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PubMed1998

Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates.

OBJECTIVES: The purposes of this study were to investigate the use of computed tomography (CT) imaging in patients with suspected acute appendicitis and to evaluate the impact of CT on negative appendectomy and perforation rates. In patients clinically diagnosed of acute appendicitis the reported overall negative appendectomy rate is about 15-20%; 10% in men and 25-45% in women of childbearing age. This is associated with a perforation rate of 21-23%. METHODS: This is a retrospective analysis of 146 consecutive patients presenting with clinical symptoms suspicious of appendicitis over a 2-yr period in whom CT examinations were performed before therapy was instituted. The overall negative appendectomy and perforation rates were calculated for the entire group, as well as for the 54 women aged 15-50 yr in the childbearing cohort. RESULTS: The negative appendectomy rate was 4% in 122 patients operated on and the perforation rate was 22%. Among 36 women 15-50 yr of age operated on, the negative appendectomy rate was 8.3% and the perforation rate was 19%. Surgery was avoided in 24 patients, 18 of whom were women of childbearing age. CONCLUSIONS: The judicious use of CT imaging in patients with equivocal clinical presentation suspected of having appendicitis led to a significant improvement in the preoperative diagnosis. It resulted in a substantial decrease in the negative appendectomy rate compared to previously published reports, without incurring an increase in the perforation rate.

Acute Disease↗
PubMed2003

Appendectomy during childhood and adolescence and the subsequent risk of cancer in Sweden.

OBJECTIVE: Researchers have speculated that surgical excision of lymphoid tissue, such as appendectomy, early in life might confer an increased risk of cancer. In this study, we determined the risks of cancer for people who had appendectomy performed during childhood. METHODS: We studied the risk of cancer in a large Swedish cohort of children who had appendectomy performed during the period of 1965-1993. Standardized incidence ratios (SIRs) were computed using age-, gender-, and period-specific incidence rates derived from the entire Swedish population as comparison. Hospital discharge diagnosis data were used to examine cancer risks by categories of surgery, medical conditions, and type of appendicitis. The average length of follow-up was 11.2 years. RESULTS: We found no excess overall cancer risk but noted a significant excess for stomach cancer (SIR: 2.45; 95% confidence interval [CI]: 1.1-4.8) and a borderline increase of non-Hodgkin's lymphoma (NHL; SIR: 1.55; 95% CI: 1.0-2.3). The elevated risks for both cancers were only evident 15 or more years after appendectomy (stomach cancer, SIR: 3.82; 95% CI: 1.7-7.5; NHL, SIR: 2.49; 95% CI: 1.4-4.2). CONCLUSIONS: It is reassuring that there was no overall increase of cancer several years after childhood appendectomy. Increased risks for NHL and stomach cancer, occurring 15 or more years after appendectomy, were based on small absolute numbers of excess cancers. As 95% of the subjects were younger than 40 years at exit, this cohort requires continuing follow-up and monitoring.

Adolescent↗
PubMed2002

Laparoscopic versus open appendectomy: results of a retrospective comparison in an Israeli hospital.

BACKGROUND: Acute appendicitis is one of the most common conditions requiring surgical intervention. Open appendectomy has been a safe and effective operation for acute appendicitis for more than a century. Recently, several authors proposed that the new technique of laparoscopic appendectomy should be the preferred treatment for acute appendicitis. However, unlike laparoscopic cholecystectomy, LA has not yet gained popularity. OBJECTIVES: To compare open with laparoscopic appendectomy for length of operation, complications, postoperative pain control, length of hospitalization, and hospital costs. METHODS: A sample of 194 patients who underwent OA and LA during 1995 was randomly selected for the study. Patients' demographic data, preoperative laboratory and physical values, histopathologic diagnosis of removed appendix, mean operating time, length of hospitalization, and postoperative pain control and complications were reviewed. RESULTS: Acute appendicitis was confirmed in 66% of patients. The groups were similar demographically (gender and mean age). We could not find any statistical differences in intraoperative and postoperative complications and use of antibiotics. The operative time was longer in the OA group (62.4 vs. 57.3 minutes), but the difference was not statistically significant (P = 0.075). The hospital stay was 2.5 days in the LA group and 2.7 days in the OA group. Higher operative costs were observed in the LA group. CONCLUSION: Laparoscopic appendectomy is comparable to open appendectomy with regard to complications, length of operation, hospital stay, but it is more costly. Laparoscopic appendectomy does not offer any significant benefit over the open approach.

