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Objective: To evaluate rates of postoperative infection in patients with acute purulent appendicitis or gangrenous perforated appendicitis after laparoscopic appendectomy (LA). Methods: In this retrospective cohort study the medical records of patients who had undergone LA for acute appendicitis at Yijishan Hospital of Wannan Medical College between January 2015 and December 2019 were reviewed. The patients were divided into 2 groups based on the sequential order in which peritoneal irrigation, suction, and extraction of appendix had been performed. In Group 1 peritoneal irrigation and suction had been performed before extraction of the appendix, and in Group 2 they had been performed after extraction of the appendix. Demographic details, surgery duration, time to first flatus, length of hospital stay, total hospitalization expenses, and postoperative complications were analyzed. Results: The final study sample included 571 patients, 116 (20.3%) in Group 1 and 455 (79.7%) in Group 2. There were no significant differences in demographic characteristics, preoperative white blood cell counts, surgery durations, lengths of hospital stay, or total hospitalization expenses between the 2 groups (P > .05). Time to first flatus was significantly shorter in Group 1 (2.1 ± 0.5 days) than in Group 2 (2.3 ± 0.6) (P = .016), and the incidence of surgical wound infection was lower in Group 1 (6.9%) than in Group 2 (14.1%) (P = .038). There were no significant differences in the rates of intra-abdominal abscess, small bowel obstruction, or readmission within 30 days between the 2 groups (P > .05). Conclusion: Patients with acute purulent appendicitis or gangrenous perforated appendicitis are at high risk of surgical wound infection. Peritoneal irrigation and suction before appendix extraction may reduce the incidence of postoperative wound infection. [ABSTRACT FROM AUTHOR]

Purpose: To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome.Methods: Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery.Results: A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)).Conclusions: There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the most common reasons for emergency surgery. At Stockholm South General Hospital, information on all patients - 15 years or older - undergoing surgery for acute appendicitis is included in a quality register. Data on surgical method, preoperative imaging, hospital stay, intraoperative findings, and 30-day complications were recorded for each patient. From January 2004 to December 2014, 5,614 consecutive patients were registered. The percentage of patients examined with preoperative imaging increased from 30% in 2004 to 93% in 2014. The use of laparoscopic appendectomy increased from 6 to 79%. Negative appendectomies decreased from 7.5-10 to 1.7%. The mean perforation rate was 28.6%. Some form of postoperative complication occurred in 6.6% of those on whom laparoscopy was performed and 10.5% of those who underwent an open surgery, with a significant difference (p < 0.001) in the rate of surgical site infections (surgical site infections, higher in open cases) but with no difference in the number of deep postoperative abscesses. The overall hospital stay decreased from 2004 to 2014 for perforated and non-perforated appendicitis. The overall 30-day mortality rate was 0.12%. Changes in preoperative imaging and treatment strategy for appendicitis during this period resulted in a lower rate of negative appendectomies with acceptable complication rates and shortened hospital stay. [ABSTRACT FROM AUTHOR]

Purpose: The diagnosis of acute appendicitis is mainly clinical and is correct in about 80% of patients, but 20-33% present with atypical findings, which resulted in a negative appendectomy rate of 20-30%. The graded compression ultrasound method in the diagnosis of acute appendicitis was reported with a sensitivity of 89%, and specificity of 95%. In this study, we aim to evaluate the graded compression ultrasonography in the diagnosis of acute appendicitis, its influence on the clinical judgment to operate, and its role in lowering the negative appendectomy rate. Methods: 1073 patients treated surgically for acute appendicitis between January 2005 and December 2014 were reviewed. Ultrasound findings, histopathological diagnosis, and positive or negative appendectomy rates were analyzed. Results: 647 (60.3%) patients were males and 426 (39.7%) females. The mean age was 26.5 years. Positive ultrasound findings were recorded in 892 (83.13%), while negative findings were recorded in 181 (16.87%). Positive appendectomy was recorded in 983 (91.6%), while negative appendectomy was recorded in 90 (8.4%). The sensitivity was 83%, specificity was 100%, and the rate of negative appendectomy was 8.39%. Conclusion: Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Oxidative stress is a complicated process, which was defined as an increase in prooxidants and decrease in antioxidants caused by various mechanisms, including inflammation and surgical trauma. The association between acute appendicitis and oxidative stress has been showed in previous studies. However, comparison of oxidative stress in laparoscopic or open appendectomy (OA) has not been established. PATIENTS AND METHODS: Patients who were diagnosed as acute appendicitis between October 2012 and January 2013 were randomized to open (OA, n = 50) and laparoscopic appendectomy (LA, n = 50). Blood samples for oxidative stress markers (total oxidant status [TOS] and total antioxidant status [TAS]), C-reactive protein (CRP) and white blood cells (WBC's) were collected just before the surgery and 24 h after surgery. RESULTS: There were no differences in preoperative values of WBC and CRP between LA and OA groups (P = 0.523 and 0.424), however, in postoperative 24th h, CRP was reduced in LA group (P = 0.031). There were no differences in preoperative levels of TOS, TAS, and oxidative stress index (OSI) between LA and OA groups. In the postoperative 24th h, TOS and OSI were found to be significantly higher in OA group when compared to LA group (P = 0.017 and 0.002) whereas no difference was detected in TAS level in the postoperative 24th h (P = 0.172). CONCLUSIONS: This double-blind, randomized clinical trial provides evidence that LA for uncomplicated appendicitis is associated with significantly lower oxidative stress compared with OA. Some of the advantages of LA may be attributed to the significant reduction of oxidative stress in these patients. [ABSTRACT FROM AUTHOR]

