Can the Modified Systemic Inflammation Score Predict Complicated Appendicitis?

OBJECTIVE: To differentiate between complicated and uncomplicated acute appendicitis using the modified systemic inflammation score (mSIS) preoperatively. STUDY DESIGN: Observational study. Place and Duration of the Study: The Emergency Surgery Service of General Surgery Clinic of Ankara Bilkent City Hospital, Turkey, between 2021 and 2022. METHODOLOGY: The study included 2,584 patients older than 18 years who underwent surgery with the diagnosis of acute appendicitis. Patients with malignant diseases and those younger than 18 were excluded. The patients' demographic characteristics, laboratory data, surgical notes, and pathology results were electronically obtained and analysed. According to the surgical findings and pathology records, gangrenous, perforated, and phlegmonous cases and those with any abscess focus were included in the complicated group and the remaining cases were included in the uncomplicated group. mSIS was evaluated as 0 if albumin was ≥4.0 g/dL and LMR (the lymphocyte-to-monocyte ratio) was ≥3.4, 1 if albumin <4.0 g/dL or LMR <3.4, and 2 if albumin <4.0 g/dL and LMR <3.4. RESULTS: mSIS was 0 in 868 (33.6%) cases and 1-2 in 1,716 (66.4%) cases. When the patients with mSIS values of 0 and 1-2 were compared, there was a statistically significant difference (p=0.03). mSIS 1-2 was found to have 85% sensitivity and 42% specificity in predicting complicated appendicitis. In addition, the probability of complicated appendicitis was 1.48 times higher among the patients with an mSIS of 1-2. CONCLUSION: Complicated appendicitis cases can be predicted preoperatively by simply calculating mSIS using the routine laboratory parameters. KEY WORDS: Complicated acute appendicitis, mSIS, Appendectomy.

A new, simple marker for predicting complicated appendicitis in patients with normal white blood cell count indicator; LUC.

BACKGROUND: The aim of this study was to investigate the ability of a new marker that could be easily obtained to differentiate between complicated and uncomplicated appendicitis in a patients with a white blood cell (WBC) count within the normal range. METHODS: The patients who underwent surgery with histopathologically proven acute appendicitis (AA) between January 2021 and October 2022 were evaluated retrospectively. Patients were classified into two groups as uncomplicated and complicated appendicitis, based on the surgical and histopathological findings. Groups were compared in terms of laboratory parameters at the time of hospital admission. RESULTS: During the study period, 2589 patients underwent an appendectomy, among these 612 patients who had a WBC count within the normal range at the time of admission were analyzed. Uncomplicated appendicitis was detected in 79.6% of the patients and complicated appendicitis in 20.4%. Neutrophil%, neutrophil-to-lymphocyte ratio, C-reactive protein, and total bilirubin levels were significantly higher, whereas lymphocyte%, lymphocyte count, lymphocyte-to-monocyte ratio, sodium levels, and large unstained cells (LUC)% were significantly lower in patients with complicated appendicitis. Multiple logistic regression analysis revealed that lower LUC% (Odds Ratio [OR]: 0.45; 95% Confidence Intervals [CI]: 1.08-2.09; P=0.01) and higher total bilirubin levels (OR: 1.50; 95% CI: 1.08-2.09; P=0.01) were independent risk factors for complicated appendicitis. CONCLUSION: In patients with a diagnosis of AA with a normal WBC value, LUC% obtained from the complete blood count can be used as a new parameter predicting the diagnosis of complicated appendicitis.

Is gastro-gastric fixation suture necessary in laparoscopic adjustable gastric banding? A prospective randomized study.

BACKGROUND: The reason for gastro-gastric suture (GGS) in laparoscopic adjustable gastric banding (LAGB) is to prevent migration, slippage, and pouch dilatation. Despite various suturing techniques, these complications are still quite common. In our study, we prospectively randomized patients for GGS and analyzed outcome. METHODS: Between September 2006 and February 2008, eighty patients were randomized before LAGB procedure with pars flaccida technique. Forty patients had GGS for band fixation (Group 1), and 40 patients did not (Group 2). Groups were compared for length of surgery (LOS), length of hospital stay (LOHS), early and late complications, and percent of excess weight loss (%EWL). Mann-Whitney U test was used to define statistical differences between groups. P<.05 was accepted as significant. RESULTS: Mean body mass index (BMI) of groups 1 and 2 were 43.3±4.9 and 42.2±4.3 kg/m(2), respectively. Mean LOHS was 29.2±9.3 and 25.2±10.5 hours in groups 1 and 2, respectively. There was no statistically significant difference between groups 1 and 2 in comparison of %EWL (P=.344 and P=.132, respectively). There was a significant difference in LOS between groups, and it was shorter in group 2 (P<.05). In terms of complications, slippage rate was higher, migration and port complications were lower in group 2 although not statistically significant (P>.05). Pouch dilatation rate was similar in both groups. CONCLUSIONS: LOS is shorter without GGS. There is no difference in rates of slippage, migration, pouch dilatation complications, and %EWL between either approach. In light of our findings, we think that routine use of GGSs should be revisited.

