The use of monopolar diathermy in laparoscopic appendectomy, Is it really safe?

Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors

Appendicular peritonitis as a variant of Crohn's disease manifestation in children recovered from a novel coronavirus infection COVID-19.

Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Acute appendicitis

Acute appendicitis is inflammation of the vermiform appendix. It is the commonest general surgical emergency in children and young adults, yet its diagnosis can still confound even the most skilled surgeon due to its highly variable presentation of appendicitis, with fewer than 50% of patients exhibiting classical features. Taking a detailed history and performing a careful examination remains the cornerstone of diagnosis. Urinalysis and blood tests, particularly C-reactive protein, are useful adjuncts and are performed routinely. Radiological imaging, commonly ultrasound and computed tomography scans, also have a role when the diagnosis is unclear and/or other common conditions need to be excluded, such as gynaecological pathology in young females. Nevertheless 20% of appendices removed in UK are histologically normal. Appendicitis scoring systems may further assist in stratifying risk and increasing the accuracy of diagnosis. Recently, there has been growing interest in non-surgical management of appendicitis, particularly during the COVID-19 pandemic. Antibiotics alone have been used to successfully treat uncomplicated appendicitis (without perforation, abscess or gangrene) in the short-term, however nearly 40% of these cases eventually require appendicectomy. Surgery, usually laparoscopic appendicectomy, remains the treatment of choice for acute appendicitis and non-operative management is reserved for specific cases.Copyright © 2023

Appendicular peritonitis as a variant of Crohn's disease manifestation in children recovered from a novel coronavirus infection COVID-19.

Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Appendicular peritonitis as a variant of Crohn's disease manifestation in children recovered from a novel coronavirus infection COVID-19.

Immune changes arising against the background of COVID-19 can lead to the manifestation of autoimmune diseases and provoke the development of Crohn's disease. In the presented work, we describe two clinical cases of manifestation of Crohn's disease in children after suffering a novel coronavirus infection COVID-19. Moreover, the variant of manifestation in both cases was spilled purulent appendicular peritonitis. In the first case, the child underwent a traditional appendectomy and abdominal sanitation. However, the choice of traditional appendectomy in this version of the pathological process led to severe consequences for the patient (a complicated postoperative period and multiple surgical interventions), including for the formed intraperitoneal abscesses and intestinal fistula, which is most characteristic of Crohn's disease. Therefore, the patient was diagnosed with Crohn's disease only after numerous operations. Regarding the second case, the situation was completely different, despite the obvious manifestations of ARVI (sore throat, fever), which led to the belated diagnosis of appendicitis in this child. Laparoscopic appendectomy and simultaneous adequate abdominal sanitation made it possible to avoid repeated surgical interventions in this case. In both cases, patients at the diagnosis were sent to federal clinics to select specific therapy. In our opinion, it is worth paying close attention to pediatric patients with a novel coronavirus infection and abdominal pain syndrome since this may be onset of inflammatory bowel disease.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Early intraabdominal complications after laparoscopic appendectomy: the status quo and the prospects for prevention

Acute appendicitis (AA) is the most common cause of acute surgical abdominal pain in patients all over the world. Appendectomy (AE) is still associated with relatively high risk of surgical site infection (SSI), regardless of surgical technique and approach, de-spite decades of practice. The incidence of SSI is 7% overall, ranging from 0 to 37.4%. According to various authors, SSI risk factors can be: conversion, experience of the surgeon, the type of inflammation of the process and the timing of the disease, the severity of systemic inflammation, operations at night, some signs according to CT, the features of surgical technique, and even COVID-19. But neither of authors point the laparoscopic approach as an independent risk factor for SSI, however, some of them was hypothesized that carboxyperitoneum and thermal exposure of surgical energy can damage the mesothelium and promote the translocation of microorganisms. Modern methods for diagnosing and assessing SSI after AE are also considered in this re-view: computed and magnetic-resonance imaging, as well as ultrasound diagnostics also with elastography. Thoroughly adher-ence to international guidelines for the prevention of SSI can reduce it incidence, however world experience shows that the list of measures to reduce the risk of SSI development is not limited to this. The surgical community is off to develop clear guidelines for the prevention of early SSI after AE. © 2022, Media Sphera Publishing Group. All rights reserved.

