Hyperbilirubinemia as a diagnostic tool in patients with perforated appendicitis: a prospective study

Background: This study was conducted to determine the effectiveness of hyperbililrubinemia as diagnostic tool to predict perforated appendicitis.Methods: Patients presenting to department of general surgery of SS Medical College and Hospital during the period from June 2017 to June 2019 with features of appendicitis and liver function tests on admission undergoing laparoscopic or open appendectomy were included in this study. Age, duration of symptoms, temperature, white blood cell counts, bilirubin levels and histological data were collected. Culture and sensitivity of peritoneal fluid was done. Patients were grouped according to histological examination of appendectomy specimens and comparison was made between the groups.Results: The mean bilirubin level of all patients was 0.95 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.8 mg/dl and o.5 mg/dl, p<0.001). Hyperbilirubinaemia had a specificity of 88% and a positive predictive value of 88.89% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 70%.Conclusions: patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels. Hyperbilirubinemia alone is not a strong enough predictor, but might be more useful when integrated into a scoring system.

A Cross-Sectional Study of Neutrophilto- Lymphocyte Ratio in Diagnosing Acute Appendicitis in Hospital Melaka

@#Background: Acute appendicitis is one of the most common surgical emergencies. However, its proper diagnosis is complicated. This study aims to evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to diagnose acute appendicitis in pre-operative state. Methods: Histopathological examination of appendicectomies conducted between 2016 and 2017 in Melaka Hospital, Malaysia were traced and categorised into three groups: i) G1 (normal appendix), ii) G2 (acute appendicitis) and iii) G3 (perforated appendicitis). The reports were randomised and a total of 338 samples were collected. NLR values were compared between the three different groups and analysed. Results: The median values of NLR for G1, G2 and G3 were 2.37, 5.25 and 9.27, respectively. We found a statistically significant difference in NLR between G1 and G2 (P < 0.001), and G2 and G3 (P < 0.001). The diagnostic values of NLR for acute appendicitis and perforated appendicitis were 3.11 (sensitivity: 75.23%, specificity: 68.70%) and 6.17 (sensitivity: 76.32%, specificity: 58.72%), respectively. There was a substantial correlation between NLR and disease severity, and a moderate correlation between NLR and duration of admission. Conclusion: NLR, with a sensitivity of 75.23% and specificity of 68.70%, is a useful and reliable adjunct in diagnosing acute appendicitis. Hence, it will help in reducing the rate of negative appendicectomies.

Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis

PURPOSE: A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy. METHODS: A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review. RESULTS: Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases. CONCLUSION: Patients older than 45 years old with a CT radiologist's read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.

Frequency of wound infection in non-perforated appendicitis with use of single dose pre-operative antibiotics

Background: Antibiotics are used both pre and post operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of postoperative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. Aim: The aim of this study was to see the frequency of wound infection with the single dose preoperative antibiotics. Materials and methods: Present observational study was conducted at Department of General Surgery, Govt. Stanley Medical College and Hospital for period of one year. A total of 100 patients with non-perforated appendicitis were followed for wound infection till 8th postoperative day. Results: 100 patients, 64 male and 36 female were included in this study. In entire series, 6 patients were developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic single dose antibiotic is efficacious in 94% patients. Conclusion: Single dose pre-operative antibiotics were found to be effective in controlling postoperative wound infection without the need of extending antibiotics to post-operative period in cases of non-perforated appendicitis.

An unexpected gangrenous duplication of ileum

Alimentary tract duplication is a rare congenital anomaly which may involve any part of the alimentary tract extending from stomach to rectum. Clinical presentation may mimic an inflamed appendix as described in this case. A 9-year-old boy with a clinical diagnosis of perforated appendix was noted to have a normal appendix intra-operatively. On further search for an underlying pathology, a gangrenous ileal duplication was discovered. En-bloc resection with primary bowel anastomosis was done. Histopathology report revealed a gangrenous small bowel duplication. We discuss the preoperative diagnostic dilemma and management options in approaching this rare entity.