Acute Disease↗
PubMed2004

[Appendectomy by minimally invasive surgery].

OBJECTIVE: To analyze the results obtained with the laparoscopic appendectomy in a trial of 106 cases from 1997 to December of 2002 in a surgeons group. Comparing the results with the papers of the literature to qualified the safety and security of the method and to establish the advantages upon the open appendectomy. BACKGROUND DATA: The laparoscopic appendectomy is a technique that in the past ten years has proof its safety and efficacy to resolve the problems of vermiform appendix. METHODS: Prospective trial of 106 patients with probability or diagnosis of acute appendicitis approach to laparoscopic appendectomy. With statistical analysis of the data. RESULTS: 106 patients, 42 male and 62 female, average age 30.8, diagnosis of acute appendicitis before surgery of 70%, and with abdominal pain in 30%. Of the data obtained only the total count of leucocytes have the statistical value in the diagnosis of acute appendicitis. The average of surgical time was of 70.7 minutes, the average of length of hospital stay was of 74 hours. Diagnosis of acute appendicitis in 83% of the cases, normal appendix 10.3%, another pathology 6.7%. Conversion rate of 5.5% (6 patients). Abscess 3, peritonitis 1, hemorrhage 1, appendix rupture 1. Morbidity of 3.7% wound infection. Mortality 0%. CONCLUSIONS: The surgical indications for the laparoscopic appendectomy are the same that for open surgery. The technique is safe and effective that can be carried out in any patient, still in cases or perforated appendicitis or gangrenous. The success is depend of the experience of the surgical team. The wound infection, recovery time, postoperative pain are less in the laparoscopic appendectomy.

Adult↗
PubMed2006

[Clinical improvement of severe ulcerative colitis after incidental appendectomy: a case report].

Recent reports have demonstrated a negative association between appendectomy and ulcerative colitis. Many retrospective studies have shown that appendectomy appears to be protective against ulcerative colitis. Although the function of appendix is not known, all these studies have suggested that alterations in mucosal immune responses leading to appendicitis or resulting from appendectomy may negatively affect the pathogenic mechanisms of ulcerative colitis. Herein, we report a 45-year-old man who was diagnosed as severe ulcerative colitis 2 years ago. Colonoscopy revealed a feature of pancolitis. He has been treated with several courses of corticosteroids over 2 years. However, dosage of steroid was not tapered down because of the recurrence of symptoms. He was admitted with a diagnosis of acute appendicitis, and underwent appendectomy. Two months after the appendectomy, clinical symptoms and colonoscopic findings improved gradually. Two years after the appendectomy, the patient improved without the recurrences of symptoms, and is stably treated with sulfasalazine alone.

Appendectomy↗
PubMed1989

[Elective appendectomy associated with cesarean section].

A prospective study was conducted in 90 patients divided in two different groups: the first group included 45 labor patients operated of cesarean section and elective appendectomy, the second group included 45 labor patients operated of cesarean section without appendectomy (control group). The purpose was to evaluate if the elective removal of the appendix increase the postoperative morbidity. The most common indication of cesarean section was the mother-fetus disproportion (55.5%). The main type of uterine incision was the segmental transverse (over 90% of the cases). Appendectomy added 11.2 minutes to the operation time, as compared with the control group (p less than 0.01). There were 4 cases (8.8%) of decidual infection in the appendectomy group and 2 cases (4.4%) of decidual infection (one of these complicated with wound dehiscence) in the control group. Nevertheless there was not difference statistically significative in comparing the morbidity between the groups (p = 0.33). There were no complications directly attributable to elective appendectomy. It is concluded that the elective appendectomy does not increase the postoperative morbidity in labor patients undergoing cesarean section and it requires a good selection of patients to be appendectomized.