Management of Acute Appendicitis during Covid Pandemic-What Did We Learn

Aim: During the COVID-19 pandemic, UK intercollegiate guidelines shifted to favour non-operative approach and open surgical approach when required in the management of acute appendicitis. The aim of this study was to assess diagnostic and management approaches during the COVID-19 peak and post-peak period and further evaluate short term patient outcomes. Method(s): A retrospective observational study was performed which included all patients with a clinical or radiological diagnosis of acute appendicitis during peak of COVID-19 (01/04/2020-30/ 06/2020) and post-peak (01/07/2020-30/ 09/2020). Patient demographics, clinical presentation, investigative findings, management approach and clinical outcomes were recorded by two observers. Result(s): Sample consisted of 188 patents (COVID peak N = 88;post-peak N = 102). There was no significant difference between baseline characteristics (age, ASA, F:M, biochemical markers, CT findings). The median duration of symptoms were 1.5 days during peak and 2 days post-peak. During COVID peak more imaging was performed to confirm the diagnosis (peak 69.3% vs post peak 57%;P = 0.081) with CT being the most common modality (N = 101, 76.5%). Majority of the patients were managed surgically during both periods (79.5% vs 81%). Conservative management failure rate was 27% (N = 10) (peak 27.8% vs post-peak 26.3%). More laparoscopic appendicectomies were performed during post-peak period (96.5% vs 65.3%;P < 0.001) and open appendicectomies were more frequent during peak (34.7% vs 3.4%;P < 0.001). There were no significant differences identified in patient outcomes between the two groups (P > 0.05). Only one patient developed mild COVID postoperatively. Less negative appendicectomies were performed during COVID peak (10.7% vs 16.5% post-peak). Conclusion(s): Laparoscopic appendicectomy remains to be a safe approach to manage acute appendicitis, even in 'time-limited' situations. Cross sectional imaging is a helpful tool in aiding the appropriate management plan in acute appendicitis cases.

The effect of the COVID pandemic on operative experience of laparoscopic appendicectomy

Aims: The COVID-19 pandemic has led to many changes in The delivery of surgical services;perhaps The greatest of these, for The long-term sustainability of Surgery at least, is that on training. This study aimed to describe The effect of these changes on operative experience of laparoscopic appendicectomy Methods: All patients who had Surgery for suspected appendicitis from 2016 to 2021 were identified from a prospectively maintained database of surgeries. Data for 2020 and 2021 were compared with preceding years. Result(s): Conclusion(s): In 2020, there were fewer operations performed for appendicitis and markedly reduced opportunities for trainees. This may reflect a fall in acute admissions, greater reliance on pre-operative imaging and reployment of surgical juniors. With a focus on returning to 'normal' in 2021 and a commitment to preserving surgical services, training opportunities have returned for laparoscopic appendicectomy despite The impact of COVID.

Is it time for global adoption of endoscopic retrograde appendicitis therapy of acute appendicitis?

Acute appendicitis is a common abdominal surgical emergency worldwide. Abraham Groves performed the first documented open appendectomy in 1883. Although appendectomy is still the most effective treatment in cases of acute appendicitis, it causes a range of complications and carries the risk of negative appendectomy. In the awake of covid-19, the latest guidelines recommend antibiotic therapy as an acceptable first line treatment for acute appendicitis. However, patients treated with antibiotics have a recurrence risk of up to 30% at 1 year. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as promising non-invasive treatment modality for acute uncomplicated appendicitis (AUA) which involves cannulation, appedicography, appendiceal stone extraction, appendiceal lumen irrigation, and stent insertion. ERAT aims to relieve the cause of appendicitis (e.g., obstruction or stenosis of the appendiceal lumen) and thus effectively prevent the recurrence of appendicitis. In addition, it can make a definitive diagnosis of acute appendicitis during endoscopic retrograde appendicography. Studies have shown that 93.8 to 95% of AUA patients did not have a recurrence following ERAT. In this study, we aim to summarize the current body of evidence on ERAT to situate it alongside currently established therapies for acute appendicitis, in particular, AUA.

Laparoscopic appendectomy for acute appendicitis in patients with COVID-19 confirmation: A case report.