Comparison of early and late changes in immunoglobulins and acute phase reactants after laparoscopic adjustable gastric banding in patients with morbid obesity.

BACKGROUND: There are differences in the levels of inflammation mediators, lipids, and formed elements of the blood in morbidly obese patients compared with individuals of normal weight. In the current study, the change in these parameters was determined in patients who achieved weight loss by undergoing laparoscopic adjustable gastric banding (LAGB) by comparing preoperative, and early (3 months) and late (12 months) postoperative values. METHODS: The body mass index (BMI), weight, blood pressure, and waist circumference of 72 patients treated by LAGB procedures between September 2006 and February 2009 were measured and recorded. Pre- and postoperative 3- and 12-month C-reactive protein (CRP), immunoglobulin (Ig) G, IgA, IgM, fibrinogen (Fbg), complement components C3 and C4, total cholesterol, triglycerides, low-density lipoprotein-C and high-density lipoprotein-C levels, and leukocyte, neutrophil, lymphocyte, and platelet counts were also measured. Results were presented as mean +/- SD. The preoperative values were compared with the 3- and 12-month values. A p value < 0.05 was considered statistically significant. RESULTS: BMI, weight, blood pressure, and waist circumference measurements were reduced at 3 and 12 months postoperatively compared with preoperative values (p < 0.05). Among the inflammatory mediators, IgG, IgM, and Fbg were reduced to near-normal values, beginning in the early postoperative period (p < 0.05). There was no significant reduction parallel to weight loss with respect to CRP, C3, C4, and IgA values at 3 months postoperatively (p > 0.05). However, the 12-month values of these parameters were significantly reduced (p < 0.05). CONCLUSIONS: Morbid obesity leads to significant changes in the levels of inflammation mediators. While there is a significant reduction in some of these mediators accompanying slight weight loss in the early period following an LAGB procedure, significant changes occur in other mediators in the late period when there is a larger amount of weight loss.

Frantz's tumor (solid pseudopapillary tumor) of the pancreas. A case report.

CONTEXT: A solid pseudopapillary tumor of the pancreas is a rare neoplasm which, for the most part, affects young women and has a relatively favorable prognosis with a low malignant potential. These tumors usually have unclear clinical features and may form very large masses before being diagnosed. CASE REPORT: We report the case of a 29-year-old woman who underwent complete resection of the tumor using a distal pancreatectomy and splenectomy procedure. The patient is being followed-up and in good condition. A review of the relevant literature is also presented. CONCLUSIONS: A solid pseudopapillary tumor of the pancreas is a rare condition with a low potential for malignancy and favorable prognosis; surgical resection is generally curative.

Occult intrabiliary rupture of hydatid cysts in the liver.

The aim of this study was to investigate the effects of various surgical modalities directed at the cavity of hydatid cysts in patients with occult intrabiliary rupture. In this respect, 324 patients with hydatid cyst of the liver operated on during 1983-2003 were analyzed; among them, 39 patients with occult intrabiliary rupture were included in the study. Clinical symptomatology, physical examination, laboratory findings, results of imaging studies, the localization and size of the cyst, and operative findings were reviewed. Twelve patients had complications, and there was no mortality. The most common complication was bile fistula. The average postoperative hospital stay was 7.0 +/- 3.8 days for patients with omentoplasty and 6.0 +/- 2.5 days for those who underwent cavitary drainage. For patients who do not have bile-stained cystic fluid, the utilization of scolicidal agents is appropriate. Although the opening of the duct is sutured when it is identified, the risk of biliary fistula is not clearly correlated with this approach. In such cases, omentoplasty provides a good alternative to cavitary drainage.

Use of laparoscopic splenectomy in developing countries: analysis of cost and strategies for reducing cost.

BACKGROUND: In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. PATIENT AND METHODS: Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. RESULTS: The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US $1,055 in the LS group and $1,664 in the OS group. The overall total cost was $1,664 for the OS group and $2,064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. CONCLUSION: The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.