High white blood cell count and erythrocyte sedimentation rate are associated with perforated appendicitis in children

PURPOSE: To investigate the predictors of perforated appendicitis (PA) in pediatric patients with appendicitis seen in the emergency department. METHODS: We retrospectively reviewed 564 pediatric patients ( 13.5 × 109/L (odds ratio [OR], 3.27; confidence interval [CI], 1.49–7.18; P = 0.003) and ESR > 15 mm/h (OR, 3.18; 95% CI, 2.13–4.74; P < 0.001) are independent predictors of PA. CONCLUSION: WBC count and ESR might be better predictors of PA in pediatric patients with appendicitis in the emergency department than the Alvarado score and CRP concentration.

HYPERBILIRUBINEMIA MIGHT BE A MARKER OF GANGRENOUS/PERFORATED APPENDICITIS: A RETROSPECTIVE STUDY / Мэс засал

Introduction: Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum total bilirubin may be a useful marker for appendiceal perforation. The aim of this study was to determine and compare pre-operative total bilirubin level and other diagnostic tools (patient age, duration of symptoms, Alvarado score, white blood cell, C-reactive protein, ultrasound and contrast enchanced CT scan) in cases of acute appendicitis in order to improve the clinical decision making. Materialsand methods: We identified 102 patient with acute appendicitis after excluding those with other causes of hyperbilirubinemia among the 180 patients that underwent a laparoscopic or an open appendectomy from June, 2011 to March, 2015 in UB Songdo Private Hospital. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and postoperatively by histopathological examination. According to histological results, these cases were classified two groups: positive(acute appendicitis with perforation and/or gangrene) and negative(acute appendicitis without perforation or gangrene). Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using independent sample t test, Chi square test, and direct logistic regression. The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly increased(1,5mg/dL) in case of negative group and much higher (3,6mg/dL) in cases of positive group (P <0.001). The level of total bilirubin was higher than 3 mg/dL in cases of gangrenous/ perforated appendicitis while in cases with acute appendicitis it was lower than 3 mg/ dL. Also Alvarado score (P <0.01), C-reactive protein (P <0.001) and contrast enchanced CT scan (P <0.05) were statistically significant diagnostic tools for acute appendicitis. Conclusion: Assessment of preoperative total bilirubin is useful for the differential diagnosis of gangrenous/perforated appendicitis.

HYPERBILIRUBINEMIA MIGHT BE A MARKER OF GANGRENOUS/PERFORATED APPENDICITIS: A RETROSPECTIVE STUDY / Мэс засал

Introduction: Delayed or wrong diagnosisin patients with appendicitis can result inperforation and consequently increasedmorbidity and mortality. Serum total bilirubinmay be a useful marker for appendicealperforation. The aim of this study wasto determine and compare pre-operativetotal bilirubin level and other diagnostictools (patient age, duration of symptoms,Alvarado score, white blood cell, C-reactiveprotein, ultrasound and contrast enchancedCT scan) in cases of acute appendicitis inorder to improve the clinical decision making.Materialsand methods: We identified102 patient with acute appendicitis afterexcluding those with other causes ofhyperbilirubinemia among the 180 patientsthat underwent a laparoscopic or an openappendectomy from June, 2011 to March,2015 in UB Songdo Private Hospital.These cases were also subjected toliver function tests and clinical diagnosiswas confirmed perioperatively and postoperativelyby histopathological examination.According to histological results, these caseswere classified two groups: positive(acuteappendicitis with perforation and/organgrene) and negative(acute appendicitiswithout perforation or gangrene). Theirclinical and investigative data were compiledand analyzed. Statistical analysis wasperformed using independent sample t test,Chi square test, and direct logistic regression.The level of significance was set at P< 0.05.Results: Serum total bilirubin was foundto be significantly increased(1,5mg/dL) incase of negative group and much higher(3,6mg/dL) in cases of positive group (P<0.001). The level of total bilirubin washigher than 3 mg/dL in cases of gangrenous/perforated appendicitis while in cases withacute appendicitis it was lower than 3 mg/dL. Also Alvarado score (P <0.01), C-reactiveprotein (P <0.001) and contrast enchanced CTscan (P <0.05) were statistically significantdiagnostic tools for acute appendicitis.Conclusion: Assessment of preoperativetotal bilirubin is useful for the differentialdiagnosis of gangrenous/perforatedappendicitis.

Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess

PURPOSE: Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port. METHODS: The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016. RESULTS: Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5-14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30-155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0-3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0-5 days) and 3 days (1-7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection. CONCLUSION: Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.

Comparative Analysis of Laparoscopic Versus Open Appendectomy for Perforated Appendicitis in Children Under 12 Years Old at a Single Institute

PURPOSE: The purpose of this study is to evaluate the outcome of laparoscopic (LA) vs. open appendectomy (OA) in children under 12 years old with perforated appendicitis. METHODS: We reviewed the medical files of 156 children who underwent LA (n=96), OA (n=59), and conversion (CO) (n=1), and compared duration of operation, length of hospital stay, incidence of wound infection, mechanical ileus, intra-abdominal abscess (IAA), and re-admission. RESULTS: Compared to OA, LA resulted in longer duration of operation (58.32+/-17.105 min vs. 44.27+/-18.735 min; p=0.001), but fewer wound infections (2.1% vs. 10.2%; p=0.054), and fewer cases of mechanical ileus (0% vs. 5.1%; p=0.053). No differences in the length of hospital stay (5.85+/-1.824 days vs. 6.10+/-3.027 days; p=0.526), IAA (2.1% vs. 1.7%; p=1.000), or re-admissions (2.1% vs. 5.1%; p=0.369) were observed. CONCLUSION: We report that although LA showed an association with longer duration of operation compared to OA, it is superior to OA with regard to incidence of wound infection and mechanical ileus.

Factores de riesgo asociados a la apendicitis aguda perforada

Objetivo: Determinar los factores de riesgo asociados a la apendicitis aguda perforada en el Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) Materiales y métodos: Estudio de casos (apendicitis perforada) y controles (apendicitis flegmonosas) pareados 1:2 de febrero 2003 a enero 2009 en el HEPOTH. Se analizaron 7 variables con la t de Student y 4 cualitativas con el x2 corregido de McNemar. Resultados: Se obtuvieron 107 casos y 178 controles. El sexo, la edad promedio de intervención y el peso promedio no fueron significativamente distintos. La mayoría de los sujetos procedía de la provincia de Panamá. El tiempo de intervención fue la variable con mayor fuerza de asociación ( 66.5 vs 34.2 horas ; p<.001; IC 95% 21.0-46.0) aunque también resultaron estadisticamente significativos el percentil del peso para la edad ( p=.048), los leucocitos preoperatorios (p=.027), los neutrófilos preoperatorios (p=.010), la historia de vómitos (p<.0001), de diarrea (p<.0001) para a perforación apendicular. La temperatura preparatoria promedio fue significativamente distinta en ambos grupos (p<.001) pero clínicamente no relevante (37.8 vs 37.2ºC). El uso de antibióticos preoperatorios resultó ser un factor protector (p<0.0001); OR 0.31; IC 95% 0.20-0.47). Conclusiones: El tiempo de intervención desde el primer síntoma es el principal factor de riesgo para la perforación apendicular. Algunos otros criterios clínicos y paraclínicos también deben tomarse en consideración para el diagnóstico y el tratamiento oportuno. El uso preoperatorio de antimicrobianos profilácticos y analgésicos puede mejorar los resultados y la condición del paciente pediátrico con apendicitis aguda.