Introduction: Strategies to postpone elective surgeries were proposed to maintain the hospital capacity to cater for coronavirus disease 2019 (COVID-19) and emergency non-COVID cases. Non-operative management (NOM) was recommended when possible during the COVID-19 era. However, the optimal approach to acute appendicitis (AA) in patients with COVID-19 remains controversial. Presentation of case: A 25-year-old man who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) was referred to our institution with a diagnosis of AA with appendicolith. Chest computed tomography did not detect evidence of pneumonia. Laparoscopic appendectomy was performed after strict infection prevention measures were taken. The postoperative course was uneventful. No respiratory symptoms such as cough or sputum production occurred postoperatively. No signs of infection in medical staff or spread in the operating room and infectious disease ward were observed. Discussion: The treatment policy should fully consider the risk of COVID-19 infection to medical staff and the risk of aggravation in patients who tested positive for SARS-Cov-2. Surgery was chosen over NOM for AA with appendicolith because the presence of appendicolith was thought to indicate a high probability of treatment failure in NOM and possible perforation; thus, case more difficult measures were required for SARS-Cov-2-positive cases. Conclusion: Careful assessment of the patient's condition and consideration of the treatment method is important, rather than choosing NOM over operative management based solely on SARS-Cov-2-positive status. Laparoscopic appendectomy with adequate infection control measures can be safely performed in SARS-Cov-2-positive cases.

Trends in California ophthalmology surgical volume during the COVID pandemic

Purpose : Pandemic era restrictions on non-essential travel, redistribution of healthcare resources, and nursing shortages have impacted the ability of ophthalmologists to deliver care. California had among the strictest 2020 restrictions during the pandemic with reallocation of non-essential surgical resources. This study assesses changes in surgical volume of common ophthalmic procedures in California since the COVID-pandemic. Methods : The California Health and Human Services Agency (Office of Statewide Health Planning & Development) maintains ambulatory and emergency room procedural databases. Common ophthalmic procedures and surgical volumes were extracted for 29 CPT codes from 2014-2020. Procedures with fewer than 100 cases were excluded. Results : Overall, ophthalmology surgical volume decreased by 19% from 2019 to 2020. Greatest declines were for anterior lamellar corneal transplant (39%) and pterygium with graft (38%). Simple cataract surgeries declined by 29% in 2020, compared to an average annual decline of 3% from 2014-2019. Volume increased only for two surgeries: aqueous shunt with graft (2%) and complex retinal detachment (0.2%). Temporal artery biopsies, historically stable with 0.2% average change from 2014-2019, declined by 28% in 2020. Retinal detachment repairs declined by 20% and 17% (with and without vitrectomy, respectively). In comparison, laparoscopic appendectomy only declined by 2% in 2020. Limitations of this study include role of population changes and changes in annual coding practices. Conclusions : COVID era declines were noted across almost all ophthalmic surgeries with steep drops in perceived non-urgent procedures such as pterygium and cataract. However, delays in cataracts and other conditions can result in increased disease burden and morbidity for patients. Uniquely, tube shunt procedures increased, perhaps due to progression of glaucoma from delayed routine care. For vision-preserving surgeries such as retinal detachment repair, lack of accessible care during the pandemic is especially concerning.

Same-Day Discharge after Laparoscopic Appendectomy for Simple Appendicitis in Pediatric Patients-Is It Possible?

(1) Background: One-day surgery has been widely adopted for many elective laparoscopic procedures in pediatric patients. Recently, the same protocol has been investigated for some emergency procedures, such as laparoscopic appendectomy. This study aimed to evaluate the safety and effectiveness of discharge from hospital within 24 h in pediatric patients who received laparoscopic appendectomy for uncomplicated acute appendicitis. (2) Methods: From 1 March 2021 to 1 May 2022, a total of 180 pediatric patients who were discharged from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis were included in this prospective single-center study. The primary outcome of this study was the safety of discharge from hospital within 24 h after laparoscopic appendectomy for uncomplicated appendicitis, as well as the parental satisfaction with this protocol. Secondary outcomes included the rate of readmission or unplanned return to the operating room, the complication rate and a cost-effectiveness analysis. For each patient, demographic data, preoperative evaluation (physical examination, laboratory data, imaging), duration of surgery, intraoperative and postoperative complications, length of hospital stay and pain levels, as well as parental satisfaction with this protocol, were recorded. (3) Results: The median age was 11 years (interquartile range (IQR) 10, 14). The majority of the patients (63.8%) were males. The median length of hospital stay after surgery was 15 h (IQR 12, 19). The highest level of satisfaction, at discharge, was recorded in most of the respondents (n = 155, 86.1%), while the remaining 25 (13.9%) expressed moderate levels of satisfaction. The median pain levels according to a visual analogue scale for all postoperative days were low (range 0-4). In four patients (2.2%), unplanned readmission before the seventh postoperative day because of postoperative intraabdominal abscess was recorded. All patients with abscess formation were treated conservatively. The majority of the parents (n = 175; 97.2%) expressed the highest level of satisfaction during the outpatient follow-up examination on the seventh postoperative day. (4) Conclusions: Same-day discharge after laparoscopic appendectomy for simple appendicitis in pediatric patients was safe and feasible. Parental satisfaction with this protocol was very high. With the right protocol and parent education, pediatric patients who underwent laparoscopic appendectomy because of non-complicated acute appendicitis may be successfully treated in this way.