Adolescent↗
PubMed1983

Appendectomy in the surgical treatment of endometriosis.

To address the question of when to perform an appendectomy in the surgical treatment of endometriosis, a series of 500 consecutive appendectomies was reviewed. In 104 patients with pelvic endometriosis who were undergoing appendectomy, the appendix was a relatively common (13%) extragenital site of endometriosis. Gross inspection of the appendix is not sufficient to exclude endometriosis, as 38% of appendices with histologic evidence of endometriosis had a normal appearance. Patient age and the severity of endometriosis do not appear to be risk factors for appendiceal involvement. No increased postoperative morbidity was demonstrated in 65 patients who had an appendectomy when compared with a similar group of 60 patients who did not have an appendectomy. The study supports 1) removal of the appendix in patients undergoing noninfertility surgery for endometriosis, as a high prevalence of occult endometriosis was observed in this group; and 2) excision of an abnormal appendix in patients with endometriosis during infertility surgery although appendectomy for occult involvement is not supported in this group.

Appendectomy↗
PubMed1994

[Initial experience with laparoscopic appendectomy].

On the basis of analysis of their personal experience and the literature data, the authors claim that appendectomy under control of a laparoscope is an alternative to the traditional operation. Laparoscopic appendectomy was conducted in patients with acute and chronic appendicitis. The indication for appendectomy in chronic form of the disease is determined by the results of complete clinical examination and laparoscopic inspection of the region of the right iliac fossa, which is undertaken before each operative intervention. The authors performed laparoscopic appendectomy with the use of a monitor which made it possible for the operating team to watch the operation. The base of the process was ligated with an endoligature or compressed with clips, and then cutoff by means of high frequency current. The stump of the process was not buried in the cupula of the cecum. Laparoscopic appendectomy for chronic appendicitis was performed, as a rule, as a simultaneous intervention in laparoscopic cholecystectomy or operations undertaken for other diseases. The authors did not encounter in the postoperative period any complications associated with appendectomy. The postoperative period was somewhat easier than after the traditional intervention. The motor activity of the patients was completely restored as early as the second-third day. Experience shows competence of such operations.

Acute Disease↗
PubMed1993

Incidental appendectomy during nephrectomy for Wilms' tumor.

Incidental appendectomy is frequently performed during nephrectomy for Wilms' tumor. The rationale for this approach is that the onset of appendicitis during a period of neutropenia after chemotherapy may cause increased morbidity. Additionally, children receiving chemotherapy or radiation therapy, or both, may experience abdominal pain, producing a diagnostic dilemma if the appendix is still present. We reviewed the charts of 1,910 children enrolled in the Third National Wilms' Tumor Study who underwent primary nephrectomy. Four hundred and fifty-five patients (23.8 percent) had appendectomy at the time of nephrectomy. An inversion appendectomy was performed upon 188 patients, and the appendix was excised in 267. Infectious complications and postoperative intestinal obstructions occurred with equal frequency in children who did or did not undergo appendectomy. The median follow-up period for the entire group of patients was 5.1 years. Only three of the 1,455 children (0.2 percent) who did not have an incidental appendectomy had appendicitis at two, seven and ten months after nephrectomy. None of the three children experienced any perioperative morbidity after appendectomy. These data suggest that incidental removal of the appendix is not essential for children undergoing removal of a Wilms' tumor.

Appendectomy↗
PubMed1996

[Diagnostic problems in acute appendicitis and indications for laparoscopic appendectomy].

