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Objective:To retrospectively analyze the independent risk factors of complicated appendicitis(CA)in children under five years old and establish a clinical prediction model, and to evaluate the clinical application of this model.Methods:A retrospective analysis was performed on children under five years old who underwent appendectomy at Children′s Hospital of Shanghai Jiao Tong University School of Medicine from January 2018 to December 2021.The children were divided into CA group and uncomplicated appendicitis group according to whether there was sign of perforation or gangrene in appendiceal tissue after operation.The differences in clinical features and preoperative laboratory test results between two groups were compared.The independent risk factors of CA were identified and a clinical prediction model was established.The clinical prediction model was verified by receiver operating characteristic curve.Results:A total of 140 children were enrolled in this study, including 84 cases in the CA group and 56 cases in uncomplicated appendicitis group.Univariate and binary Logistic regression analysis showed that the duration of symptoms>23.5 h( OR=6.650, 95% CI 2.469-17.912, P<0.05), abdominal muscle tension( OR=3.082, 95% CI 1.190-7.979, P<0.05) and C-reactive protein>41 mg/L ( OR=3.287, 95% CI 1.274-8.480, P<0.05) were independent risk factors for CA( P<0.05). The clinical prediction model of CA was constructed by the above mentioned three independent risk factors.The area under the receiver operating characteristic curve of the clinical prediction model was 0.881(95% CI 0.825-0.936), the sensitivity was 77.4%, the specificity was 87.5%, the positive predictive value was 91.3% and the negative predictive value was 70.0%. Conclusion:Acute appendicitis in children under five years old is more likely to progress to CA if the duration of symptoms>23.5 h, the level of C-reactive protein is increased, and the abdominal muscle tension is accompanied.The clinical prediction model of CA constructed by common clinical information in pediatric clinics has good prediction efficiency, which provides a simple and feasible reference method for clinicians to distinguish CA from uncomplicated appendicitis.
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Background: Acute appendicitis is one of the most frequent surgical emergencies and is a common cause of non-traumatic acute abdominal emergencies that require surgical intervention. Most complicated appendicitis started de novo as simple appendicitis raising the notion that it is a disease in evolution that has become of clinical importance due to delayed or missed diagnosis. Complicated appendicitis has been associated with a significant risk of postoperative septic complications, including wound infections and intra-abdominal abscess formation. This study aimed to evaluate the types of complicated appendicitis and their relationship to patient's demographic data, postoperative course and the length of hospital stay in Al-Basra Teaching Hospital. Methods: This was a prospective clinical study involving patients with acute appendicitis admitted to Al-Basra Teaching Hospital from January 2017 to October 2019. The demographic data, types of complicated appendicitis, hospitalization duration, and postoperative complications were evaluated. The patients were divided into six groups according to age. All data were recorded and analyzed. Results: A total of 1210 patients, age from 6 to 69 years, mean age of patients was 23.45, males out-numbered females. Perforated appendicitis represents the main type of complicated appendicitis, and it was reported mostly among elderly patients. Patients with complicated appendicitis had a longer hospitalization and more postoperative complications than patients with non-complicated appendicitis. Conclusion: we concluded that nearly one third of the patients with acute appendicitis had complicated appendicitis, so they need a special pre and postoperative care and old age had non classical clinical picture with poor outcome.
Subject(s)
Humans , Appendicitis/complications , Postoperative Care , Postoperative Complications/prevention & control , General Surgery , Wound Infection/prevention & control , Prospective Studies , Abdominal Abscess/prevention & control , Delayed Diagnosis , Length of StayABSTRACT
Early diagnosis and treatment of acute appendicitis prevents development of markers that have been used to improve the diagnostic accuracy in appendicitis. The objective of this study was to assess the role of procalcitonin in the prediction of complications of appendicitis. METHODSA cross sectional study involving 110 patients diagnosed with acute appendicitis was conducted. After obtaining ethical clearance, informed written consent was obtained from the patients. Blood investigations such as total leucocyte counts, C reactive proteins and procalcitonin levels were done. Cases were categorized into uncomplicated appendicitis (n=67) and complicated appendicitis (n=43). Descriptive analysis, ROC analysis of predictive validity, and Shapiro Wilk test comparing all the three parameters in both the groups was done using IBM SPSS version 22. RESULTSThe mean age was 29.59 ± 9.17 years. 67 (60.91%) had uncomplicated appendicitis and 43 (39.09%) had complicated appendicitis. The WBC, hsCRP, serum procalcitonin percentile had good predictive validity in predicting score as indicated by the area under the curve (0.822). Serum procalcitonin value had a sensitivity of 97.67% in predicting the type of appendicitis and specificity of 94.03%. CONCLUSIONSSerum procalcitonin is a better biomarker than total leucocyte count and hs-C reactive protein in predicting complications of appendicitis and differentiating it from uncomplicated appendicitis.
