Analysis of the Effectiveness of Laparoscopic Appendectomy Compared to Laparotomy in the Treatment of Acute Appendicitis

Objective:To analyze the clinical effects of laparoscopic appendectomy compared to traditional laparotomy in treating acute appendicitis.Methods:90 patients with acute appendicitis were selected as research subjects.They were divided into a control group and an observation group,with 45 cases in each group.The control group underwent traditional laparotomy,while the observation group underwent laparoscopic appendectomy.The intraoperative indicators,postoperative recovery indicators,postoperative stress indicators,and postoperative complications of the two groups were compared.Results:The operative time of the observation group was longer,but the incision length was shorter and the blood loss was lesser(P<0.05);the observation group had shorter postoperative first gas-passing time,recovery of gastrointestinal function,ambulation time,and lower postoperative pain score.The observation group had lower postoperative stress index levels(P<0.05);the observation group had a lower postoperative complication rate(P<0.05).Conclusion:Aside from prolonging the operative time,laparoscopic appendectomy is more ideal than traditional laparotomy in all other indicators and has better therapeutic effects in treating acute appendicitis.

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.

Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.

Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy:A systematic review and meta-analysis

Objective:To compare the benefits of enhanced recovery after surgery(ERAS)pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy.Methods:We looked for publications using the keywords“Enhanced Recovery After Surgery,”“Fast-track Surgery,”“Laparoscopic Appendectomy,”and“Laparoscopic Appendicectomy”in PubMed/Medline,Embase,and the Cochrane library.Operative time,lesser length of stay,oral intake timing,readmission rate,pain/satisfaction levels,readmission rate,and surgical site infections were recorded and analyzed.Results:A total of 95 articles from registers and 161 articles from databases were identified.Three eligible studies were included.The ERAS pathways had a lesser length of stay[Z=2.06,MD=−1.05,95%CI=(−2.04,−0.05),P=0.04]and an earlier start to postoperative feeds[Z=6.22,MD=−267.49,95%CI=(−351.80,−183.19),P<001].Conclusions:ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care.Both approaches have similar operative time,surgical site infection incidence,and readmission rate.Clinical registration:This review is registered with INPLASY202280005.

Laparoscopic versus Open Appendectomy Outcomes

Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is about 11%. Objective: To compare laparoscopic vs open appendectomy with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission. Methods: This prospective comparative study is performed in the Department of Surgery, North West Aramed Forced Hospital, Tabuk, Kingdom of Saudi Arabia. All patients between 13 and 60 years of age admitted through the accident and emergency (A&E) department with a clinical diagnosis of acute appendicitis and those who completed follow-up are included in the study. All those patients in whom a clinical diagnosis of acute appendicitis was not established or have a palpable mass in the right lower quadrant, suggesting an appendiceal abscess and those who does not give consent are excluded from the study. We reviewed the medical records of all patients who underwent a laparoscopic and open appendectomy in King Salman Armed Forces Hospital, Saudi Arabia from 1/1/2012 to 31/12/2015. Result: A total of 502 patients underwent Appendectomy at King Salman Armed Forces Hospital from 1/1/2012 till 31/12/2015. Of these, 203 were male (40.4%) and 299 were female (59.6%). The mean age was 18 years. Alvarado Score more than 7 in 93% of patients diagnosed with appendicitis. Comorbidities included diabetes 21 (5.56%) and hypertension 7 (1.39%). The mean Body Mass Index (BMI) was 20 kg/m2. 328 patients (65.3%) underwent Open Appendectomy (OA). None of Laproscopic appendectomy(LA) had a conversion. The mean operative time was 76 minutes (44 minutes and 50 minutes for OA and LA, respectively). Mean hospital stay in OA 2 days and one day LA. Eight cases (1.6%) developed seroma (6 cases in OA and 2 cases in LA with rates of 1.2% and 0.4% respectively). Nine patients (1.6%) had wound infection, 8 in OA and one in LA with rate of 1.5% and 0.2% respectively). Four patients (0.8%) develop the hematoma (3 cases in OA and one case in LA with rates of 0.6% and 0.2% respectively). Seven cases of reported appendectomy develop the pelvic abscess (1.4%) (5 cases in OA and 2 cases in LA with rates of 1% and 0.4% respectively). Conclusion: Alvarado Score carries high significance in the diagnosis of acute appendicitis. Laparoscopic appendectomy has improved diagnostic accuracy along with advantages in terms of fewer seroma, hematoma, wound infections, faster recovery, and earlier retention to normal activity but longer operative time.

Appendiceal bleeding caused by vascular malformation: A case report

BACKGROUND Acute lower gastrointestinal bleeding(LGIB)is a common occurrence in clinical practice.However,appendiceal bleeding is an extremely rare condition that can easily be overlooked and misdiagnosed.The preoperative detection of appen-diceal bleeding often poses challenges due to the lack of related guidelines and consensus,resulting in controversial treatment approaches.CASE SUMMARY We presented a case of a 33-year-old female who complained of hematochezia that had lasted for 1 d.Colonoscopy revealed continuous bleeding in the appen-diceal orifice.A laparoscopic appendectomy was performed immediately,and a pulsating blood vessel was observed in the mesangium of the appendix,accor-dingly,active bleeding into the appendicular lumen was considered.Pathological examination revealed numerous hyperplastic vessels in the appendiceal mucosa and dilated capillary vessels.CONCLUSION The preoperative detection of appendiceal bleeding is often challenging,colo-noscopy is extremely important,bowel preparation is not routinely recommend-ed for patients with acute LGIB or only low-dose bowel preparation is recom-mended.Laparoscopic appendectomy is the most appropriate treatment for appendiceal bleeding.

Laparoscopic treatment of perforated appendicitis

The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis.

What is the optimal treatment for appendiceal mass formed after acute perforated appendicitis?

We read with great interest the editorial article by Meshikhes AWN published in issue 25 of World J Gastroenterol 2011.The article described the advantages of emergency laparoscopic appendectomy compared with interval appendectomy as a new safe treatment modality for the appendiceal mass.The author concluded that the emergency laparoscopic appendectomy was a safe treatment modality for the appendiceal mass,and might prove to be more cost-effective than conservative treatment,with no need for interval appendectomy.However,we would like to highlight certain issues regarding the possibility of percutaneous catheter drainage to successfully treat the appendiceal mass,with no need for appendectomy,too.

Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and metaanalysis

BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing:A single-center study

BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.

Samonella typhi infection-related appendicitis:A case report

BACKGROUND Acute appendicitis is one of the most common acute abdominal emergencies around the world,which is always associated with infection.Infection with Salmonella typhi,an enteric pathogen,is a rare cause of acute appendicitis.We here report a patient with acute appendicitis associated with Samonella typhi infection,accompanied with spleen and kidney infarction,providing a rare example for a common surgical emergency.CASE SUMMARY A 25-year-old Pakistani man presented to the hospital with a 3-d history of fevers,vomiting,and abdominal pain.Computed tomography(CT)revealed a thickened intestinal wall of the ileocecal junction with multiple enlarged lymph nodes nearby.He was diagnosed with acute appendicitis and received laparoscopic appendectomy,which showed mild inflammation of the appendix.After the surgery,the patient presented again with a high fever(>39℃)and diarrhea.A CT angiography scan indicated spleen and kidney infarction.According to the blood culture,the diagnosis was finally clear to be Samonella typhi infection.The pyrexia and enteric symptoms were relieved after the application of intravenous levofloxacin.CONCLUSION This case,characterized by the combination of Salmonella typhi infection,acute appendicitis,and renal and splenic infraction,serves as a rare example for a common surgical emergency.