1. Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States
- Author
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Maria Ruiz, Sergio Huerta, Anny Hernandez-Ochoa, Gabriela Alejo, and Cesar Ortiz
- Subjects
Adult ,Hospitals, County ,Male ,medicine.medical_specialty ,media_common.quotation_subject ,03 medical and health sciences ,0302 clinical medicine ,Institution ,Medicine ,Humans ,030212 general & internal medicine ,Laparoscopy ,Hospitals, Teaching ,media_common ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General surgery ,Public health ,Public Health, Environmental and Occupational Health ,Middle Aged ,Appendicitis ,Guatemala ,United States ,Infectious Diseases ,030220 oncology & carcinogenesis ,Acute appendicitis ,Acute Disease ,Treatment strategy ,Female ,business - Abstract
Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.
- Published
- 2020