Aim The present study examined the status and trends of laparoscopic appendectomy ( LA) in China as a developing country and compared its surgical outcomes with open appendectomy ( OA). Patients and Methods A retrospective study was performed on 12 586 consecutive patients who underwent appendectomy for acute appendicitis at nine hospitals in China between 2011 and 2013. A multivariate logistic regression model was used to assess independent risk factors associated with the development of postoperative complications. Results The annual proportion of LA increased from 11.5 per cent to 20.8 per cent to 40.7 per cent in the 3-year period. In comparison to OA, LA was associated with a lower postoperative complication rate (7.6 per cent vs 9.5 per cent, P = 0.001), a shorter hospital stay (mean: 5.4 days vs 6.5 days, P < 0.001) and a lower 30-day readmission rate (2.3 per cent vs 3.1 per cent, P = 0.020). Multivariate analysis revealed that LA was independently associated with a decreased postoperative complication rate for all patients [odds ratio (OR): 1.44, P = 0.01], for a subgroup of patients with perforated appendicitis (OR: 4.32, P < 0.01) and for a subgroup of patients with unperforated appendicitis (OR: 1.50, P = 0.01). Conclusions The use of LA has increased rapidly in China in recent years. LA has been found to significantly lower the postoperative complication rate, even in perforated appendicitis. The laparoscopic procedure could be the preferred method for the surgical treatment of acute appendicitis in China in the future. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the second most common gastrointestinal diagnosis mandating urgent operation in the U.S. The current state of adult appendectomy, including patient and hospital characteristics, complications, and predictors for complications, are unknown. Methods: Retrospective review of U.S. Nationwide Inpatient Sample 2003-2011 for appendectomy in ≥18-year-olds was performed. Primary outcomes measures included postoperative complications, length of stay, and patient mortality. Categorical variables were analyzed by χ2, trend analyses by Cochran-Armitage. Multivariable logistic regression was performed to adjust for predictors of developing complications. Results: 1,663,238 weighted appendectomy discharges occurred. Over the study period, complications increased from 3.2 to 3.8 % ( p < 0.0001), but the overall mortality decreased from 0.14 to 0.09 % ( p < 0.0001) and mean LOS decreased from 3.1 to 2.6 days ( p < 0.0001). The proportion of laparoscopic appendectomy increased over time, 41.7-80.1 % ( p < 0.0001). Patients were increasingly older (≥65 years: 9.4-11.6 %, p < 0.0001), more obese (3.8-8.9 %, p < 0.0001), and with more comorbidities (Elixhauser score ≥3: 4.7-9.8 %, p < 0.0001). After adjustment, independent predictors for postoperative complications included: open surgery (OR 1.5, 95 % C.I. 1.4-1.5), male sex (OR 1.6, 95 % CI 1.5-1.6), black race (vs. white: OR 1.5, 95 % CI 1.4-1.6), perforated appendix (OR 2.8, 95 % CI 2.7-3.0), greater comorbidity (Elixhauser ≥3 vs. 0, OR 11.3, 95 % CI 10.5-12.1), non-private insurance status (vs. private: Medicaid OR 1.3, 95 % CI 1.2-1.4; Medicare OR 1.7, 95 % CI 1.6-1.8), increasing age (>52 years vs. ≤27: OR 1.3; 95 % CI 1.2-1.4), and hospital volume (vs. high: low OR 1.2; 95 % CI 1.1-1.3). Predictors of laparoscopic appendectomy were age, ethnicity, insurance status, comorbidities, and hospital location. Conclusions: Laparoscopic appendectomy is increasing but is unevenly deployed across patient groups. Appendectomy patients were increasingly older, with more comorbidities and with increasing rates of obesity. Black patients and patients with public insurance had less utilization of laparoscopy and inferior outcomes. [ABSTRACT FROM AUTHOR]