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Background: Acute appendicitis in children is the most common surgical emergency. Good outcomes have been reported with laparoscopic appendectomy (LA) in children for uncomplicated appendicitis. But the use of laparoscopy for complicated appendicitis in children is more controversial. Higher incidences of postoperative abdominal and wound infections have been reported. The purpose of this study was to retrospectively compare LA and open appendectomy (OA) for complicated appendicitis in children.Methods: The outcome of 73 patients with complicated appendicitis was retrospectively analyzed. There were 36 children in the LA group and 37 in the OA group. Data collection included demographics, duration of symptoms, type of complicated appendicitis, operative time, resumption of diet, early and late complication, length of hospitalization and duration of antibiotic use.Results: No significant difference was found with respect to age, duration of symptoms and total leucocyte count between two groups. The operative time for LA (55.83±4.81 minutes for LA versus 67.16±4.27 minutes for OA; p=0.0001) was shorter. Patients in the LA group returned to oral intake earlier (2.83±0.31 days for LA versus 3.84±0.33 days for OA; p=0.001) and had a shorter length of hospital stay (5.11±0.55 days for LA versus 7.92±1.06 days for OA; p=0.0001). The incidence of wound infection in group LA was 5.5% compared to 18.9% in OA group.Conclusions: The laparoscopic technique for complicated appendicitis in children is feasible, safe. Laparoscopic appendectomy should be the initial procedure of choice for most cases of complicated appendicitis in children.
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Background: This study is conducted from November 2018 to November 2019 in this institute, where comparison of performance statistics is done between CT scan and Ultrasonography in patients with complicated appendicitis scheduled for conservative management, elective or emergency surgery. Aim of the study was to evaluate and compare the performance statistics of CT scan and Ultrasonography in complicated appendicitis.Methods: The CT scan or USG findings of 87 patients were reviewed. The patients were divided into two groups i.e. CT scan group (group-1/18 patients), USG group (group-2/69 patients). Satistical analysis Student”s t-test, Fischer”s test, p-value, k-value.Results: Clinical signs, CT findings, USG findings, complications at surgery and histological examinations were noted. 2, 3, 13, patients presenting with CT features and 5, 13, 51 patients presenting with USG features of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass respectively. No clinical signs showed a significant association with the presence of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass or the complication encountered at surgery.Conclusions: In this study, by comparing CT scan group and USG group in complicated acute appendicitis, CT scan can change the plan of management in doubtful cases, decrease length of hospital stay and expenses, reduce the complication rate and negative laparotomy rate, and reduce the episodes of conversion to open surgery.
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Background: A laparoscopic appendectomy (LA) was performed mostly on uncomplicated appendicitis due to opinions about its safety when it was first introduced. Nevertheless, there are still concerns about surgical difficulties in managing complicated appendicitis with laparoscopy, possible post-op complications and conversion to an open appendectomy (OA) during the surgery.Methods: The study consists of 30 patients who underwent laparoscopic appendectomy in department of General Surgery at Assiut University hospitals. The study population was enrolled after fulfilling the selection criteria from department of General Surgery. Informed consent was taken from all the patients who are involved in this study. Patients diagnosis was based on clinical findings, complete blood counts, and abdominal sonography.Results: Thirty patients underwent laparoscopic appendectomy for complicated appendicitis. Of the 30 patients, perforated appendix cases are 27, gangrenous appendix are 1, appendicular abscess only one case. Post operation wound infection, conversion rate and hospital stay rate very less.Conclusions: The present study proved that laparoscopic appendectomy is the best approach in complicated appendicitis.
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Objective To analyze the efficacy of umbilical one trocar laparoscopic appendectomy (UOTLA) in treatment of complicated appendicitis in children. Methods Clinical data of 78 cases of children patients with complicated appendicitis from January 2012 to October 2015 was summarized, including 44 cases as UOTLA group received umbilical one trocar laparoscopic appendectomy, 34 cases as OA group received open appendectomy. Then statistically analyzed all the patients' operation time, postoperative hospital stay, postoperative abdominal abscess, incision infection, early inflammatory intestinal obstruction and pain level. Results The laboratory test results of C reaction protein (CRP) had no significant difference between the two groups, while peripheral white blood cell count decreased more significantly in UOTLA group than that in OA group; the operation time of UOTLA group was shorter than that in OA group with no statistical difference [(66.59 ± 33.24) vs (72.86 ± 30.36) min, P > 0.05], but postoperative hospital stay was shorter [(8.21 ± 1.67) vs (9.21 ± 2.01) d, P 0.05); incision infection: 6 cases in UOTLA group, 9 cases in OA group (P > 0.05); early inflammatory intestinal obstruction: 1 cases in UOTLA group, 5 cases in OA group (P > 0.05); the pain level, postoperative recovery time was significantly shorter in UOTLA group compared with OA group (P 0.05]. Conclusion UOTLA is safe and effective for complicated appendicitis in children due to minimally invasive, less pain and faster recovery without significant increase in the cost and postoperative complications. It can be applied in children with purulent, perforated appendicitis and gangrene, perforated appendicitis and other complicated appendicitis.
