results. To achieve a unique disease classification system is necessary, in order to improve results. Prophylactic antibiotics are sufficient in uncomplicated appendicitis; complicated acute appendicitis require a short course of antibiotics. Non-surgical treatment can be considered in selected patients with uncomplicated acute appendicitis. Conclusions: Currently, laparoscopic appendectomy is preferred, there is a tendency to use ambulatory protocols and shortened antibiotics prescriptions.
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To investigate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (ERAT) in children with acute uncomplicated appendicitis complicated with intussusception. Data of 6 patients with acute uncomplicated appendicitis complicated with intussusception who received modified ERAT were collected from October 2018 to February 2020 in Pediatrics Department of Tangdu Hospital. The reduction rate of intussusception, the success rate of ERAT appendiceal intubation and endoscopic treatment, the remission time of clinical symptoms, the time of white blood cells return to normal, the length of hospital stay, complications and recurrence were summarized. All the 6 patients were confirmed to be acute uncomplicated appendicitis combined with ileocecal intussusceptions under colonoscopy. Endoscopic intussusception reduction and ERAT were performed successfully. The mean time of disappearance of abdominal tenderness was 1.3 days after the therapy, and the time of white blood cells return to normal was 1 day after surgery. The endoscopic treatment were all successful and the length of hospital stay was 3-6 days. No complications or recurrence of intussusception and appendicitis occurred during the follow-up period of 6-12 months. Modified ERAT can effectively, safely and minimally invitingly treat acute uncomplicated appendicitis with intussusception in children on the basis of definite diagnosis.
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RESUMEN El objetivo del trabajo es profundizar en los diferentes aspectos cognoscitivos sobre las nuevas evidencias concernientes al tratamiento de la apendicitis aguda y comparar los resultados obtenidos con las diferentes técnicas quirúrgicas empleadas actualmente y el tratamiento conservador. Se realizó una revisión bibliográfica y se seleccionaron artículos en las fuentes electrónicas: Web of Science, Scielo, Elsevier, PubMed, Medline y Google, publicadas en la presente centuria en idiomas español e inglés. La apendicetomía mediante laparotomía ha sido siempre la regla de oro para el tratamiento de la apendicitis aguda. En 1982, se introdujo el acceso laparoscópico que ha demostrado ser tan seguro y eficiente como el convencional. En 2004, la cirugía endoscópica a través de orificios naturales; en 2007 por un solo puerto y en 2015 mediante endoscopia retrógrada. La evolución del cuadro clínico es variable por lo que se han propuesto estrategias como la cirugía ambulatoria, el tratamiento conservador seguido o no de cirugía de intervalo, a fin de evitar intervenciones innecesarias con morbilidad y mortalidad similares a las realizadas con urgencia. La apendicetomía mediante laparotomía o laparoscopia aun es la regla de oro del tratamiento de la apendicitis aguda, aunque se impone el acceso laparoscópico, han surgido nuevas técnicas invasivas y la cirugía ambulatoria. La antibioticoterapia es esencial y como tratamiento único tiene como objetivo disminuir los costos y la morbilidad asociada a la cirugía; por tanto, actualmente el tratamiento adecuado de esta enfermedad es controversial y dependerá de los protocolos de actuación establecidos, el estado del paciente y los recursos disponibles(AU)
ABSTRACT The objective of this work is to study in depth the different cognitive aspects about the new evidences concerning the treatment of acute appendicitis and to compare the results obtained with the different surgical techniques currently used and the conservative treatment. A bibliographic review was carried out and articles were chosen from the electronic sources Web of Science, Scielo, Elsevier, PubMed, Medline, and Google, published in this century in Spanish and in English. Appendectomy by laparotomy has always been the gold standard for the treatment of acute appendicitis. In 1982, laparoscopic access was introduced, which has proven safe and efficient as conventional access. In 2004, endoscopic surgery through natural orifices was used; in 2007, it was performed by a single port, and in 2015, through retrograde endoscopy. The evolution of the clinical picture is variable so strategies have been proposed such as ambulatory surgery, conservative treatment followed or not by interval surgery, in order to avoid unnecessary interventions with morbidity and mortality similar to those performed with urgency. Appendectomy by laparotomy or laparoscopy is still the golden standard of the treatment of acute appendicitis, although laparoscopic access is required, new invasive techniques and outpatient surgery have emerged. Antibiotic therapy is essential and, as a single treatment, aims to reduce costs and morbidity associated with surgery; therefore, the adequate treatment of this disease is currently controversial and will depend on the established protocols of action, patient condition, and the available resources(AU)
Subject(s)
Humans , Appendicitis/therapy , Natural Orifice Endoscopic Surgery/methods , Ambulatory Surgical Procedures/adverse effects , Laparotomy/methods , Review Literature as TopicABSTRACT
Objective To investigate the value of endoscopic retrograde appendicitis therapy ( ERAT) in the diagnosis and treatment of atypical acute appendicitis. Methods All the 48 patients suspected of atypical acute appendicitis in Jiangsu Province Hospital from January 2015 to December 2016 were randomly divided into ERAT group and conservative treatment group according to the treatment method. The final appendectomy rate of the two groups was analyzed. Results Only 17 of the 24 patients in the ERAT group received endoscopic treatment because of complex conditions or personal wishes, and 16 cases were diagnosed as acute appendicitis. Surgical resection was performed in 5 cases because of recurrence of the disease after ERAT, and the appendectomy rate was 31. 2％ ( 5/16 ) . In the conservative treatment group, all 24 patients were treated with antibiotics. Twenty of them underwent surgical resection with appendectomy rate of 83. 3％ ( 20/24) , and 1 of them had appendiceal perforation. The appendectomy rate of the ERAT group was significantly lower than that of the conservative treatment group (χ2=11. 111, P<0. 05) . Conclusion ERAT has a high diagnostic and therapeutic value for atypical acute appendicitis.
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Objective To study the skills and effects of endoscopic retrograde appendicitis therapy (ERAT) in treating patients with uncomplicated acute appendicitis .Methods We enrolled 21 patients with suspected acute appendicitis who then underwent emergent ERAT between October 2014 and January 2015 .The data of treatment were collected and the operative skills and effects of ERAT were analyzed . Results ERAT was completed successfully in all the patients ,resulting in a success rate of 100% .Mean operation time of ERAT was (49 .7 ± 18 .2) min and mean hospital stay was (3 .3 ± 1 .6)d .Cannulation of the appendix lumen was the most critical step of ERAT ,and cannulation time [(5 .7 ± 4 .9)min , P< 0 .05] was shortened significantly by the use of LoopTip guidewire . Fourteen patients with intraluminal appendicoliths (7 of massive appendicoliths , 4 of sand‐like appendicoliths and 3 of sand‐like appendicoliths with luminal stenosis ) underwent endoscopic lithotomy successfully with balloon or basket ,with the success rate of 100% .One patient who presented perforation after appendicolith removal by basket was cured with conservative treatment .Appendix stent was inserted ,then pulled out after 1 week in 9 patients ,while no complaint or complication of the stent was observed .Operation time of ERAT shortened with the increase of case number .Conclusion ERAT is an effective and safe therapy for treating patients with uncomplicated acute appendicitis .The high success rate and safety of ERAT will be achieved by selecting suitable instruments for cannulation and appendicolith removal ,deciding suitable indications for stenting ,and accumulating of operative cases .