Background: In spite of improvement in modern diagnostic technology, diagnosis of appendicitis based on clinical suspicion, leads to removal of normal appendix. Sometimes, Modified Alvardo Score system is helpful in minimizing the same. Aim: To evaluate the sensitivity and specificity of Modified Alvarado Score (MAS) and Ultrasonography (USG). Material and Methods: 350 patients suspected of acute appendicitis were admitted, investigated and treated. They were evaluated using Modified Alvarado Scoring and all cases were subjected to ultrasonography. The sensitivity and specificity of Modified Alvarado Score and Ultrasonography were correlated with histopathological findings. Results: Modified Alvarado score ≥7 was seen in158 patients in whom 151(95.60%) had histopathologically proved acute appendicitis and 7 (4.43%) patients were histopathologically negative. Modified Alvarado score <7 was observed in 192 patients among whom 81 (42.19%) were histopathologically proved acute appendicitis and 111 (57.81%) patients were histopathologically negative. Among 158 with Modified Alvarado Score ≥ 7, 152 (96.2%) were ultrasonographically diagnosed as acute appendicitis and 6(3.8%) patients were ultrasonography negative. Among 192 patients those with Modified Alvarado Score <7, 97 (50.52%) were ultrasonographically diagnosed as acute appendicitis and 111 (57.8%) patients were histopathologically negative. Conclusion: An application of Modified Alvarado Scoring system and USG preoperatively as a protocol in patients with suspected appendicitis, the sensitivity is 98.44% for MAS and 98.33% for USG and specificity is 94.4% for Modified Alvarado Scoring and 90% for USG. In acute appendicitis, MAS is a good diagnostic indicator, and it is highly sensitive in diagnosis of appendicitis. Combined use of MAS and USG is very effective in diagnosis of appendicitis and it helps in reducing number of negative appendicectomy. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis [ABSTRACT FROM AUTHOR]

Background: Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013. Materials and Methods: Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients) and non-operated (260 patients) the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients. Results: Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis. Conclusion: Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis (AA) is one of the most common reasons for emergency surgery within the abdominal cavity in Poland. Aim: To compare outcomes of surgical treatment of AA using both classical (OA) and laparoscopic methods (LA). Material and methods: Retrospective analysis of 299 patients (157 men and 142 women) operated on in 2008--2011 due to AA. The following comparisons between LA and OA were done: mean operative time, mean hospital stay after surgery, conversion rate, proportion of LA to OA in successive years. Results: Laparoscopic appendectomy was performed in 170 (56.9%) patients (74 men and 96 women), whereas OA was done in 89 (29.8%) patients (44 men and 45 women). In 13.4% of patients (24 men and 16 women) conversion from LA to OA was done. Mean operating time was 53.4 ±16.1 min (range: 25--100 min) for LA, and 55.4 ±20.2 min (range: 20--140 min) for OA; p = 0.64. Mean hospital stay after LA was 4.0 ±1.2 days (range: 2--9 days), while it was 6.0 ±4.2 days (range: 2--28 days) after OA; p < 0.001. Laparoscopic appendectomy was 24.1% of all appendectomies performed in the year 2008, 54.1% in the year 2009, and in consecutive years 71.7% in 2010 and 65.6% in 2011. Conclusions: Laparoscopic appendectomy method did not require longer surgery times and entailed shorter hospital stays as compared with OA. In our opinion, LA should be the preferred approach in surgical treatment of AA in adults. [ABSTRACT FROM AUTHOR]

Introduction: Acute appendicitis is the most common abdominal pathology requiring emergent surgical procedure. For treatment, laparoscopic surgery is commonly performed. For appendix stump closure different procedures are used. Aim: Evaluation of the results of patients in whom the stump of the appendix was closed with a hand-made loop during laparoscopic appendectomy (LA). Material and methods: Patients in whom the stump of the appendix was closed with a hand-made loop during LA were included in the study. Reports of patients were collected from patient files retrospectively. Laparoscopic appendectomy was applied through 3 ports. Two loops were placed in the stump of the appendix. Loop was a modification of the Roeder loop that has been described in the literature and has been shown to be safe. Results: Sixty-one patients were included in the study. Twenty-four of them (39%) were female, 37 of them (61%) were male. The age range is from 13 to 60 (average age is 30) years. During the postoperative period, one surgical wound infection and two intraabdominal abscesses were detected. There was no leakage from the stump of the appendix in any patients. Conclusions: One of the most important components of cost of LA is the technique of closure of the stump. Stapler, endoloop, various clips or a hand-made loop could be used for closure. We recommend using a hand-made loop for closure as an easy, safe and cheap method. [ABSTRACT FROM AUTHOR]

Purpose: To determine the rate of negative appendectomy and clarify the causes of negative appendectomy in patients with clinically suspected acute appendicitis who had surgery after 64-section helical computed tomography (CT). Material and Methods: A retrospective analysis of 1057 patients who had appendectomy after 64-section helical CT was performed to determine the rate of negative appendectomy. The 64-section helical CT examinations obtained with submillimeter and isotropic voxels in the patients with negative appendectomy were analyzed by two readers and compared to clinical, operative and histopathological reports, discharge summaries and original radiology reports. Results: The negative appendectomy rate was 1.7% (18/1057). Appendix enlargement (N6 mm) and fat stranding were present in 17 (17/18; 94%) and 6 patients (6/18; 33%), respectively. In 13 patients (13/18; 72%) 64-section helical CT findings were consistent with acute appendicitis. Interpretive errors in original imaging reports were identified in five patients (5/18; 28%). Conclusion: The preoperative use of 64-section helical CT results in a very low rate of negative appendectomy. Patients with negative appendectomy have 64-section helical CT findings consistent with a diagnosis of acute appendicitis in the majority of cases. Interpretive errors are less frequent. [ABSTRACT FROM AUTHOR]