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Objetivo: Evaluar las complicaciones en pacientes intervenidos por apendicitis complicada y manejados sin drenaje. Sede: Hospital General del Estado de Sonora ''Dr. Ernesto Ramos Bours'', México. Diseño: Estudio retrospectivo, transversal, descriptivo y observacional. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Se incluyeron 101 pacientes con diagnóstico postoperatorio de apendicitis aguda complicada, en 97 de ellos no fue colocado drenaje. Las variables a evaluar fueron complicaciones postoperatorias, así como el uso de antibióticos en todos los pacientes, y los resultados se confrontaron con lo publicado acerca de complicaciones postquirúrgicas por apendicitis complicada. Resultados: De los 97 manejados sin drenaje, 8 presentaron complicaciones (8.2%): fiebre en tres, seroma en uno, infección superficial del sitio quirúrgico en dos e infección profunda del sitio quirúrgico (formación de colecciones intraabdominales) en dos. Todos los pacientes respondieron a manejo terapéutico, sin reintervención. Conclusión: El porcentaje de complicación fue de 8.2%, menor a lo reportado en la literatura revisada.
Objective: To assess complications in patients subjected to surgery due to complicated appendicitis and managed without drainage. Setting: General Hospital of the State of Sonora ''Dr. Ernesto Ramos Bours'', Mexico. Design: Retrospective, cross-sectional, descriptive and observational study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: We included 101 patients with a diagnosis of acute complicated appendicitis; in 97 of them no drainage was used. Assessed variables were post-operative complications, as well as the use of antibiotics in all patients, and results were compared with the published literature on post-surgical complications due to complicated appendicitis. Results: Of the 97 patients, managed without drainage, eight presented complications (8.2%): fever in three, seroma in one, superficial infection at the surgical site in two, and deep infection at the surgical site (intra-abdominal collections) in two. All patients responded to therapeutic handling, without re-intervention. Conclusion: The complication rate was 8.2%, which is below that reported in the reviewed literature.
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PURPOSE: Due to coverage by the nationwide medical insurance system for laparoscopic appendectomy, the laparoscopic approach for complicated appendicitis has been widely performed in Korea. The aim of this study is to evaluate the surgical outcomes and cost effectiveness of laparoscopic appendectomy for complicated appendicitis. METHODS: This study included 33 patients who underwent the laparoscopic approach (LA) and 26 patients who underwent the open approach (OA) for the complicated appendicitis between March, 2005 and February, 2010. We compared the outcomes of the length of stay, the complications and the costs. RESULTS: The hospital stay was 4.9 days for LA and 6.2 days for OA. (p>0.05) The overall complication rates were 21% (7/33) for LA and 27% (7/26) for OA. (p>0.05) All the complications were managed conservatively and there was no mortality in either group. The total cost and the patient's charge was Won 3,390,421 and Won 1,574,093 for LA and Won 3,260,523 and Won 1,493,510 for OA, respectively (p>0.05). CONCLUSION: The laparoscopic approach is safe, efficacious and cost effective. It should be the initial procedure of choice for most cases of complicated appendicitis.