A retrospective study analyzing the outcome of 400 appendectomies for acute appendicitis in two different hospitals revealed a negative appendectomy rate of over 25%. As a consequence we altered the operative strategy by employing diagnostic laparoscopy in combination with laparoscopic appendectomy in all uncertain cases while still carrying out a conventional appendectomy when there was diagnostic certainty. Preliminary results show that laparoscopic appendectomy is a safe procedure and that the new concept reduces the negative appendectomy rate.

Acute Disease↗
PubMed1996

[Technique and significance of stump management for outcome of laparoscopic appendectomy].

We compared 140 appendectomies in a prospective study with regard to length of operation, stay in hospital and intra- and postoperative complications. We operated by four methods and made up four groups, 35 patients in each: (1) application of RODER-loop and manual stump-sinking; (2) application of RODER-loop without manual stump-sinking; (3) application of Endo-GIA; (4) conventional appendectomy according to McBurney. Intraoperative complications occurred mainly in laparoscopic appendectomy, while disturbances of wound-healing were observed mainly in conventional appendectomy. The analysis of postoperative complications in laparoscopic appendectomy showed the most complications in the second group (RODER-loop without stump-sinking), while using the Endo-GIA involved only a little risk. In a clear situs the laparoscopic appendectomy with the RODER-loop with manual stump-sinking is recommended; in cases with a difficult preparation or advanced appendicitis the application of the Endo-GIA is a safe technique with the best results.

Appendectomy↗
PubMedDate not supplied

A comparison of laparoscopic and open appendectomy.

BACKGROUND AND OBJECTIVES: To compare laparoscopic appendectomy with traditional open appendectomy. METHODS: Seventy-one patients requiring operative intervention for suspected acute appendicitis were prospectively compared. Thirty-seven patients underwent laparoscopic appendectomy, and 34 had open appendectomy through a right lower quadrant incision. Length of surgery, postoperative morbidity and length of postoperative stay (LOS) were recorded. Both groups were similar with regard to age, gender, height, weight, fever, leukocytosis, and incidence of normal vs. gangrenous or perforated appendix. RESULTS: Mean LOS was significantly shorter for patients with acute suppurative appendicitis who underwent laparoscopic appendectomy (2.5 days vs. 4.0 days, p < 0.01). Mean LOS was no different when patients classified as having gangrenous or perforated appendicitis were included in the analysis (3.7 days vs. 4.1 days, P = 0.11). The laparoscopy group had significantly longer surgery times (72 min vs. 58 min, p < 0.001). There was no significant difference in the incidence of postoperative morbidity. CONCLUSIONS: Laparoscopic appendectomy reduces LOS as compared with the traditional open technique in patients with acute suppurative appendicitis. The longer operative time for the laparoscopic approach in our study is likely related to the learning curve associated with the procedure and did not increase morbidity.

Appendectomy↗
PubMed1992

Bilateral atrial appendectomy abolishes increased plasma atrial natriuretic peptide release and blunts sodium and water excretion during volume loading in conscious dogs.

The atrial appendages contain most of the atrial natriuretic factor (ANF) in the mammalian heart, and atrial appendage mechanical function predicts ANF secretion during volume loading. To demonstrate the crucial role of the atrial appendages in ANF release, we first measured hemodynamics and changes in plasma ANF after injection of 1,000 ml i.v. normal saline in conscious dogs and again after bilateral atrial appendectomy; we next measured changes in renal function using infusions of atriopeptin 24 to achieve plasma levels corresponding to levels achieved during volume loading; and we lastly measured renal function during acute volume expansion and also after atrial appendectomy. Plasma ANF increased from 65 +/- 11 to 246 +/- 54 pg/ml after volume loading but did not increase after atrial appendectomy. Atrial appendectomy did not alter the tachycardia or hemodynamic effects of volume loading. Infusion of 10 ng/kg/min atriopeptin 24 increased plasma ANF from 50 +/- 9 to 234 +/- 54 pg/ml, increased urine output 34 +/- 10%, and increased sodium excretion 62 +/- 10% in dogs with intact atrial appendages. Renal function was compared in dogs before atrial appendectomy: 20, 40, and 60 minutes after volume loading, urine flow rate increased by 5.9 +/- 0.5, 6.9 +/- 0.4, and 4.4 +/- 0.8 ml/min, while sodium excretion increased by 717 +/- 60, 839 +/- 84, and 582 +/- 57 mueq/min. After atrial appendectomy urine flow rate increased 2.1 +/- 0.7, 2.7 +/- 0.7, and 2.0 +/- 0.6 ml/min, and sodium excretion increased only by 327 +/- 110, 324 +/- 77, and 340 +/- 92 mueq/min (p less than 0.01) during volume loading.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Altered left atrial compliance after atrial appendectomy. Influence on left atrial and ventricular filling.