Introduction: Abscess formation and perforation are complications of acute appendicitis that lead to localized or generalized peritonitis. The long-term implications of complicated appendectomy remain largely unknown. Materials and methods: In the present study, it was investigated whether patients with complicated appendicitis experienced more abdominal complaints after long-term follow-up when compared to uncomplicated cases. In addition, the influence of operation technique (open versus laparoscopic) was studied. A retrospective analysis of 1,481 appendectomies for acute appendicitis was performed in two centers from January 2000 until January 2006. Demographic data, operative reports, intraoperatively adhesions and complications, abdominal pain, and satisfaction were monitored. In total, 1,433 patients were invited to fill out a questionnaire with a median follow-up of 7.1 years. Questionnaires of 526 (37 %) patients were suitable for analysis. Results: Perforation, abdominal abscesses, or adhesions at initial operation did not result in more abdominal complaints when compared to appendectomy for uncomplicated acute appendicitis. Additionally, no significant differences in abdominal complaints were seen between laparoscopic and open techniques. Conclusion: In conclusion, the results of our study show that after follow-up of 7 years, the incidence of abdominal complaints was not influenced by operative technique or whether acute appendicitis was complicated or not. This finding does not support a causative role for adhesions with regard to chronic abdominal complaints. Our data enables surgeons to inform their patients about the long-term results of appendectomy, whether it was complicated or not. [ABSTRACT FROM AUTHOR]

Background Children with acute abdominal pain represent most of the admitted cases to the pediatric surgical department, one third of these cases are acute appendicitis. Early diagnosis of "no appendicitis" or "appendicitis" on the basis of pediatric appendicitis score could potentially save emergency department's time and resource use and could avoid time cost and risks for further evaluation. Objective Evaluation of Samuel scoring system in diagnosing children with acute appendicitis and their need for surgery. Methods One hundred and twelve patients aged between 5 to 15 years who presented with abdominal pain suggestive of acute appendicitis were studied. A complete data from patients were analyzed by using Samuel score. The clinical findings used by previously mentioned scoring system were analyzed to determine reliability of pediatric appendicitis score (PAS). The Final diagnosis was determined by histopathological report for patients' undergone appendicectomy. Results The mean (median, SD) score for children with acute appendicitis and non-acute appendicitis were 4.9 (5, 1.8) and 4.6 (5, 1.7) respectively. No variable (of the known signs and symptoms regarded as pathognomonic for acute appendicitis) shows a significant value in the diagnosis of acute appendicitis. A PAS of ≥ 4 had a sensitivity, specificity, Positive predictive value (PPV), and Negative predictive value (NPV) of 0.78, 0.27, 0.87, and 0.16 respectively. Conclusion The diagnosis of acute appendicitis and the need for surgery is still a matter of clinical judgment which can be built with practice, and although the PAS could provide useful diagnostic information in children with suspected acute appendicitis, it cannot be used as sole method for determining the need for surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate if the presence and distribution of intraluminal air in the appendix contributes to the computed tomography (CT) diagnosis of appendicitis. We identified 100 consecutive patients (57 men and 43 women; mean age, 38) with CT prior to appendectomy for acute appendicitis over a 5-year period and a control group of 100 consecutive patients (29 men and 71 women; mean age, 39) who underwent CT for acute abdominal pain without appendicitis. Patients were scanned using multidetector row CT scanners at 1.25 or 5-mm slice thickness, peak tube voltage of 120 kVp, and milliamperse automatically adjusted to attain a noise index of 12. Ninety-two of 100 study patients and 95 of 100 controls received 150 mL intravenous contrast. Two independent readers noted the presence and distribution pattern of intraluminal air in the appendix, appendiceal diameter, wall hyperemia, wall thickening (>3 mm), and wall stratification and presence of any secondary signs of appendicitis including fat stranding and free fluid. Data were compared between groups using Fisher's exact test and Student's t test. Intraluminal air in the appendix was more common in control patients versus patients with appendicitis (66 of 100 versus 27 of 100, p < 0.001). No significant differences in the patterns of intraluminal air were found between cases and controls. Among appendicitis cases, there was no significant difference in mean appendiceal diameter (12.8 versus 12.0, p = 0.20) or number of CT signs of appendicitis (1.93 versus 1.86, p = 0.78) in cases with intraluminal air versus without. No case of appendicitis demonstrated intraluminal air without secondary signs of appendicitis. Although intraluminal air is sometimes assumed to exclude a diagnosis of appendicitis, it is actually a common finding seen in up to 27 % of cases at CT. The pattern of intraluminal air was not helpful in differentiating a normal appendix from appendicitis. [ABSTRACT FROM AUTHOR]