Subject(s)
Humans , Appendectomy , Appendicitis , Cost-Benefit Analysis , Fees and Charges , Insurance , Korea , Length of Stay , Retrospective StudiesABSTRACT
PURPOSE: Early detection of appendicitis has increased due to development of computed tomography and ultrasonography, yet we are frequently meeting complicated appendicitis, including perforation, abscess and a gangrenous appendicitis due to delayed diagnosis. For that reason, we want to evaluate predictive factors for the complicated appendicitis. METHODS: A total of 128 patients with appendicitis, after 13 patients with a duration of under 12 hours and 15 patients with pathological non-appendicitis were excluded from 156 patients, who visited Kwangju Christian Hospital from November 2008 to November 2010 were retrospectively reviewed. RESULTS: There were 62 patients (48.3%) with simple appendicitis and 66 patients (51.7%) with complicated appendicitis. In univariate analysis, age (P < 0.001), C-reactive protein (P < 0.001) and the diameter of the appendix (P = 0.006), were found to be significant. Multivariate analysis demonstrated that C-reactive protein was an independent predictor for complicated appendicitis (odds ratio, 1.371; 95% confidence interval, 1.155 to 1.628; P < 0.001). The cut-off value of C-reactive protein was set at 7.05 mg/dL by using receiver operating characteristic curve (0.805; sensitivity, 57.6%; specificity, 98.3%). CONCLUSION: This study suggests that if C-reactive protein is above 7.05 mg/dL, immediate and proper management should be performed due to a high probability of complicated appendicitis, especially in young children or elderly patients who frequently present with vague symptoms.
Subject(s)
Aged , Child , Humans , Abscess , Appendicitis , Appendix , C-Reactive Protein , Delayed Diagnosis , Multivariate Analysis , Retrospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
PURPOSE: Although laparoscopic appendectomies (LAs) are performed universally, a controversy still exists whether the LA is an appropriate surgical approach to complicated appendicitis (CA). We retrospectively evaluated the outcomes of laparoscopic versus open appendectomies for CA. METHODS: We retrospectively analyzed 60 consecutive patients who were diagnosed as having CA from July 2009 to January 2011. Outcomes such as operative time, time to soft diet, length of hospital stay, and postoperative complications were analyzed. RESULTS: There were no statistically significant differences in operative time between the LA and the open appendectomy (OA) groups. Return to soft diet was faster in the LA group (2.1 +/- 1.2 vs. 3.5 +/- 1.5 days; P = 0.001). Length of hospital stay was shorter for the LA group (4.4 +/- 2.3 vs. 5.8 +/- 2.9 days; P = 0.045). The overall complication rates showed no statistically significant difference between the two groups. In cases involving a periappendiceal abscess, the LA had a significantly higher incidence of intra-abdominal abscess (IAA) and postoperative ileus (PI; P = 0.028). CONCLUSION: The LA showed good results in terms of the time to soft diet, the length of hospital stay, and surgical site infection (SSI) whereas the overall complication rates were similar for the two groups. However, the LA was associated with significantly higher incidence of IAA and PI for the cases with a periappendiceal abscess. Therefore, when using a LA, the surgeon must take great care to minimize the incidence of IAA and PI if a periappendiceal abscess is present.
Subject(s)
Humans , Abdominal Abscess , Abscess , Appendectomy , Appendicitis , Diet , Ileus , Incidence , Length of Stay , Operative Time , Postoperative Complications , Retrospective StudiesABSTRACT
PURPOSE: Laparoscopic appendectomy has many benefits compared to the open technique, such as easy localization of the appendix, less scarring for cosmetic reasons and less reported wound infection. However, for patients with complicated appendicitis, controversy exists as to whether laparoscopic appendectomy is a safe procedure. Some recent studies have reported no significant difference of the complication rate compared to that of the open procedure, suggesting that laparoscopic appendectomy could be used as an alternative procedure. This study was performed to evaluate the safety and benefits of laparoscopic appendectomy as compared to that of the open technique for treating complicated and uncomplicated appendicitis. METHODS: We studied the patients who underwent appendectomy by either the laparoscopic or open technique at Bundang Jaesaeang General Hospital between January 2005 and September 2008. Of the total 2,226 patients, there were 168 patients in the laparoscopic appendectomy (LA) group and 2,058 patients in the open appendectomy (OA) group. We compared the patient demographic data and perioperative outcomes of the two groups. RESULTS: Both patient groups were comparable in terms of age. The mean operative time was 91.8 minutes in the LA group and 47.2 minutes in the OA group (p<0.00). There were no significant differences between the two groups in terms of the mean hospital stay. The noncomplicated appendicitis LA group showed a quicker time to start an oral diet (p=0.03) & wound infection (p=0.032). For complicated appendicitis, there were no differences of wound infection & intestinal obstruction between the two groups. CONCLUSION: Although laparoscopic appendectomies requires a longer operation time, it did not lengthen the hospital stay nor delay the start of a soft oral diet. Appendiceal abscess in complicated appendicitis did not occur in the laparoscopic or open appendectomy groups. Therefore, laparoscopic appendectomy is a safe procedure for both complicated and uncomplicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.
