Appendicitis Research Papers - Academia.edu (original) (raw)

BACKGROUND: Appendicitis remains an intriguing disease entity, and there are severe unresolved postulations in the mind of clinicians worldwide. The primary concern is the likelihood of progression to perforation and the potential... more

BACKGROUND: Appendicitis remains an intriguing disease entity, and there are severe unresolved postulations in the mind of clinicians worldwide. The primary concern is the likelihood of progression to perforation and the potential implications in contemporary African settings. A systematic review study has not been carried out for appendicitis research in Africa. AIM: To examine the literature critically and to present an update on current controversies on acute appendicitis with some particular emphasis on contemporary African settings. METHOD: A review of publications obtained from Medline search, medical libraries, and Google. RESULTS: Twenty-four audits were included in the quantitative analysis. Some were excluded from the subgroup analyses. Negative appendicectomies occurred at a rate of 18 % (488/3 862). Women were more likely to have a negative appendicectomy than men (32% versus 12%, p < 0.02). The perforation rate for appendicectomy patients was 28% (880/3 480), and the mortality rate was 3% (522/3 454). The current global research efforts are focused on the role of 'antibiotics' in the treatment and genetics of acute appendicitis CONCLUSION: Appendicitis remains a significant health challenge in Africa due to the attendant high incidence of perforations and complications. The current trend suggests that a nonsurgical, antibiotic approach in the treatment of uncomplicated appendicitis may be beneficial but remains 'controversial' with very low acceptance in Africa. This article reviews the current 'state of the art' in the evaluation and management of appendicitis that is leading to stratified care for patients, mainly in contemporary African settings.

BACKGROUND: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver... more

BACKGROUND: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resource constrained mission hospital settings, northwestern region of Cameroon. METHODS: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22. RESULTS: A total of 103 patients who had pre-operative evaluation with Ultrasound scan and subsequently underwent surgery with histo-pathological examination of the removed appendix were analyzed. Their ages ranged from 15 to 65 years with a mean age of 30.6 ± 18. There were 62 males and 41 females with a ratio of 1.5:1. Of the 103 patients, (n = 90; 87.4%) cases were diagnosed as AA by histopathology while (n = 9; 8.7%) cases were negative. Ultrasound was positive in (n = 75; 72.8%) cases, equivocal in (n = 16; 15.5%), and negative in (n = 10; 10.4%) cases. Sensitivity of ultrasound from this study when compared with ultrasound as the gold standard was 90.2% with a specificity of 85.6%; while Overall accuracy was 72.4%. The calculated kappa scores for inter-observer variability among radiologists were 0.13 to 0.28. Age and gender had no significant relationship with the accuracy of ultrasound in this study (p value = 0.2 and 0.7 respectively). CONCLUSION: Ultrasound scan is more useful in detecting than in ruling out appendicitis. The radiological criteria for acute appendicitis, the accuracy of various imaging modalities and the limitations of the available research are described in this series. The interobserver variability in the ultrasonography interpretation of appendicitis is of significant impact in resource- limited surgical emergency settings like ours, which is a rural tropical population in the developing country.

Purpose A key step during laparoscopic appendicectomy is securing the appendiceal stump. This has traditionally been achieved using vicryl endoloops, but increasing evidence suggests that the use of polymeric clips (Hem-o-lok) may be a... more

Purpose A key step during laparoscopic appendicectomy is securing the appendiceal stump. This has traditionally been
achieved using vicryl endoloops, but increasing evidence suggests that the use of polymeric clips (Hem-o-lok) may be a
safe and viable method. Current evidence for its clinical use in laparoscopic appendicectomy is unknown. We performed a
systematic review of the literature examining the clinical outcomes of laparoscopic appendicectomy using polymeric clips
compared to other methods of stump closure.
Methods A systematic literature review based on PRISMA guidelines was performed using MEDLINE, PubMed, EMBASE
and Cochrane library databases between 2000 and 2017. All studies analysing appendiceal stump closure during laparoscopic
appendicectomy using polymeric clips compared to other methods of stump closure were included. The methodological quality
of the included studies was assessed using the Cochrane Handbook for Systematic Reviews. The review was registered
with the PROSPERO register of systematic reviews.
Results Ten studies were included, involving 702 patients, 7 of which were prospective studies and 1 a randomised control
trial. Polymeric clips were found to be the cheapest method (€20.47 average per patient) and also had the lowest rate of
complications (2.7%) compared to other commonly used closure methods. Meanwhile, operative time and duration of inpatient
stay were similar between groups.
Conclusions Current evidence suggests that polymeric clips are an effective and cost-efficient method for stump closure in
laparoscopic appendicectomy for acute appendicitis. Further high-quality evidence is required before polymeric clips can
be recommended as the gold standard for appendiceal stump closure.
Keywords Appendicectomy · Stump closure · Polymeric clips