Aim: To determine the risk factors associated with perforated acute appendicitis at the Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" (HEPOTH) Materials and methods: Matched 1:2 cases control study ( perforated vs flegmonous) from February 2003 to January 2009 at the HEPOTH. Seven quantitative variables were analyzed with Student t and 4 qualitatives variables were analyzed McNemar ´s corrected x2. Results: One hundred and seven cases and 178 controls were obtained.Gender, mean intervention age, and mean weight were not significantly different . Most of the subjects came from the province of Panama. Time until intervention was the variable with the most association strength ( 66.5 vs 34.2 hours ; p<.001; IC 95% 21.0-46.0) even though weight for age percentile ( p=.048), preoperatory leucocytes (p=.027), preoperatory neutrophils (p=.010), and the history of vomits (p<.0001), and diarrhea(p<.0001) also resulted statistically significant for appendices perforation. Mean preparatory temperature was significantly different (p<.001) but not clinically relevant (37.8 vs 37.2ºC) between both groups. The use of preparatory antibiotics turned out to be a protection factor (p<0.0001); OR 0.31; IC 95% 0.20-0.47). Conclusions: Time until intervention since the first symptoms is the main risk factor for appendiceal perforation. Some other clinical and paraclinical criteria must also be taken into account for a timely diagnosis and treatment. Preoperatory use of prophylactic antimicrobial and analgesics can improve the results and the condition of the pediatric patient with acute appendicitis.

Advantage of Laparoscopic Appendectomy for Perforated Appendicitis / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy (LA) is currently more popular than an open appendectomy (OA), because of its advantages, such as a decrease in postoperative pain, short hospitalization and quick recovery. On the other hand, the efficacy and safety of a laparoscopic appendectomy for complicated appendicitis is controversial. Therefore, this study compared the efficacy and safety of LA and OA. METHODS: This study reviewed retrospectively 262 patients with perforated appendicitis who underwent ether open or laparoscoic appendectomy between January 2001 and December 2010. The medical record and video were used to collect data. The operative time, length of hospital stay, time to diet, time to remove drain and complications were assessed. RESULTS: There were 207 and 55 patients in the OA and LA group, respectively. The operation times were significantly longer in the LA group than the OA group (OA group 68.25+/-33.08 vs. LA group 90.80+/-47.64 min) (p<0.05). The length of hospital stay was longer in the OA group than the LA group (OA group 10.96+/-5.24 vs. LA group 8.86+/-5.18 days) (p<0.05). The time to diet and time to remove the drain was longer in the OA group than the LA group (p<0.05). The postoperative complication rate was similar in the two groups. CONCLUSION: The operative time was longer in the LA group but the length of hospital stay, time to diet, and time to remove drain was longer in the OA group. Such merits show that laparoscopic appendectomy is a good surgical option for perforated appendicitis.

Laparoscopic Versus Open Appendectomy for Simple and Perforated Appendicitis in Children / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy is a popular surgical treatment of choice for children with appendicitis. This study compared laparoscopic appendectomy (LA) with an open appendectomy (OA) in children with simple appendicitis (SA) and perforated appendicitis (PA) to confirm the safety and effectiveness of the laparoscopic procedure. METHODS: A retrospective medical record review was performed on 193 patients who underwent an appendectomy at our institution from January, 2008 to August, 2011. The demographic properties and postoperative factors including complications were assessed. RESULTS: Among 140 SA, there were 81 and 59 cases of OA and LA, respectively. In SA, the time to bowel movement in LA was shorter than OA (0.9 vs. 1.2 days, p=0.0005) and the number of times analgesics were used in LA were significantly lower than OA (1.8 vs. 2.5, p=0.027). Of 53 PA, 30 cases received OA whereas 23 cases underwent LA. In patients with PA, the LA group were older (124.0 vs. 98.8 months, p=0.027) with a longer operative time (93.5 vs. 68.2 minutes, p=0.02). On the other hand, the time to diet was faster in LA (1.8 vs. 3.2 days, p=0.02). In both SA and PA, there were no significant differences between OA and LA with respect to gender, hospital stay, drain insertion, duration of antibiotics usage, and complications. In SA, the LA group had fewer complications than the OA group with borderline significance. CONCLUSION: LA is a safe and effective way to treat SA and PA in children.

Optimal Time for Appendectomy in Perforated Appendicitis of Children

PURPOSE: It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients. METHODS: Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay. RESULTS: During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5degrees C at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course. CONCLUSION: For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.

