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.

Modified technical protocol for single-port laparoscopic appendectomy using needle-type grasping forceps for acute simple appendicitis:A case report

BACKGROUND Because of the mild inflammatory status in acute uncomplicated appendicitis,our team developed a novel technical protocol for single-port laparoscopic appendec-tomy using needle-type grasping forceps(SLAN)and achieved positive clinical outcomes.However,the intraoperative procedure lacked stability and fluency due to a series of problems highlighted by the small incision design of the proto-col(only 1 cm long).Therefore,there is a growing clinical demand to further opti-mize the SLAN protocol.CASE SUMMARY An adult male patient was admitted for persistent right lower abdominal pain with preoperative computed tomography findings suggestive of appendicitis accompanied by localized peritonitis.A modified technical protocol for SLAN based on minimally invasive surgical principles was used,and the patient was confirmed to have acute simple appendicitis by postoperative pathological ana-lysis.Postoperative recovery was uneventful,and no postoperative complications,such as incision infection or severe incision pain,were observed.The patient was discharged successfully on postoperative day 2.CONCLUSION The modified technical protocol of SLAN may be a new minimally invasive surgical alternative for patients with acute simple appendicitis.

Influence of sarcopenia and frailty in the management of elderly patients with acute appendicitis

In developed countries,the average life expectancy has been increasing and is now well over 80 years.Increased life expectancy is associated with an increased number of emergency surgical procedures performed in later age groups.Acute appendicitis is one of the most common surgical diseases,with a lifetime risk of 8%.A growing incidence of acute appendicitis has been registered in the elderly population and in the oldest groups(>80 years).Among patients>50-year-old who present to the emergency department for acute abdominal pain,15%have acute appendicitis.In these patients,emergency surgery for acute appendicitis is challenging,and some important aspects must be considered.In the elderly,surgical treatment outcomes are influenced by sarcopenia.Sarcopenia must be considered a precursor of frailty,a risk factor for physical function decline.Sarcopenia has a negative impact on both elective and emergency surgery regarding mortality and morbidity.Aside from morbidity and mortality,the most crucial outcomes for older patients requiring emergency surgery are reduction in function decline and preoperative physical function maintenance.Therefore,prediction of function decline is critical.In emergency surgery,preoperative interventions are difficult to implement because of the narrow time window before surgery.In this editorial,we highlight the unique aspects of acute appendicitis in elderly patients and the influence of sarcopenia and frailty on the results of surgical treatment.

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 vs mini-incision open appendectomy

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Revisiting delayed appendectomy in patients with acute appendicitis

Acute appendicitis(AA)is the most common acute abdomen,and appendectomy is the most common nonelective surgery performed worldwide.Despite the long history of understanding this disease and enhancements to medical care,many challenges remain in the diagnosis and treatment of AA.One of these challenges is the timing of appendectomy.In recent decades,extensive studies focused on this topic have been conducted,but there have been no conclusive answers.From the onset of symptoms to appendectomy,many factors can cause delay in the surgical intervention.Some are inevitable,and some can be modified and improved.The favorable and unfavorable results of these factors vary according to different situations.The purpose of this review is to discuss the causes of appendectomy delay and its risk-related costs.This review also explores strategies to balance the positive and negative effects of delayed appendectomy.

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.

Clinical significance of peri-appendiceal abscess and phlegmon in acute complicated appendicitis patients undergoing emergency appendectomy