Previous studies have shown regional differences in atrial distensibility. We studied 12 open-chest dogs to test the hypothesis that left atrial compliance is decreased after removal of the left atrial appendage and to determine the effect of altered atrial compliance on atrial reservoir and conduit function. Sonomicrometer crystal pairs were used to measure the long- and short-axis diameters of the left atrium over a wide range of intracardiac pressures and volumes obtained by intravenous hetastarch infusion both before and after suture ligation of the left atrial appendage (appendectomy). Pulmonary venous flow was measured with an ultrasonic flowmeter, and transmitral flow velocities were measured with transesophageal Doppler echocardiography. After appendectomy, the diastolic pressure-volume relation was shifted upward and to the left in six of seven dogs. The mean dynamic stiffness constant of the left atrial diastolic pressure-volume relation was significantly greater after appendectomy than before (0.20 +/- 0.11 [mean +/- SD] versus 0.14 +/- 0.08 ml-1, p < 0.01); the mean y intercept was slightly, but significantly, less after appendectomy (0.6 +/- 0.3 versus 1.3 +/- 0.6 mm Hg, p < 0.05). The left atrial reservoir volume (maximum minus minimum left atrial volume) was significantly less after appendectomy at matched left atrial pressures. The systolic to diastolic flow integral ratio of pulmonary venous flow (JFTI/KFTI), an index of the relative reservoir to conduit functions of the left atrium, increased significantly with volume infusion only before appendectomy; at matched left atrial pressure, JFTI/KFTI was significantly less afterwards.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Pitfalls in nonrandomized outcomes studies. The case of incidental appendectomy with open cholecystectomy.

OBJECTIVES: To assess the short-term outcomes of incidental appendectomy through analysis of hospital administrative data and determine the consistency and plausibility of the observed results. DESIGN: Population-based historical cohort study. SETTING: All general hospitals in Ontario between 1981 and 1990. PATIENTS: Patients undergoing open primary cholecystectomy with (7846 exposed) and without (191,599 unexposed) incidental appendectomy. MAIN OUTCOME MEASURES: In-hospital fatality rates, complication rates, and lengths of hospital stay. RESULTS: Crude comparisons showed a striking and paradoxical reduction in mortality after cholecystectomy when incidental appendectomy was performed (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23 to 0.57; P < .001); mean length of stay was also lower by -0.46 day (P < .001). After adjustment for confounding differences, such as comorbidity and nonelective surgery, mortality and lengths of stay were similar for exposed and unexposed patients; but exposed patients showed a significant increase in nonfatal complications (OR, 1.53; 95% CI, 1.39 to 1.68; P < .001). Adverse effects from incidental appendectomy emerged consistently for all three outcomes only after restricting the analysis to subgroups of patients at low surgical risk. The increased mortality for exposed patients was largest among low-risk groups; for example, among those younger than 70 years undergoing elective surgery, the OR was 2.65 (95% CI, 1.25 to 5.64; P < .001). CONCLUSION: These findings suggest that incidental appendectomy is associated with a small but definite increase in adverse postoperative outcomes. However, plausible and consistent findings were only obtained after restricting the analysis to low-risk subgroups in which unmeasured differences in patients' baseline characteristics were less likely to confound adjusted outcome comparisons. This exercise highlights the potential pitfalls in nonrandomized outcomes comparisons using data sources with limited clinical detail, such as hospital discharge abstracts.