To compare the results of open with laparoscopic appendectomy in terms of postoperative pain, rate of wound infection and hospital stay. This quasi-experimental study was conducted in Deprtment of Surgery, Ziauddin University Hospital,... more

To compare the results of open with laparoscopic appendectomy in terms of postoperative pain, rate of wound infection and hospital stay. This quasi-experimental study was conducted in Deprtment of Surgery, Ziauddin University Hospital, Karachi, over a period of six months. Patients undergoing surgery for acute appendicitis were randomly assigned into one of the two groups (A or B) after obtaining written and informed consent. In Group-A patients underwent open appendectomy and in Group B laparoscopic appendectomy was performed. Post operatively pain chart and wound infection was recorded and, at the time of discharge, number of days in hospital was calculated. Sixty patients (38 male, 22 female), with clinical diagnosis of acute appendicitis based on Alvarado score of six and above, were included in the study. They were randomized into 2 groups of A and B with 30 patients in each group. Group-A comprised open appendectomy procedure and Group-B comprised laparoscopic appendectomy. Me...

Because the precise immunopathological events occurring in appendicitis are not completely understood, possible local production of endothelin-1 (ET-1) in human appendix was investigated. We used immunohistochemistry and in situ... more

Because the precise immunopathological events occurring in appendicitis are not completely understood, possible local production of endothelin-1 (ET-1) in human appendix was investigated. We used immunohistochemistry and in situ hybridization to detect the ...

MATERIALS AND METHODS: Ninety-five consecutive patients underwent two unenhanced multi–detector row CT examinations with 4 × 2.5-mm collimation, 120 kVp, and 30 and 100 effective mAs. Two radiologists independently read the images... more

MATERIALS AND METHODS: Ninety-five consecutive patients underwent two unenhanced multi–detector row CT examinations with 4 × 2.5-mm collimation, 120 kVp, and 30 and 100 effective mAs. Two radiologists independently read the images obtained at each dose during two ...

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was... more

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. This is a multicentre, retrospective, observational study investigating the outcomes of patients undergoing emergent appendectomy in March-April 2019 vs March-April 2020. The primary outcome was the number of appendectomies performed, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs open) and the complication rates. One thousand five hundred forty one patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the inclusion criteria: 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.2%) in 2019. According to AAST, patients with complicated appendicitis operated in 2019 were 30.3% vs 39.9% in 2020 (p = 0.001). We observed an increase in the number of post-operative complications in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), the increase of a unit in the AAST score (+ 26%), surgery performed > 24 h after admission (+ 58%), open surgery (+ 112%) and conversion to open surgery (+ 166%). In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. During the first pandemic wave, patients undergoing surgery were more frequently affected by more severe appendicitis than the previous year's timeframe and experienced a higher number of complications. Trial registration number and date: Research Registry ID 5789, May 7th, 2020.

Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from... more

Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from laparoscopic and open approach. One hundred and forty-seven consecutive patients underwent appendectomy for perforated appendicitis (73 patients had laparoscopic appendectomy and 74 patients had open appendectomy. Bacteremia, endotoxemia, white blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and 6), and C-reactive protein were investigated. One hour after intervention, bacteremia was significantly higher in the open group compared with the laparoscopic group (P < 0.05). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the open group of patients in comparison with the laparoscopic group (P < 0.05). Laparotomy caused ...

Methods A descriptive study was conducted on 50 appendix specimens which were categorized as histology-positive acute appendicitis (HPAA), clinically acute appendicitis but his-tologically negative (HNAA), appendices resected for other... more

Methods A descriptive study was conducted on 50 appendix specimens which were categorized as histology-positive acute appendicitis (HPAA), clinically acute appendicitis but his-tologically negative (HNAA), appendices resected for other causes and appendices from forensic ...

ObjectiveTo determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.MethodsA prospective randomized, double-blind, placebo-controlled trial was conducted... more

ObjectiveTo determine the influence of early pain relief for patients with suspected appendicitis on the diagnostic performance of surgical residents.MethodsA prospective randomized, double-blind, placebo-controlled trial was conducted for patients with suspected appendicitis. The patients were randomized to receive placebo (normal saline intravenous [IV]) infusions over 5 minutes or the study drug (morphine 5 mg IV). All of the clinical evaluations by surgical residents were performed 30 minutes after administration of the study drug or placebo. After obtaining the clinical probability of appendicitis, as determined by the surgical residents, abdominal computed tomography was performed. The primary objective was to compare the influence of IV morphine on the ability of surgical residents to diagnose appendicitis.ResultsA total of 213 patients with suspected appendicitis were enrolled. Of these patients, 107 patients received morphine, and 106 patients received placebo saline. The n...