BACKGROUND Although antibiotic therapy has become the primary treatment for acute unco-mplicated appendicitis,the management of acute complicated appendicitis nece-ssitates careful consideration of various treatment options.AIM To analyze the clinical data of patients who underwent emergency appendectomy for acute complicated appendicitis with peri-appendiceal abscess or phlegmon,identify factors influencing the postoperative length of hospital stay(LOS),and improve treatment strategies.METHODS The clinical data of acute complicated appendicitis patients with peri-appendiceal abscess or phlegmon who underwent emergency appendectomy at The Depart-ment of Emergency Surgery,Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.RESULTS A total of 234 patients were included in our study.The duration of symptoms and the presence of an appendicolith were significantly correlated with the occurrence of peri-appendiceal abscess in patients with acute complicated appendicitis(P<0.001 and P=0.015,respectively).Patients with symptoms lasting longer than 72 h had a significantly longer postoperative LOS compared to those with symptoms lasting 72 h or less[hazard ratio(HR),1.208;95%CI:1.107-1.319;P<0.001].Additionally,patients with peri-appendiceal abscesses had a significantly longer postoperative LOS compared to those with phlegmon(HR,1.217;95%CI:1.095-1.352;P<0.001).The patients with peri-appendiceal abscesses were divided into two groups based on the median size of the abscess:Those with abscesses smaller than 5.0 cm(n=69)and those with abscesses 5.0 cm or larger(n=82).Patients with peri-appendiceal abscesses measuring 5.0 cm or larger had a significantly longer postoperative LOS than those with abscesses smaller than 5.0 cm(P=0.038).CONCLUSION The duration of symptoms and the presence of an appendicolith are significant risk factors for the formation of peri-appendiceal abscesses in patients with acute complicated appendicitis.Patients with peri-appendiceal abscesses experience a significantly longer postoperative LOS compared to those with peri-appendiceal phlegmon.

Seasonal variations of acute appendicitis and nonspecific abdominal pain in Finland

AIM: To investigate whether seasonal changes had an effect on the incidence of acute appendicitis (AA) or nonspecific abdominal pain (NSAP).

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.

Effect of the COVID-19 pandemic on patients with presumed diagnosis of acute appendicitis

BACKGROUND Acute appendicitis(AAp) is the most frequent cause of acute abdominal pain,and appendectomy is the most frequent emergency procedure that is performed worldwide.The coronavirus disease 2019(COVID-19) pandemic has caused delays in managing diseases requiring emergency approaches such as AAp and trauma.AIM To compare the demographic,clinical,and histopathological outcomes of patients with AAp who underwent appendectomy during pre-COVID-19 and COVID-19 periods.METHODS The demographic,clinical,biochemical,and histopathological parameters were evaluated and compared in patients who underwent appendectomy with the presumed diagnosis of AAp in the pre-COVID-19(October 2018-March 2020) and COVID-19(March 2020-July 2021) periods.RESULTS Admissions to our tertiary care hospital for AAp increased 44.8% in the COVID-19 period.PreCOVID-19(n = 154) and COVID-19(n = 223) periods were compared for various parameters,and we found that there were statistically significant differences in terms of variables such as procedures performed on the weekdays or weekends [odds ratio(OR):1.76;P = 0.018],presence of AAp findings on ultrasonography(OR:15.4;P < 0.001),confirmation of AAp in the histopathologic analysis(OR:2.6;P = 0.003),determination of perforation in the appendectomy specimen(OR:2.2;P = 0.004),the diameter of the appendix(P < 0.001),and hospital stay(P = 0.003).There was no statistically significant difference in terms of interval between the initiation of symptoms and admission to the hospital between the pre-COVID-19(median:24 h;interquartile range:34) and COVID-19(median:36 h;interquartile range:60) periods(P = 0.348).The interval between the initiation of symptoms until the hospital admission was significantly longer in patients with perforated AAp regardless of the COVID-19 or pre-COVID-19 status(P < 0.001).CONCLUSION The present study showed that in the COVID-19 period,the ultrasonographic determination rate of AAp,perforation rate of AAp,and duration of hospital stay increased.On the other hand,negative appendectomy rate decreased.There was no statistically significant delay in hospital admissions that would delay the diagnosis of AAp in the COVID-19 period.

Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases

AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.