Outcomes of laparoscopic appendectomy during the level 3 alert of the coronavirus disease 2019 pandemic in Taiwan: Experience in a referral center

Background: Emerging studies have reported an increased proportion of complicated cases of acute appendicitis and increased prehospital delay during the coronavirus disease 2019 (COVID-19) pandemic. We wondered whether there was a difference in the perioperative outcomes of laparoscopic appendectomy during the 69-day level 3 alert in our community. Materials and Methods: Adult patients who underwent laparoscopic appendectomy for acute appendicitis between May 19 and July 26, during the years of 2019, 2020, and 2021 at our institution, were included. Patient demographics, clinical presentation, interval from emergency department (ED) arrival to operation, operation duration, hospital stay, and postoperative complications were analyzed using SPSS Statistics. The Kruskal-Wallis and Pearson Chi-square tests were used for the analysis of numerical and nominal variables, respectively. Results: A total of 94, 102, and 63 cases were included during the corresponding periods in 2019, 2020, and 2021, respectively. Patient age, sex, symptom duration at presentation, percentage of leukocytosis, bacteremia, complicated appendicitis, and white blood cell count showed no group differences. The interval between ED arrival and surgery was not significantly different (P = 0.753). There were no significant differences in the operation duration (P = 0.094), estimated blood loss (P = 0.273), or proportion of drain insertion (P = 0.626). The length of hospital stay (P = 0.681), incidence of postoperative complications (P = 0.894), and postoperative complications according to the Clavien-Dindo classification (P = 0.241) were not significantly different among the groups. Conclusion: Adult patients undergoing laparoscopic appendectomy at our institution during the level 3 alert of the COVID-19 pandemic had no statistically significant differences in perioperative outcomes, including operation time, estimated blood loss, hospital stay, and complication rates.

Pediatric Appendicitis Management During the COVID-19 Pandemic: What Has Changed?

Introduction: The most common surgical emergency in the paediatric group during the coronavirus disease-2019 (COVID-19) pandemic is appendicitis, as it was before. This study aimed to evaluate clinical differences of paediatric appendicitis cases and changes in the management strategy between the pandemic and non-pandemic period. Methods: Cases during the non-pandemic period (March-July 2019) and pandemic period (March-July 2020) were analysed. Demographic data, duration of symptoms, physical examination, laboratory and radiological findings, paediatric appendicitis score (PAS), operative techniques, medical treatment, complications and hospital stay were evaluated retrospectively. Results: This study enrolled 70 patients during the non-pandemic period and 48 patients during the pandemic period. Duration of symptoms was significantly prolonged (p<0.001) and PAS was significantly increased during the pandemic period (p=0.001). Abdominopelvic ultrasonography detected abscess formation in one (1.4%) patient and 10 (20.8%) patients during the non-pandemic period and pandemic period, respectively. Complicated appendicitis was significantly higher (p=0.025) and the hospital stay were significantly longer during the pandemic period (p=0.017). Conclusion: During the COVID-19 pandemic, fewer patients presented to the paediatric emergency department with suspected appendicitis. Complicated appendicitis cases and hospital stay increased during the same period. The COVID-19 pandemic caused some changes in our approach to paediatric appendicitis cases such as the effective use of personal protective equipment, PAS scoring system and abdominopelvic ultrasonography. © 2021 by Society of Pediatric Emergency and Intensive Care Medicine.

Delayed diagnosis and subsequently increased severity of acute appendicitis (compatible with clinical-pathologic grounds) during the COVID-19 pandemic: an observational case-control study.

