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Background: To define the benefits of different methods for diagnosis of pediatric appendicitis in Taiwan, a nationwide cohort study was used for analysis.Methods: We identified 44,529 patients under 18 years old who had been hospitalized with a diagnosis of acute appendicitis between 2003 and 2012. We analyzed the percentages of cases in which ultrasound (US) and/or computed tomography (CT) were performed and non-perforated and perforated appendicitis were diagnosed for each year. Multivariate logistic regression analyses were performed to evaluate risk factors for perforated appendicitis.Results: There were more cases of non-perforated appendicitis (N = 32,491) than perforated appendicitis (N = 12,038). The rate of non-perforated cases decreased from 0.068% in 2003 to 0.049% in 2012; perforated cases remained relatively stable at 0.024%~0.023% from 2003 to 2012. The percentage of CT evaluation increased from 3% in 2003 to 20% in 2012; the rates of US or both US and CT evaluations were similar annually. The percentage of neither CT nor US evaluation gradually decreased from 97% in 2003, to 79% in 2012. The odds ratios of a perforated appendix for those patients diagnosed by US, CT, or both US and CT were 1.227 (95% confidence interval (CI) 0.91, 1.65; p = 0.173), 2.744 (95% CI 2.55, 2.95; p < 0.001), and 5.062 (95% CI = 3.14, 8.17; p < 0.001), respectively, compared to patients who did not receive US or CT. The odd ratios of a perforated appendix for those patients 7-12 and ≤6 years old were 1.756 (95% CI 1.67, 1.84; p < 0.001) and 3.094 (95% CI 2.87, 3.34; p < 0.001), respectively, compared to those 13-18 years old.Conclusions: Our study demonstrated that using CT scan as a diagnostic tool for acute appendicitis increased annually; most patients especially those ≤6 years old who received CT evaluation had a greater risk of having perforated appendicitis. We recommend a prompt appendectomy in those pediatric patients with typical clinical symptoms and physical findings for non-complicated appendicitis to avoid the risk of appendiceal perforation. [ABSTRACT FROM AUTHOR]

Background: Conversion from laparoscopic cholecystectomy to open cholecystectomy leads to the loss of the advantages of this minimally invasive procedure and significantly increases length of hospital stay as well as cost. The conversion from laparoscopic to open cholecystectomy is more frequent among patients with acute cholecystitis and in elderly patients. This study evaluated whether fundus-first laparoscopic cholecystectomy could lower the conversion rate in geriatric patients with acute cholecystitis. Materials and Methods: During a twelve-month period, 112 patients (36 of them age 65 years or older) underwent fundus-first laparoscopic cholecystectomy for acute cholecystitis in a tertiary care university hospital in central Taiwan. Results: The conversion rate in the elderly patients was 2.7% (1/36). No major perioperative complications were observed. Minor complications—port-site infection and subhepatic fluid collection—occurred in two patients (5.5%). Conclusion: Laparoscopic cholecystectomy with a fundus-first approach is a safe, effective operative procedure for elderly patients with acute cholecystitis when performed by an experienced laparoendoscopic surgeon. [ABSTRACT FROM AUTHOR]