Over a 7-year period, we isolated 294 Actinomyces-like organisms (ALOs) which were not clearly identifiable. Using well-defined probes coding for sequences specific for recently described Actinomyces species (A. turicensis, A. radingae,... more

Over a 7-year period, we isolated 294 Actinomyces-like organisms (ALOs) which were not clearly identifiable. Using well-defined probes coding for sequences specific for recently described Actinomyces species (A. turicensis, A. radingae, and A. europaeus), we were able to identify 128 strains. The majority belonged to the A. turicensis species. A. radingae was found only in patients with skin-related pathologies. A. europaeus was also detected in patients with urinary tract infections. The main sources of A. turicensis were genital infections, followed by skin-related and urinary tract infections. Additional clinical pictures were appendicitis, cholecystitis, ear, nose, and throat infections, and bacteremia. In a small number of patients these ALOs were found as the only pathogen. Strains of the three species were tested by two widely used biochemical identification methods. A. turicensis was easily identifiable by both these methods. We conclude that these ALOs are not infrequent pa...

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the... more

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy. Posterior wall was repaired using nylon darn in both cases. Acute appendicitis should be considered in the differential diagnosis of obstructed right inguinal hernia.

Chronic abdominal Pain in children is a very common cause of hospital admission. Many of them are discharged without a diagnosis even after battery of investigations. Laparoscopy plays a significant role in diagnosis and management of... more

Chronic abdominal Pain in children is a very common cause of hospital admission. Many of them are discharged without a diagnosis even after battery of investigations. Laparoscopy plays a significant role in diagnosis and management of many causes of acute and chronic abdominal pain. The purpose of this study was to determine the efficacy of laparoscopy as an efficient diagnostic and management tool in children with chronic abdominal pain. A descriptive, prospective case series was collected in the department of Paediatric surgery Mayo's Hospital Lahore, over the period of 5 years between Jan 2007-Dec 2013. The data of consecutive 50 patients, who were admitted in the department with the diagnosis of chronic abdominal pain, was recorded. All patients who had 2-3 admissions in hospital for last 2 months and failed to establish a definitive diagnosis after clinical examination and base line investigations underwent laparoscopy. The details of associated symptoms, finding of laparos...

In acute appendicitis the bowel transmissibility of the intestinal flora increases in relation to inflammation and edema formation. We can therefore observe an immunologic response in patients, which is detectable using different bacteria... more

In acute appendicitis the bowel transmissibility of the intestinal flora increases in relation to inflammation and edema formation. We can therefore observe an immunologic response in patients, which is detectable using different bacteria isolated from the normal intestinal flora. Our aim was to measure this immunologic reaction and to detect the relationship between this response and histologic types of acute appendicitis. Sera from 47 cases, comprising 38 patients suffering from appendicitis and 9 healthy controls, were examined. The sera were taken shortly before appendectomy and 14 days after operation. The antigens were lipopolysaccharides (LPS) extracted from bacteria of normal intestinal flora: Escherichia coli O21, O22, O33, O61, O68, Bacteroides fragilis and an absolute rough mutant: Shigella sonnei Re 4350. Antibodies were detected by ELISA. We showed a direct relationship between severity of appendicitis and registered antibody titer. Both aerobic and anaerobic bacteria play a role in infection in appendicitis. According to our serologic results the synergy of B. fragilis with E. coli from normal flora is more important in the initiation of inflammation, but in the perforation process the role of E. coli seems more important compared to that of B. fragilis.

Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by... more

Background Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. Methods A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. Results One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). Conclusions The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in compli...

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become... more

Acute appendicitis (AA) is the most common surgical disease, and appendectomy is the treatment of choice in the majority of cases. A correct diagnosis is key for decreasing the negative appendectomy rate. The management can become difficult in case of complicated appendicitis. The aim of this study is to describe the worldwide clinical and diagnostic work-up and management of AA in surgical departments. This prospective multicenter observational study was performed in 116 worldwide surgical departments from 44 countries over a 6-month period (April 1, 2016-September 30, 2016). All consecutive patients admitted to surgical departments with a clinical diagnosis of AA were included in the study. A total of 4282 patients were enrolled in the POSAW study, 1928 (45%) women and 2354 (55%) men, with a median age of 29 years. Nine hundred and seven (21.2%) patients underwent an abdominal CT scan, 1856 (43.3%) patients an US, and 285 (6.7%) patients both CT scan and US. A total of 4097 (95.7%...