Adult↗
PubMed2002

[Open vs. laparoscopic appendectomy].

This article discusses the question of whether open or laparoscopic appendectomy is preferable in today's clinical routine. The article is based on data from randomized studies, evaluation of meta-analyses, and data from nonrandomized, multicentric studies evaluating the treatment of appendicitis in routine clinical practice. According to the data analysis, open appendectomy (OA) offers advantages with regard to a significantly shorter operative time and lower hospital costs. Laparoscopic appendectomy (LA) is characterized by a significantly decreased rate of failed septic wound healing and faster recovery. Both procedures can be performed with the same degree of safety and comparable outcome for acute appendicitis. Laparoscopic appendectomy offers significant advantages for establishing a precise diagnosis in young fertile women and overweight patients suffering from lower abdominal pain. The currently available data do not provide precise guidelines for the treatment of perforating appendicitis. However, we found significant evidence indicating an increased rate of postoperative intra-abdominal abscess after laparoscopic appendectomy. Thus, a laparoscopic approach cannot be regarded as a standard technique in advanced appendicitis.

Abdominal Abscess↗
PubMedDate not supplied

Computed tomography of superior mesenteric vein thrombosis following appendectomy.

During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after an appendectomy. No sign of SMV was present at appendectomy, and a period of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, the appendicitis was complicated. These patients had nonspecific signs and symptoms, although two of them had elevation of blood hepatic enzyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an intraluminal clot. In one case, CT showed extension of the thrombus to the portal vein with the presence of low-attenuation areas in the liver, consistent with hepatic infarcts. Two patients had predisposing diseases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicitis, and early appendectomy in appendicitis can prevent this complication. Moreover, as in any abdominal surgery, early appendectomy may be complicated by thrombosis of the SMV, thus creating problems of postoperative diagnosis. The complication is more frequent when the initial operation is performed under difficult conditions (peritonitis), or when the patient presents with a coagulopathy. CT is useful in the diagnosis of SMV thrombosis, thus leading to early management with anticoagulant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction.

Adolescent↗
PubMed2006

Interval appendectomy after conservative treatment of an appendiceal mass.

INTRODUCTION: The purpose of this study was to clarify the role of interval appendectomy after conservative treatment of an appendiceal mass. METHODS: From January 1998 to December 2003, patients with an appendiceal mass who received conservative treatment at the Taipei Veterans General Hospital were studied retrospectively. Data on demographics, rate of appendicitis recurrence, duration of hospital stay, and complication rate were collected and analyzed. RESULTS: A total of 165 patients were included (89 males, 76 females). The mean age was 53.6 years (range 7-89 years). The rate of appendicitis recurrence after conservative treatment was 25.5%; most recurred within 6 months after discharge (83.3%). The benefit of preventing recurrence is less than 16% if interval appendectomy is performed 6 weeks after discharge and less than 10% if it is done 12 weeks later. The complication rate of appendectomy performed before or after recurrence was 10% in both groups. The duration of the second hospital stay for patients who underwent interval appendectomy before or after recurrence was 4.43 +/- 3.32 vs. 6.75 +/- 5.73 days (P = 0.023). Of the 165 patients, 17 (10.3%) had their diagnosis changed after survey or surgery, and 5 (3.03%) were found to have colon cancer upon follow-up. CONCLUSIONS: Patients who recovered from conservative treatment of an appendiceal mass should undergo colonoscopy or barium enema to detect any underlying diseases and to rule out coexistent colorectal cancer. Routine interval appendectomy benefits less than 20% of patients.

Adolescent↗