Purpose: Previous authors have suggested that a diverticulum of the vermiform appendix has a higher risk of perforation than acute appendicitis. Therefore, this study compared appendiceal diverticulitis with acute appendicitis to explain the characteristics of appendiceal diverticulitis. Methods: Data for this study came from a retrospective analysis at the Department of Surgery at Fukuoka Tokushukai Hospital from January 2005 to June 2008. Twelve cases of appendiceal diverticulitis and 378 cases of acute appendicitis were analyzed. Results: The patients with appendiceal diverticulitis were older than those with acute appendicitis (42.7 ± 15.4 vs. 29.1 ± 17.7; p = 0.009). The white blood cell (WBC) level was lower (11332 ± 4658 vs. 14236 ± 3861; p = 0.011) and the CRP level was higher (8.65 ± 8.94 vs. 4.34 ± 6.34, p = 0.022) in those with appendiceal diverticulitis than in those with acute appendicitis. A preoperative diagnosis for appendiceal diverticulitis was made in 4 out of 12 (33.3%) by ultrasonography (US). The perforation rate was higher in appendiceal diverticulitis than that in acute appendicitis (33.3 vs. 9.8%; p = 0.009). Conclusions: Appendiceal diverticulitis is more likely to perforate over the progression of the clinical course, which would mandate appendectomy when appendiceal diverticulitis is detected by US, even if the patient has no severe abdominal pain. [ABSTRACT FROM AUTHOR]

Purpose: Different techniques, including clips, have been used to close the stump in laparoscopic appendectomy. The aim was to investigate the results after application of a newly developed titanium clip for this operation. Methods: From June 2008 to February 2010, 104 patients from two different hospitals undergoing laparoscopic appendectomy were included in this prospective study. Closure of the appendix base was generally intended with a titanium double-shanked clip (DS-Clip). The variables of interest were intra-and postoperative complications, operation time and hospital stay. Furthermore, an evaluation of the clip's practicability by the surgeon was performed using a standardised questionnaire. Results: In 104 patients screened intraoperatively, four patients had to be excluded as the operating surgeon felt that the clip was not adequate for closing the stump, generally because of severe inflammation of the base of the appendix with involvement of the caecum. One patient developed an intra-abdominal abscess which had to be drained interventionally; no reoperations were necessary. The overall complication rate, the operation time and the hospital stay were well comparable with other devices for appendix stump closure such as staplers, loops or polymeric clips. The practicability of the clip was mainly rated as excellent or good by the operating surgeons. Conclusion: This study suggests that the presented titanium DS-Clip is a safe and cost-effective technique for securing the appendix base in laparoscopic appendectomy. The application is easy and can be learned quickly, making it a good option also for teaching hospitals. [ABSTRACT FROM AUTHOR]

Background: Emergency surgical procedures frequently must be performed at times when availability of adequately trained personnel is problematic yet the requirements for maintaining surgical quality and patient safety remain unchanged. This report aims to describe a safe, effective, transumbilical, one-port laparoscopic technique for appendectomy that can be performed by one surgeon. Methods: Between January 2006 and December 2008, transumbilical one-port laparoscopic appendectomy (TOPLA) was used by two pediatric surgeons in the authors' department to treat 152 consecutive patients presenting with simple and complicated appendicitis. With the patient placed in the Trendelenburg position and rotated to the left, a single surgeon was easily able to perform the procedure using a 10-mm 0° operative laparoscope (Karl Storz) with a 5-mm working channel. The appendix was lifted with transabdominal suspensory sutures to facilitate its removal. The results were compared with those for 112 patients receiving open appendectomy (OA) during the same period. Results: The operative time was significantly shortened using TOPLA (mean, 61.5 min) compared with using OA (mean, 118.3 min) ( p = 0.000). Despite significantly higher numbers of patients with complicated appendicitis enrolled in the TOPLA arm of the study, the rate of wound infection was significantly lower after TOPLA (0%, 0/152) than after OA (9.8%, 11/112) ( p = 0.000). The number of patients requesting intramuscular or intravenous analgesics for pain relief was significantly lower after TOPLA than after OA. The overall results for TOPLA were comparable with those for the more common three-port laparoscopic procedure, but it offers the alternative of having an inconspicuous scar hidden within the umbilicus. Conclusion: This report describes a simple and safe laparoscopic procedure that offers an effective way for one surgeon to treat simple and complicated appendicitis through a single port with satisfactory cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Background: Currently, laparoscopic appendectomy (LA) provides a safe and effective alternative to open appendectomy (OA), but its use remains controversial. This study aimed to evaluate the efficiency and safety of LA through a metaanalysis. Methods: Randomized controlled trials (RCTs) comparing LA and OA published between January 1992 and February 2010 were included in this study. Strict literature appraisal and data extraction were carried out independently by two reviewers. A metaanalysis then was performed to evaluate operative time, hospital cost, postoperative complications, length of analgesia, bowel function recovery, day liquid diet began, hospital stay, and return to work and normal activity. Results: The metaanalysis comprised 25 RCTs involving 4,694 patients (2,220 LA and 2,474 OA cases). No significant differences were found between the LA and OA groups in terms of age, gender, body mass index (BMI), or type of appendiceal inflammation. Compared with OA, LA showed advantages of fewer postoperative complications (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55-0.98; p = 0.04), less pain (length of analgesia: weighted mean difference [WMD], −0.53; 95% CI, −0.91 to −0.15; p = 0.007), earlier start of liquid diet (WMD, −0.51; 95% CI, −0.75 to −0.28; p < 0.0001), shorter hospital stay (WMD, −0.68; 95% CI, −1.02 to −0.35; p < 0.0001), and earlier return to work (WMD, −3.09; 95% CI, −5.22 to −0.97; p = 0.004) and normal activity (WMD, −4.73; 95% CI, −6.54 to −2.92; p < 0.00001), but a comparable hospital cost (WMD of LA/OA ratio, 0.11; 95% CI, −0.18 to 0.40; p = 0.47) and a longer operative time (WMD, 10.71; 95% CI, 6.76-14.66; p < 0.00001). Conclusion: Despite the longer operative time, LA results in less postoperative pain, faster postoperative rehabilitation, a shorter hospital stay, and fewer postoperative complications than OA. Therefore, LA is worth recommending as an effective and safe procedure for acute appendicitis. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis in an inguinal hernia that has been called as "Amyand's Hernia" since the day on which Claudius Amyand has described the condition. That was the first appendectomy ever reported in the literature. The incidence of acute appendicitis in an inguinal hernia is 0,13 % of all cases with acute appendicitis. Herein, the patients diagnosed with Amyand's hernia are evaluated retrospectively. Methods: The clinical, laboratory and radiological findings in patients with Amyand's hernia between 2005 and 2008 are evaluated. Results: In this period, 2250 patients with hernia were operated and hernioplasty was performed. Amyand's hernia was diagnosed in only 21 patients. The age ranged from 18 to 78 years (median, 55 years). The most common symptoms were right inguinal mass and abdominal pain, and the most common findings were right inguinal mass and right lower quadrant tenderness. Leukocytosis and neutrophilia were detected in 4 patients. Appendectomy plus hernioplasty in 8 patients and appendectomy plus mesh hernioplasty in 9 patients were performed. Conclusion: When diagnosed in the operating room, appendectomy through herniotomy is the procedure of choice in Amyand's hernia. Herein we report 21 cases with Amyand's hernia and review the literature. [ABSTRACT FROM AUTHOR]