Appendiceal Crohn's disease clinically presenting as acute appendicitis

AIM: To determine the incidence of appendiceal Crohn's disease(CD) and to summarize the characteristic histologic features of appendiceal CD.METHODS: We reviewed the pathology files of 2179 appendectomy specimens from January 2007 to May2013. The computer-assisted retrieval search facility was utilized to collect specimens. We selected those cases that were diagnosed as CD or chronic granulomatous inflammation and defined the final diagnosis according to the histologic findings of CD, including transmural lymphocytic inflammation, non-caseating epithelioid granulomas, thickening of the appendiceal wall secondary to hypertrophy of muscularis mucosa,mucosal ulceration with crypt abscesses, mucosal fissures, and fistula formation. RESULTS: We found 12 cases(7 male and 5 female patients, with an average age of 29.8 years) of appendiceal CD. The incidence of appendiceal CD was 0.55%.The chief complaints were right lower quadrant pain,abdominal pain, lower abdominal pain, and diarrhea.The duration of symptom varied from 2 d to 5 mo.The histologic review revealed appendiceal wall thickening in 11 cases(92%), transmural inflammation in all cases(100%), lymphoid aggregates in all cases(100%), epithelioid granulomas in all cases(100%), mucosal ulceration in 11 cases(92%), crypt abscesses in 5 cases(42%), perforation in 2 cases(17%), muscular hypertrophy in 1 case(8%), neural hyperplasia in 5 cases(42%), and perpendicular serosal fibrosis in 8 cases(67%).CONCLUSION: A typical and protracted clinical course, unusual gross features of the appendix and the characteristic histologic features are a clue in the diagnosis of appendiceal CD.

Clinical significance of appendicoliths in elderly patients over eighty years old undergoing emergency appendectomy:A single-center retrospective study

BACKGROUND Acute appendicitis with an appendicolith is one of the most common abdominal emergencies in elderly patients and is more likely to progress to gangrene and perforation.AIM To analyze the clinical data of elderly patients undergoing emergency appende-ctomy for acute appendicitis,aiming to improve treatment strategies.METHODS The clinical data of 122 patients over 80 years old who underwent emergency appendectomy for acute appendicitis at the Department of Emergency Surgery of Zhongshan Hospital,Fudan University from January 2016 to March 2023 were retrospectively analyzed.The patients were divided into two groups based on the presence of an appendicolith or not,and clinicopathological and surgery-related features were compared between the two groups.RESULTS The duration of abdominal pain in all 122 patients ranged from 5 to 168 h.All patients underwent emergency appendectomy:6 had an open appendectomy,101 had a laparoscopic appendectomy,and 15 required conversion from laparoscopic to open surgery,resulting in a conversion rate of 12.9%(15/116).The patients were divided into two groups:Appendicolith group(n=46)and non-appendi-colith group(n=76).Comparisons of clinicopathological features revealed that patients with appendicoliths were more likely to develop appendiceal gangrene(84.8%vs 64.5%,P=0.010)and perforation(67.4%vs 48.7%,P=0.044),and had a lower surgical conversion rate(2.2%vs 19.7%,P=0.013).The median length of hospital stay was 5.0 d for both groups and there was no significant difference between them.All patients were successfully dis-charged.CONCLUSION Around 40%of patients over 80 years old with acute appendicitis have an appendicolith,increasing their risk of developing appendiceal gangrene and perforation,and therefore should receive timely surgical treatment.

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.

Laparoscopic Appendectomies at Brazzaville University Hospital

Introduction: Acute appendicitis represents an urgent surgical condition, requiring the removal of the vermiform appendix. Laparoscopy is the standard surgical approach. This study aimed to outline the epidemiological, clinical, therapeutic, and outcome characteristics of patients undergoing laparoscopic surgery for acute appendicitis. Patients and Methods: A descriptive, retrospective analysis was carried out in the Emergency and Digestive Surgery departments of the University Hospital Center of Brazzaville, spanning two years from January 1, 2021, to December 31, 2022. The study included all patients who underwent laparoscopic surgery for non-complicated acute appendicitis. Results: The study included 12 cases of non-complicated acute appendicitis treated with urgent laparoscopy. The mean age of the patients was 37 ± 8.9 years, with a sex ratio of 0.7. The predominant symptom leading to consultation was pain in the right iliac fossa, with an average time to consultation of 6.4 ± 5.7 hours. Patient histories included diabetes in one case, obesity in two cases, and one case of prior abdominoplasty. During surgery, a phlegmonous appendix was observed in nine patients. The average duration of hospital stay was 3.6 ± 1.3 days, with all patients experiencing uncomplicated recoveries. Conclusion: The practice of emergency laparoscopic appendectomy is still relatively infrequent in our setting and presents an ongoing challenge.

