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Background Emergency appendicectomy is the most common emergency surgical procedure performed in Australia. Despite this frequency, there is a relative paucity of contemporary, broad-based, local data that examine how emergency appendicectomies are currently performed and what are the outcomes from these operations. Methods A multicentre, prospective, observational study was performed. Patients were recruited by local investigators for a period of 2 months with 30-day follow-up. Patients were eligible for study inclusion if they underwent an emergency appendicectomy for suspected acute appendicitis. The primary outcome of the study was the negative appendicectomy rate (NAR), with secondary outcomes including 30-day complication rates, method of operation and conversion rates. Results A total of 1189 patients were recruited across 27 centres. The NAR across all centres was 19.0%. 98.2% of appendicectomies were performed with a laparoscopic-first approach. The rate of conversion from laparoscopy to open operation was 2.4%. 9.4% of patients were recorded as having one or more of the following complications: readmission (6.6%), surgical site infection (1.9%), intra-abdominal abscess (2.7%) or further intervention (1.5%). Patients who had an open operation had higher rates of readmission and surgical site infection. Conclusion The NAR found in this study is within the traditional measures of acceptance; however, this rate is high when measured against modern international benchmarks. [ABSTRACT FROM AUTHOR]

Background: The rectus sheath block is effective in elective paediatric operations, but has not been previously studied in acute laparoscopic surgery. We investigated its effect on pain after laparoscopic appendicectomy for acute appendicitis. Methods: Children aged 8-14 years admitted to a paediatric teaching hospital participated in a randomized clinical trial comparing a rectus sheath block using bupivacaine plus adrenaline with saline control. The primary outcomes were pain scores and opiate use, and secondary outcomes were time in the post-anaesthetic care unit, duration of hospitalization and recovery. Results: Children in the nerve block group reported significantly reduced global pain scores compared with controls in the first 3 h after surgery, estimated mean 2.22 versus 3.94, effect size -1.80 (P= .008). Pain scores after 3 h did not differ between the groups. The groups did not differ in opiate requirements, length of hospital stay or recovery after discharge. Conclusions: In children undergoing acute laparoscopic appendicectomy, a rectus sheath block reduced early post-operative pain, and could contribute to a multimodal recovery programme. [ABSTRACT FROM AUTHOR]

Background Incidental appendiceal neuroendocrine neoplasms are identified in 1% of surgical resections for suspected appendicitis. A proportion of these patients will require further surgery because of high risk features, which include mesoappendiceal involvement or an involved margin. While an open appendicectomy technique usually involves en bloc mesoappendiceal resection, the increasingly common laparoscopic method often skeletonizes the appendix, leaving the mesoappendix in situ. This retrospective observational study investigates whether routine resection of the mesoappendix rather than skeletonization would reduce the need for further surgery in patients with an incidental finding of appendiceal neuroendocrine neoplasm. Methods We included appendicectomies performed over an 11-year period at Auckland City Hospital and identified all cases of incidental appendiceal neuroendocrine neoplasms. Histological data were collected to assess the risk of lymphatic spread and need for further surgery. Mesoappendix resection versus preservation and its effect on the recommendation for further surgery was recorded. Results An appendiceal neuroendocrine neoplasm was present in 73 (1%) of 7109 appendicectomy specimens. Of these, 10 patients (14%) required right hemicolectomy. Five of these could potentially have been spared the need for further surgery had the mesoappendix been removed en bloc with the appendix. Discussion We recommend en bloc mesoappendix resection during appendicectomy in order to better stage the neoplasm and reduce the need for unnecessary further surgery. [ABSTRACT FROM AUTHOR]

The present study investigates the effect of delay in appendicectomy on the outcome of surgery and also examines the contribution of patient and physician related delay to the stage of appendicitis.During a 12-month period, 114 consecutive adult patients undergoing appendicectomy for acute appendicitis were monitored prospectively. Time of onset of symptoms, presentation to the hospital, surgery consultation, decision to operate and starting of surgery were all noted. The stage of the appendicitis was identified based on operative findings and pathology reports. Postoperative events were recorded. The stage of appendicitis and outcome were related to the prehospital and in-hospital delay of each patient.There were three (2.6%) normal, 62 (54.4%) early inflamed and 49 (43%) cases of advanced appendicitis. The total delay from onset of symptoms to performance of appendicectomy was 2.4 times longer in the advanced appendicitis group than in the early inflamed appendicitis group. There was no significant difference in the in-hospital delay between the two groups. Delay in the resumption of oral feed and total hospital stay were significantly higher in the advanced appendicitis group.The present prospective study concludes that morbidity caused by acute appendicitis correlates directly with delay in treatment. In the majority of cases the delay in treatment is predominantly caused by patient related factors. The negative appendicectomy rate can be reduced by close observation of cases with clinical uncertainty without increasing the morbidity. [ABSTRACT FROM AUTHOR]

Background: This retrospective review was undertaken to determine if time between presentation and appendicectomy is a factor affecting morbidity and length of hospital stay for patients with proven appendicitis. Methods: The notes of patients who underwent an appendicectomy at Wellington Public Hospital, New Zealand between June 2002 and February 2004 were retrospectively reviewed. Delay from admission until surgery was noted. Other variables recorded were age, sex, operation type (laparoscopic or open), white cell count, pulse rate and temperature at admission, antibiotic usage, ancillary investigations (e.g. ultrasound), operative findings, length of admission and in-hospital complications. Results: A total of 480 appendicectomies were carried out. Four hundred and fifty-seven (95%) records were retrieved, and 436 (91%) included the required information and were analysed. Ninety-one (21%) resected appendices were pathologically normal, 275 (63%) were nonperforated, 61 (14%) were perforated and 9 (2%) had appendicular abscesses. The mean waiting time from admission to operation was 14.5 h (range, 1.6–99 h). There were 36 complications in 31 (7%) patients. The mean hospital stay was 74.4 h (range, 9.2–372 h). Three hundred and forty-five admitted patients had histologically proven appendicitis. Patients who waited 12–24 h for their surgery, when compared with those that waited less than 12 h, did not have a statistically significant difference in either perforation rates ( P = 0.66) or abscess formation ( P = 0.14). There was also no statistically significant difference in the postoperative length of hospital stay ( P = 0.6) or complication rate ( P = 0.92) in patients who waited >24 h for their surgery. Patients with appendicitis who waited for >24 h ( n = 44) had more abscesses ( P = 0.0001). There was also a statistically significant difference in the perforation rate ( P = 0.0001), postoperative length of stay ( P = 0.04) and overall complication rate ( P = 0.01). Conclusion: Time to surgery of up to 24 h does not lead to an increase in complicated appendicitis or morbidity. When the time exceeds 24 h, there is an increased rate of complicated appendicitis and morbidity, including complications that are not directly related to the appendicitis. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 84-year-old woman presented with an abdomen swollen at the right lower quadrant where a mass was palpated and mentions that abdominal computed tomography (CT) scan showed a giant round lesion measuring in continuity with the caecum. It informs that a preoperative diagnosis of appendiceal mucocele (AM) was attained.

In this article, a simplified technique for laparoscopic appendectomy is described in which the base of the appendix is firstly divided, and then ligated with an endoloop. An endoloop is then passed over the appendix onto the mesoappendix and tightened to secure the blood supply. The appendix can then be freed and removed. This technique has been used by the authors in difficult cases, and has produced excellent results. [ABSTRACT FROM AUTHOR]