Background: There continues to be controversy about the necessity of interval appendectomy for delayed presentation of acute appendicitis. While recent studies suggest that the risk of recurrent disease is small, the risk of interval appendectomy is also small and does provide histologic identification and usually definitive treatment of the right lower quadrant inflammatory process. Methods: A retrospective analysis of medical records gathered from 2002 to 2007 at a major teaching hospital of 986 adult patients over the age of 13 with appendicitis were analyzed. Forty-six patients (5%) were found to have right lower quadrant abscess or phlegmon, and were managed with intravenous antibiotics. Some patients also underwent percutaneous drainage. These patients were then readmitted 6 to 26 wk later for an elective laparoscopic interval appendectomy. Results: There were 19 males and 27 females with an average age of 43 y. Ninety-four percent of the appendectomies were completed laparoscopically; 16% of patients were found to have a normal or obliterated appendix on pathologic evaluation and likely did not benefit from interval appendectomy. On the other hand, 84% of patients had persistent acute appendicitis, chronic appendicitis, evidence of inflammatory bowel disease, or neoplasm identified, and likely benefited from surgical appendectomy. Conclusions: Interval appendectomy provides diagnostic and therapeutic benefit to patients who present with a right lower quadrant abdominal inflammatory focus, and should be carefully considered in all adult patients. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the commonest surgical emergencies worldwide. There is considerable variation in prevalence of appendicoliths with appendicitis. Most of the patients with appendicoliths are asymptomatic and they are not pathognomic for acute appendicitis. However, appendicoliths show increased association with perforation and abscess formation. Appendicolith are quite common, being present in 3% of general population and in nearly 10% cases of appendicitis. However, giant appendicoliths measuring over 2 centimeters (cms) are extremely rare. Computed Tomography (CT) has increased their pre-operative diagnosis considerably. Use of spectral analysis can give us the details of composition of the stone pre-operatively. We present a young male diagnosed pre-operatively on Non-Contrast Computed Tomography (NCCT) to have a giant calcium struvite appendicolith. On laparoscopy he had a 3 cm stone and an incidental Meckel's diverticulum and underwent appendectomy. The case is presented for the unique size of the appendicolith alongwith review of literature. [ABSTRACT FROM AUTHOR]