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.

Acute myelogenous leukemia and acute leukemic appendicitis:A case report

Acute myelogenous leukemia(AML)can involve the gastrointestinal tract but rarely involves the appendix. We report a male patient who had 1 year partial remission from AML and who presented with apparent acute appendicitis as the initial manifestation of leu-kemia relapse.Pathological findings of the appendix revealed transmural infiltrates of myeloblasts,which indicated a diagnosis of leukemia.Unfortunately,the patient died from progression of the disease on the 19th d after admission.Although leukemic cell infiltration of the appendix is uncommon,patients with leu-kemia relapse can present with symptoms mimicking acute appendicitis.

Comparison of clinical and histopathological features of patients who underwent incidental or emergency appendectomy

BACKGROUND Incidental appendectomy can be defined as the removal of a clinically normal appendix during another surgical procedure unrelated to appendicitis or other appendicular diseases.AIM To compare the demographic, biochemical, and histopathological features of the patients who underwent incidental and standard appendectomy.METHODS The demographic, biochemical, and histopathological data of 72 patients(Incidental App group) who underwent incidental appendectomy during living donor hepatectomy at our Liver Transplant Center between June 2009 and December 2016 were compared with data of 288 patients(Acute App group) who underwent appendectomy for presumed acute appendicitis. The Incidental App group was matched at random in a 1:4 ratio with the Acute App group in the same time frame. Appendectomy specimens of both groups were re-evaluated by two experienced pathologists.RESULTS Statistically significant differences were found between groups in terms of age(P= 0.044), white blood cell count(P < 0.001), neutrophil(P < 0.001), lymphocyte(P< 0.001), red cell distribution width(P = 0.036), mean corpuscular hemoglobin(P= 0.001), bilirubin(P = 0.002), appendix width(P < 0.001), and presence of acute appendicitis histopathologically(P < 0.001). However, no statistically significant differences were found between groups in terms of gender, platelet, mean platelet volume, mean corpuscular volume, platelet distribution width, appendix length. While the most common histopathological findings in the Incidental App group were normal appendix vermiformis(72.2%), fibrous obliteration(9.7%)and acute appendicitis(6.9%), the most common histopathological findings in the Acute App group were non-perforated acute appendicitis(62.8%), perforated appendicitis(16.7%), lymphoid hyperplasia(8.3%), and appendix vermiformis(6.3%).CONCLUSION Careful inspection of the entire abdominal cavity is useful for patients undergoing major abdominal surgery such as donor hepatectomy. We think that experience is parallel to the surgeon's foresight, and we should not hesitate to perform incidental appendectomy when

小儿经脐单部位阑尾切除术与腹腔镜阑尾切除术的疗效对比

目的比较经脐单部位阑尾切除术与腹腔镜阑尾切除术治疗小儿急性阑尾炎的疗效。方法回顾性分析我科收治的162例14岁以下急性阑尾炎患儿的临床资料,根据手术不同将患儿分为经脐单部位手术组(n=59)与腹腔镜组(n=103)。记录患儿手术完成情况,比较2组患儿手术时间、术中出血量、胃肠道功能恢复时间、住院费用、住院时间、并发症发生情况等,观察患儿术后切口愈合情况。术后随访6个月,观察患儿切口感染、腹痛、腹胀、呕吐及大便异常等情况。结果腹腔镜组患儿手术均顺利完成,无中转开腹病例;经脐单部位组患儿有2例因查找阑尾困难,术中经脐部联用腹腔镜查找阑尾。经脐单部位手术组患儿手术时间、住院时间较均短于腹腔镜组(P<0.05)。2组患儿住院费用、术中出血量、胃肠道功能恢复时间、并发症发生率比较,差异无统计学意义(P>0.05)。经脐单部位手术组患儿术后切口愈合更美观。随访期间,2组患儿切口均愈合良好,并未出现腹痛、腹胀、呕吐及大便异常等。结论与传统腹腔镜阑尾切除术比较,经脐单部位阑尾切除术具有操作简单、手术时间和住院时间短、切口愈合更美观等优点。