Subject(s)
Humans , Abscess , Appendectomy , Appendicitis , Appendix , Cicatrix , Consensus , Cosmetics , Diet , Hospitals, General , Intestinal Obstruction , Length of Stay , Operative Time , Postoperative Complications , Wound InfectionABSTRACT
PURPOSE: Laparoscopic appendectomy (LA) is now widely practiced in most medical centers, yet there is no consensus regarding the indications and advantages of LA over the conventional technique. Various reports have demonstrated conflicting results about the merit of LA. Especially, complicated appendicitis was initially considered as a contraindication for LA. However, with the improvements of laparoscopic instruments and the technical proficiency, the choice of the operative approach mostly depends on the surgeon's experience or the patient's preference. Here we compared the outcome of LA versus open appendectomy (OA) overall and specifically in the patients with complicated appendicitis. METHODS: From January 2007 to December 2007, the records of 495 patients with the diagnosis of appendicitis were retrieved from the computer database for analysis. All the patients had given informed consent for LA or the OA technique and the patients chose the operative method. The two groups were compared with respect to the patients' demographic data, the clinical outcomes, the cost and the type of pathology RESULTS: During the study period, 195 patients (39.4%) underwent LA and 300 patients (60.6%) underwent OA. There were 53 cases (27.1%) of complicated appendicitis and 105 cases each (35%) in the LA and OA groups, respectively. The patients of the LA group revealed a significant female prevalence, a shorter hospital stay, less use of analgesics, a lower complication rate and a higher cost (p<0.005), and also a comparable operation time to the OA group. As for the complicated appendicitis, there was benefit for only the hospital stay. CONCLUSION: Usually LA has more advantage than OA except cost. Even in complicated appendicitis, LA is feasible without increase of complication.
Subject(s)
Female , Humans , Analgesics , Appendectomy , Appendicitis , Consensus , Imidazoles , Informed Consent , Length of Stay , Nitro Compounds , PrevalenceABSTRACT
PURPOSE: We performed a study comparing the morbidity of laparoscopic and open appendectomy to assess whether laparoscopic appendectomy could be an initial procedure of choice for patients suffering with complicated appendicitis (gangrene, perforation and periappendiceal abscess). METHODS: We studied the patients who underwent appendectomy by either a laparoscopic or an open technique at Chungnam National University Hospital between January 2003 and July 2006. There were 118 patients in the laparoscopic appendectomy (LA) group and 232 patients in the open appendectomy (OA) group. RESULTS: The operating times and length of hospital stay were significantly shorter for the LA group than for the OA group (P 72 hours) and small bowel obstruction. Complications were less frequent after LA compared with OA (10.2 % vs 23.7 %, respectively)(P = 0.01). There were less wound infections in the LA group than in the OA group (8.5% vs 14.2%, respectively)(P=0.02), and all the complications were minor compared with that for the OA group. A postoperative intraabdominal abscess developed in one patient in the OA group, but this didn't occur in the LA group. There were no serious complications requiring readmission or reoperation in the LA group. CONCLUSION: LA showed a significant benefit over OA in this study. The findings suggest that LA could be a safe primary choice for treating complicated appendicitis. To reach a final consensus on the scope of this study, a prospective randomized controlled study is needed in the near future.
Subject(s)
Humans , Abscess , Appendectomy , Appendicitis , Consensus , Ileus , Length of Stay , Postoperative Complications , Reoperation , Wound InfectionABSTRACT
BACKGROUND: For complicated appendicitis, in contrast to simple appendicitis, laparoscopic appendectomy (LA) is considered a relative or absolute contraindication because of the higher postoperative complication rate than that of open appendectomy (OA), especially, high incidence of intra-abdominal abscess. The purpose of this article is to assess the feasibility of LA for complicated appendicitis. METHODS: A retrospective review of 35 LA and 128 OA for the cases of gangrenous, perforated appendicitis, and periappendiceal abscess between May 1995 and June 1997 was performed. Patients were identified through the hospital pathology registry. We compared data from both groups with respect to operative times, postoperative pain, duration of ileus, length of hospital stay, and complication rate, with special attention to the incidence of intra-abdominal abscess. RESULTS: 1) The male:female ratio of LA (1:1.2) was significantly lower than that of OA (1:0.45) (p0.05). But LA was associated with higher incidence of postoperative intra-abdominal abscess (3/35, 8.6%) than OA (3/128, 2.3%) (p=0.114). There was one serious intra-abdominal abscess in the LA, which required reoperation. The rest 2 cases in the LA and all 3 cases in the OA were treated conservatively. CONCLUSIONS: LA for complicated appendicitis could afford the merits of shorter hospital stay, reduced incidenceof wound infection, and comparable incidence of overall complication rate. To reduce the incidence of postoperative intra-abdominal abscess, copious irrigation and adequate drainage should be recommended.