Objective: Appendicitis is an acute and common pathology that needs surgery. In the USA, acute appendicitis occurs in approximately 7% of the general population. Laparoscopic surgery is the surgical method of choice for the treatment of acute appendicitis but this technique is not available in periphery of Pakistan. In this study a new method of appendectomy with minimal skin incision has been introduced that can be comparable with laparoscopic appendectomy. Material & Methods: We studied 100 patients with acute appendicitis who underwent open appendectomy with minimal skin incision in Bacha Khan Medical Complex, Shah Mansoor, Swabi. Under general anaesthesia and in the supine position, the skin was incised as long as 2 cm over the McBurney point. Open appendectomy was performed through this minimal incision. The patients were monitored for 24 hours in the hospital. All the patients were examined in outpatient department after two days of their discharge. Results: One hundred patients were evaluated in this study. There were 56 men (56%). The mean of the patients' age was 12.4 ± 8.2 (± SD) year. The duration of the anaesthesia and surgery were 56 ±14 and 38 ± 8 minutes respectively. We also found that the time to liquid intake was 12 ± 3 hours, and the duration of hospital stay was 24 ± 2 hours. The mean of pain intensity in the post-op period was 2.8 ± 1 (± SD). There were few surgical complications such as wound or intra-abdominal infection, however there was no need for re-operation. Conclusion Laparoscopic appendectomy has a higher cost than open appendectomy and laparoscopic surgery is not always available everywhere in Pakistan, particularly in Khyber Pakhtunkhwa. We showed in this study that by using 'the appendectomy with minimal skin incision' the length of surgery, the length of anaesthesia, the length of hospital stay, the need for opioids and/or analgesics in the post-op period and post-op complications were within acceptable limits and also comparable to other reports of appendectomy. We can conclude that on the basis of this preliminary study, appendectomy with minimal skin incision can be recommended to those surgeons who do not have access to any kind of laparoscopic facilities. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic appendectomy becomes a usual method in the treatment of acute appendicitis, although its advantage over open appendectomy has been proven. In Bosnia and Herzegovina, a few medical centers are introducing laparoscopic appendectomy as a method of treatment of acute appendicitis. In this study we want to compare different methods of treatment of acute appendicitis. Patients and Methods: During 20 months we have analyzed 498 patients operated due to acute appendicitis. We followed the duration of operation, total hospitalization stay, complications of surgical procedure and reasons of conversion in patients operated by laparoscopic approach. Results: The duration of operation was 96 minutes in the group operated by open approach and 107 minutes in the group operated by laparoscopic approach. Total hospitalization stay was 3.9. days in the group operated by open approach and 2.3. days in the group operated by laparoscopic approach. The most frequent complication in the group operated by open approach was infection of the operative wound (56/452) and ileus (5/452), and in the group operated by laparosocopic approach ileus (1/46) was the most frequent complication. Conclusion: The patients operated by laparoscopic approach have fewer risk of wound infection, and the hospital stay is shorter. With the increase of surgeon's experience this method of treatment of acute appendicitis will become a method of choice. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. Impact of previous abdominal surgery on laparoscopic appendectomy has not been previously reported.Methods: From January 2001 to December 2005, 2029 patients with clinically suspected acute appendicitis underwent laparoscopic surgery in our hospital. Of these, 234 patients (11.5%) were found to have other pathology by intraoperative or histologic findings and were excluded from the study. The 1795 patients who underwent laparoscopic appendectomy for acute appendicitis were divided into three groups: group 1, patients without a history of previous abdominal surgery (n = 1652, 92%); group 2, patients with a history of upper abdominal surgery (n = 20, 1.1%); group 3, patients with a history of lower abdominal surgery (n = 123, 6.8%). Data were collected retrospectively by chart review and analyzed for conversion rate, operative time, intraoperative and postoperative complications, and hospital stay.Results: Of the 1795 patients, 13 (0.7%) were converted to open appendectomy because of technical difficulty. Overall mean operative time was 57.2 (range, 20-225) min. There was no mortality or intraoperative complications. Overall postoperative complication rate was 10.7% (n = 193): rate of surgical wound infection was 8.2% (n = 147), surgical wound seroma 1.3% (n = 24), and intra-abdominal abscess 0.8% (n = 14). Overall postoperative hospital stay averaged 3.2 (range, 0-39) days. There were no significant differences between the three groups regarding the conversion rate (0.8% vs. 0% vs. 0%, p = 0.567), operative time (57.3 vs. 55.8 vs. 56.9 min, p = 0.962), postoperative complication rates (10.7 vs. 10 vs. 12.2%, p = 0.863), and hospital stay (3.2 vs. 3.6 vs. 3.1 days, p = 0.673).Conclusions: Previous abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to retrospectively analyze the last 100 consecutive emergency appendectomies performed in the authors’ institution, which is a community-based teaching hospital, and look at the accuracy of the CT scan in the diagnosis of acute appendicitis. Design: Retrospective clinical study. Setting: A 600-bed community-based teaching hospital. Methods: The last 100 consecutive emergency appendectomies, which were performed at New York Methodist Hospital in 2004, were retrospectively analyzed. The collected data included the demographics of the patients, relevant history, physical examination, laboratory and radiological tests, and pathology results. The statistical analyses were performed using the JMP version 3.2 software (SAS Institute Inc., Cary, North Carolina). An alpha value of 0.05 was used in all statistical analyses, and p values were considered as being statistically significant at or below the alpha value of 0.05. Results: There was no statistically significant correlation between the acute appendicitis and some of the typical presenting symptoms and signs of acute appendicitis (rebound tenderness, low-grade fever, elevated white blood cell count, and anorexia). The sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan in this retrospective analysis were 96%, 75%, 98.5%, and 50%, respectively, with an overall efficiency of 95%. However, the sensitivity, specificity, positive predictive value, and negative predictive value of the CT scan increased after reevaluation of the false-positive, false-negative, and inconclusive CT results by an experienced radiologist in a blind fashion (97%, 100%, 100%, and 71%, respectively). The correlation between the CT scan and the pathology result was statistically significant when the CT result was positive or negative (p = 0.0001). Conclusion: The CT scan is indicated when the clinical presentation is equivocal, and it will be helpful if the result is positive or interpreted as negative only by an experienced radiology attending. [Copyright &y& Elsevier]