Hiperbilirrubinemia en apendicitis: es un factor predictivo de perforación / Hyperbilirubinemia in appendicitis: is a predictive factor of perforation

Background: An elevated total bilirubin level can be a marker for perforated appendicitis. Aim: To assess and compare the predictive value of total bilirubin, C-reactive protein (CRP), white-blood cell count, the lapse of symptoms evolution, and systemic inflammatory response syndrome (SIRS) for the diagnosis of perforated appendicitis. Material and Methods: Prospective study of 134 consecutive patients aged 33 +/- 16 years (63 males) operated for acute appendicitis of whom 49 had a perforated appendix. A preoperative blood sample was obtained to measure total bilirubin, C reactive protein and complete blood count. A systemic inflammatory response score was calculated. Results: The lapse of symptoms before operation was higher in patients with perforated appendicitis compared with their counterparts without perforation (105.2 +/- 79.3 and 38.6 +/- 17.5 hours respectively). C reactive protein values were 176 +/- 82.6 and 80 +/- 76 mg/1 respectively, (p = 0.01). Serum bilirubin values were 0.7 +/- 0.3 and 1.0 +/- 0.5 mg/dl, respectively (p = 0.05). Sixty five percent of patients with perforated appendicitis had a SIRS score between 3 and 4 points. A C reactive protein over 76.7 mg/1, a lapse of symptoms over 34.5 hours and a SIRS score of three or more had the best performance for the prediction of perforated appendicitis. Conclusions: The diagnosis of perforated appendicitis may be suspected based on CRP, SIRS, and the lapse of symptoms before operation. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

Introducción: Se ha propuesto a la hiperbilirrubinemia como un marcador específico de apendicitis perforada. El objetivo del presente estudio es el de comparar el rendimiento para la predicción de perforación de la bilirrubina total (BT) y la proteína C reactiva (PCR), leucocitosis, el tiempo de evolución del cuadro clínico y el síndrome de respuesta inflamatoria sistémica (SIRS). Métodos: Se diseñó un estudio prospectivo y observacional, en el que se aplican curvas Receiver Operating Characteristics para comparar la sensibilidad y especificidad de las variables investigadas, se determinaron los mejores puntos de corte con la mejor sensibilidad y especificidad. Resultados: El período de tiempo de evolución del cuadro clínico se encontraba prolongado en los pacientes con apendicitis perforada (105,2 +/- 79,3 h y 38,6 +/- 17,5 h) y los niveles de PCR se encontraban muy elevados (176 +/- 82,6 mg/1 y 80 +/- 76 mg/1). La mayoría de los pacientes con apendicitis perforada tuvieron una puntuación SIRS entre 3 y 4 puntos. El valor de la PCR mayor a 76,7 mg/1, el tiempo de evolución de los síntomas mayor a 34,5 h y una puntuación SIRS de 3 puntos o más obtuvieron los mejores puntos de corte con el mejor rendimiento para la predicción de apendicitis perforada. Conclusiones: El diagnóstico de apendicitis perforada puede sospecharse cuando la PCR, SIRS y el período de tiempo de evolución del cuadro clínico están elevados. No recomendamos la medición de la BT como factor predictivo de perforación en pacientes con apendicitis.

A Case of Left Ureteral Obstruction due to Acute Appendicitis / 영남의대학술지

Appendicitis is a common cause of acute abdomen in pediatrics. Periappendiceal abscesses are frequently found in the pediatric population. Acute appendicitis in children can, at times, be a difficult clinical diagnosis because of its highly variable history? and physical manifestations and its unpredictable course. Despite the uncertainty of the diagnosis, appendicitis demands prompt treatment because of the risk of perforation, which occurs in approximately one third of cases. Urological manifestations of appendicitis and appendiceal abscess can vary. Acute appendicitis presenting with ureteral stenosis and hydronephrosis is very rare. Here, we report a case of acute appendicitis with perforation and left hydronephrosis in a 3-year-old female. This case presents a 3-year-old girl with dysuria having hydronephrosis that originated from a perforated appendix.