BACKGROUND: During a global crisis like the current COVID-19 pandemic, delayed admission to hospital in cases of emergent medical illness may lead to serious adverse consequences. We aimed to determine whether such delayed admission affected the severity of an inflammatory process regarding acute appendicitis, and its convalescence. METHODS: In a retrospective observational cohort case-control study, we analyzed the medical data of 60 patients who were emergently and consecutively admitted to our hospital due to acute appendicitis as established by clinical presentation and imaging modalities, during the period of the COVID-19 pandemic (our study group). We matched a statistically control group consisting of 97 patients who were admitted during a previous 12-month period for the same etiology. All underwent laparoscopic appendectomy. The main study parameters included intraoperative findings (validated by histopathology), duration of abdominal pain prior to admission, hospital stay and postoperative convalescence (reflecting the consequences of delay in diagnosis and surgery). RESULTS: The mean duration of abdominal pain until surgery was significantly longer in the study group. The rate of advanced appendicitis (suppurative and gangrenous appendicitis as well as peri-appendicular abscess) was greater in the study than in the control group (38.3 vs. 21.6%, 23.3 vs. 16.5%, and 5 vs. 1% respectively), as well as mean hospital stay. CONCLUSIONS: A global crisis like the current viral pandemic may significantly affect emergent admissions to hospital (as in case of acute appendicitis), leading to delayed surgical interventions and its consequences.

Acute paediatric appendicitis(AA)-decreasing the negative rate of appendicectomy

Aim: The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow. Method: Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020. Results: During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period. Conclusions: The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.

Synchronous acute sub-serosal appendicitis and cholecystitis, in a patient with a long standing small bowel neuroendocrine tumor.

We report the case of a 62-year-old retired man with a long-standing small bowel neuroendocrine tumour. He presented with right-sided abdominal pain associated with nausea and vomiting. Radiographic imaging confirmed acute appendicitis and cholecystitis. We performed a synchronous laparoscopic appendectomy and cholecystectomy in the same setting. Histopathological examination of specimens confirmed the preoperative diagnoses in both organs. Our patient recovered uneventfully. The postoperative management plan focused on continuation of the follow-up for the small bowel neuroendocrine tumour. The synchronicity of both acute cholecystitis and appendicitis is extremely uncommon. We believe that our case report is the first of its kind with synchronous inflammation of the gallbladder and appendix in a patient with neuroendocrine tumour. In this report, we aim to provide insights on managing such a condition in the background of other intra-abdominal tumours.

Impact of the COVID-19 pandemic on appendicitis treatment in Germany-a population-based analysis.

PURPOSE: Acute appendicitis is one of the most common reasons for emergency medical consultation. While simple appendicitis can be treated with antibiotics or surgery, complex appendicitis including gangrene, abscess, and perforation requires appendectomy. During the COVID-19 pandemic in early 2020, an overall drop in emergency room consultations was observed. We therefore aimed to investigate the incidence and treatment strategies of acute appendicitis during that period. METHODS: Data of insurance holders with the ICD code for "acute appendicitis" or OPS procedure of appendectomy of a major health insurance company in Germany were analyzed retrospectively. Groups were built, containing of the means of March-June of 2017, 2018, and 2019, defined as "pre-COVID group" with the "COVID group," defined as data from March to June of 2020. Data was analyzed by age, sex, comorbidities, length of hospital stay, diagnoses, and treatment. Data of the COVID group was analyzed for simultaneous COVID-19 infection. RESULTS: During the COVID-19 pandemic of early 2020, an overall reduction by 12.9% of patients presenting with acute appendicitis was noticeable. These results were mainly due to decreased rates of uncomplicated appendicitis, while complicated appendicitis was scarcely affected. Especially in the group of females < 40 years, a drastic reduction was visible. Rates of extended surgery did not change. Likewise, the complication rate like appendix stump leakage or need for re-operation did not differ. In March 2020, 4.8% of acute appendicitis patients had concomitant COVID-19 infection. CONCLUSION: In line with the overall drop of emergency room visits during the COVID-19 pandemic of spring 2020 in Germany, a significantly lowered number of patients with uncomplicated appendicitis were noticeable, whereas complicated appendicitis did not differ. Also, treatment and complication rate of acute appendicitis did not change. These findings might be a hint that acute appendicitis is not a progressing disease but caused by different entities for uncomplicated and complicated appendicitis and therefore another clue that uncomplicated appendicitis can be treated with antibiotics or observation. Nevertheless provided data does not cover outpatient treatment; therefore, no statement observation or antibiotics in outpatients can be made.