Acute appendicitis is a common occurrence in children. The current trend is to perform appendicectomy once acute appendicitis is diagnosed. The aim of this study was to evaluate the types of pathology seen in appendices removed for acute appendicitis and correlate them with clinical features. The clinical, operative and histological records of 302 children who had appendicectomy at the Jos University Teaching Hospital from 1995-2003 were retrospectively reviewed. There were 123 (40.7%) boys and 179 (59.3%) girls (m: f = 1: 1.5). Their ages ranged from 2-15 years (median: 12 years). The main symptoms and signs at presentation were right lower quadrant abdominal pain, anorexia, nausea, vomiting, right quadrant tenderness, guarding and rigidity. Clinical impressions included simple acute appendicitis in 260 and perforated appendicitis in 42 patients. Of the 302 children who had clinical diagnosis of acute appendicitis, only 144 (47.7%) were confirmed at histology. Lymphoid hyperplasia was the most common pathology seen in the appendix specimens. The clinical impressions of acute appendicitis made by the surgeon agreed with pathologists' report in 63.9% and disagreed in 36.1% of cases. Negative appendicectomy rate was 52.3%. Although appendicectomy is the most commonly performed emergency abdominal surgery in children, the procedure is still associated with a high negative appendicectomy rate. [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: Acute appendicitis is the most common acute surgical condition of the abdomen. Obstruction of the lumen is the dominant factor for acute appendicitis. Although fecaliths are the usual cause of obstruction, some unusual factors could be the reason. Aim: Our aim was to document the unusual findings in appendectomy specimens. Methods and Material: The hospital records of 2458 patients (834 F) who were diagnosed as acute appendicitis and underwent open appendicectomy during last six years were retrospective according to age, sex, histopathological diagnosis, coexisting pathologies and unusual findings on histology. Statistical Analyses: All data were stored using SPSS 9.05 for Windows. Frequency and distribution of data were analysed. Results: Unusual findings were determined in 19 (0.7%) cases by histology. Parasites were found in six (0.3%) (Enterobius Vermicularis, Balantidum Coli, Schistosoma Haematobium), mucocele in 5 (0.2%), carcinoid tumour in three (0.1%), B cell malignant lymphoma in one (0.05%), leiomyoma in one (0.05%), primary appendiceal adenocarcinoma in one (0.05%), acute appendicitis with dysplastic changes in one (0.05%) and inflammatory bowel polyp was reported in remaining one case (0.05%). Conclusion: Although unusual or coexisting pathologies can be seen rarely during appendectomy, this should be kept in mind and meticulous exploration and evaluation should be performed in each cases. [ABSTRACT FROM AUTHOR]

Background: To determine the frequency of inflammed appendices and other pathologies by histopahtological examination of appendectomy specimens. Material & Methods: All patients presenting with pain right iliac fossa, diagnosed as acute appendicitis on history and clinical examination were selected. Patient age, sex, operative findings and histopathology reports were noted. Histopathology reports were analysed according to diagnosis. Results: Out of 114 patients who were diagnosed as an acute appendicitis and underwent appendectomy, 85% reports revealed acute inflammation, 8.7% were normal while 1.7% had Meckel's diverticulitis, 2.6% showed tuberculosis, one each case was diagnosed as adenocarcinoma and carcinoid. Lymphoid hyperplasia was predominant finding in acute appendicitis. Conclusion: Beside acute inflammation, histopathlogical examination of appendicitis specimens yield important clinical information like benign and malignant pathologies. All specimens of appendectomy should be sent for histopathological examination, so as not to miss any unusual or coexisting pathology. [ABSTRACT FROM AUTHOR]

During the laparoscopic appendectomy, the base of appendix is usually secured by double endoloop ligatures or by stapler. In this article we will show our initial experience in securing the base of appendix by plastic XL hem-o-lok clip during laparoscopic appendectomy. Patient, 24 years old with acute appendicitis is admitted to the Department of Surgery. After dissection of mesoappendix and appendicular artery by ultrasonic dissector, two hem-o-lok clips are placed on the base of appendix, and another clip is placed on distal part, which will be removed. Application of clip is made by hem-o-lok XL endoscopic applier. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendectomy is a safe and effective procedure, as both a diagnostic and therapeutic tool. It seems to be more effective than the corresponding open procedure. Aim of this study is to evaluate a group of patients randomly allocated either to laparoscopic appendectomy (LA) or to open appendectomy (OA).Methods: From January 1998 to December 2002, 252 consecutive and nonselected patients, 155 women and 97 men, were randomized either to LA or OA. Recorded data were operative time, postoperative length, of stay and complications.Results: Mean operative time was 45 min (range 30-120) for OA and 36 min (25-60) for LA, mean postoperative stay was 5.5 days (4-12) for OA and 3.4 days (2-8) for LA. Complication occurred in 20 patients (14.5%) for OA and in four patients (2.6%) for LA.Conclusion: We believe that LA is effective in any kind of clinical situation, with low traumatic impact and best comfort for the patient. [ABSTRACT FROM AUTHOR]