Laparoscopic Appendectomy in Children with Perforated Appendicitis

PURPOSE: It is controversial to do laparoscopic appendectomy in children with perforated appendicitis. Recently, we have adopted laparoscopic appendectomy as a first-choice method in children with perforated appendicitis. We investigate the results of laparoscopic appendectomy in perforated appendicitis and compare it with open technique. METHODS: We studied retrospectively the patients who underwent the appendectomy by either a laparoscopic or open technique for perforated appendicitis between January 2001 and December 2005. There were 117 patients in the open appendectomy (OA) group and 45 patients in the laparoscopic (LA) group. RESULTS: The operation times were significantly longer for the LA group than for the OA group (OA group 76.3+/-23.7 vs. LA group 95.4+/-32.4 min) (P0.05) and in the rate of complications (OA group: 36/117 vs. LA group: 13/45) (P>0.05) between the two groups. The incidence of postoperative ileus, intraabdominal abscess and wound infection was lower in LA group, but not significantly. CONCLUSION: Operation times and hospital days were longer in the LA group. But the incidence of complication was similar between the two groups. Considering little postoperative scar and less pain, laparoscopic appendectomy could be regarded as the optimal surgical therapy in children with perforated appendicitis.

Laparoscopic Versus Open Appendectomy for Perforated Appendicitis in Children

PURPOSE: Appendectomy is the most common emergent surgical operation in children. Laparoscopic appendectomy is currently a popular procedure in children, but pediatric laparoscopic appendectomy is controversial for its efficacy and safety, especially for perforated appendicitis. We compared the efficacy and safety between laparoscopic appendectomy (LA) and open appendectomy (OA) for treating perforated appendicitis of children. METHODS: This study involved a total of 69 patients who underwent appendectomy for perforated appendicitis at our institution between March 2005 and September 2007, and these patients were less than 15 years old. There were 41 patients in the LA group and 28 patients in the OA group. The demographic data, operative time, length of the hospital stay, bowel movement, pain control and complications were assessed. RESULTS: There was no significant difference between the LA and OA groups with respect to gender, age, the operation time, the length of the hospital stay, bowel movement and pain control. There was one complication (2.4%) in the LA group and four complications (16.6%) in the OA group, but there was no significant difference (P=0.062). There was no wound infection. CONCLUSION: Laparoscopic appendectomy for the children with perforated appendicitis is a safe procedure. Yet we need further high quality randomized trials to compare the 2 techniques.

Comparison of Laparoscopic and Open Appendectomies for Perforated Appendicitis / 中国微创外科杂志

Objective To compare the efficacy of laparoscopic appendectomy(LA) and open appendectomy(OA) for perforated appendicitis.Methods From January 2002 to December 2005,40 patients with perforated appendicitis were treated at Xuanwu Hospital,20 of them received LA,and the others underwent OA.The clinical data of the patients were retrospectively analyzed.Results The operative time in the LA group was significantly longer than that in the OA group [(75.8?11.6) min vs(54.8?9.5) min,t=6.264,P=0.000)].And the patients in the LA group returned to oral intake earlier than those in the OA group [(1.8?0.5) d vs(2.6?0.5) d,t=-5.060,P=0.000].Moreover,the periods of antibiotic use and hospital stay in the LA group were significantly shorter than those in the OA group [(3.8?0.7) d vs(6.3?1.2) d,t=-8.048,P=0.000;and(5.8?1.1) d vs(11.6?1.6) d,t=-13.359,P=0.000].Although 3 patients had incision infection in the OA group,while none of the LA group had such a complication,no significant difference was detected in the complication rate between the two groups(Fisher's exact test,P=0.115).Conclusions Laparoscopic appendectomy is superior to open surgery for perforated appendicitis because of its advantages of quick recovery,short hospitalization,less antibiotic use,and minimal invasion.LA is a safe,effective,and feasible procedure for perforated appendicitis.

Idiopathic Perforated Cecitis Mistaken as Perforated Appendicitis

The cecal perforation is very rare in pediatrics. Our center has experienced a 7-year-old girl with idiopathic perforated cecitis. The surgeon couldn't differentiate perforated cecitis from perforated appendicitis because of anatomical location, incidence and ambiguous radiologic result when this patient was admitted to our clinic due to RLQ pain.