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At least 235 records · Page 13Linked to original sources
PubMed2001

[Protective effect of appendectomy on the development of ulcerative colitis. A case-control study].

AIMS: To examine by a case-control study the relationship between appendectomy and subsequent ulcerative colitis development in a French population. METHODS: A total of 150 patients with ulcerative colitis were matched for age (+/- 5 years) and sex, with 150 controls recruited in a preventive medicine center. The following data were collected from medical records and by standardised questionnaire in consultation or by phone: appendectomy and tonsillectomy before the onset of ulcerative colitis, smoking habits and area of residence. RESULTS: The rate of previous appendectomy in patients with ulcerative colitis was 8% (12/150) compared with 30.6% (46/150) in the control group (P=0.001). There was no significant association between ulcerative colitis and tonsillectomy (25.3 and 27.3% in the control and the ulcerative colitis groups, respectively). Smoking was more frequent in the control group (36%) than in the ulcerative colitis group (25.3%) but the difference was not significant (P=0.07). In multivariate analysis, the risk of developing ulcerative colitis was significantly lower after previous appendectomy (odds ratio=0.26; 95% confidence interval: 0.13-0.55; P=7 x 10(-4)). CONCLUSION: Our study confirms the inverse association between appendectomy and subsequent ulcerative colitis, in a French population, after adjusting on smoking.

Adult↗
PubMed1992

[Negative appendectomies can be decreased by improved clinical assessment alone].

We had a 20% rate of negative appendectomies in our patients presenting with suspected appendicitis. We suggested that an improved clinical examination would reduce this rate. 84 consecutive patients presenting with suspected acute appendicitis were prospectively studied. 10 clinical features were used to calculate a score which should distinguish appendicitis and non-specific abdominal pain. 53 appendectomies with 6 (11.3%) perforations, 41 (77.4%) acute inflammations and 6 (11.3%) normal appendixes have been performed. 26 patients suffered from non-specific abdominal pain, 5 had an other surgical disease. In the appendectomized patients the score was 4.2 +/- 1.2 with perforation, 4.4 +/- 1.1 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients without operation was significantly lower (2.0 +/- 1.1; p less than 0.01). Patients with other surgical disease had a score of 2.8 +/- 1.5 with no significant difference to patients which had undergone appendectomy. Negative appendectomies were reduced by improved clinical examination from 20.3% to 11.3% without change in the rate of perforation. The remaining patients with negative appendectomies could not be identified by improved clinical examination even by means of the score. But the use of the score improved the performance of the clinicians.

Abdomen, Acute↗
PubMed2004

Laparoscopic appendectomy in children: technically feasible and safe in all stages of acute appendicitis.

This is a retrospective outcomes analysis of pediatric open and laparoscopic appendectomy in a children's hospital. One hundred three children underwent appendectomy for appendicitis by two pediatric surgeons from August 1998 to December 2002. Patients were divided into two groups, laparoscopic appendectomy (LAP) and open appendectomy (OAP), and were further subdivided by diagnosis: normal (NL), acute (AA), and ruptured (RA). There were no differences in age, sex, race, or zip codes between groups. Median age was 10 years. In the acute phase, 28 patients underwent OAP and 65 underwent LAP whereas 10 patients underwent interval appendectomy (IA) 6 weeks after percutaneous drainage of established abscesses (eight were LAP vs two OAP). In the remaining patients, the appendix was normal in 17 (18.4%) and ruptured in 24 (25.8%) pathologically. LAP took longer to perform (57 minutes vs 34.5 minutes) at higher cost (3718 dollars vs 1858 dollars) than OAP. Overall complications were lower in the LAP group (17% vs 29%), and LAP for RA had significantly fewer total complications (25% vs 62.5%). Intra-abdominal abscess increased following LAP: 9.2 per cent versus 3.6 per cent. Length of stay was shorter for LAP versus OAP in both AA (2.0 vs 2.5 days) and RA (5.5 vs 7 days).

Acute Disease↗
PubMed2004

Long-term benefits of laparoscopic appendectomy for chronic abdominal pain in fertile women.

AIM: To assess long-term benefit of laparoscopic appendectomy for chronic abdominal pain of unknown origin in fertile women. METHOD: The study included 70 fertile women aged 29.2+/-13.1 years who had undergone diagnostic laparoscopy for recurrent abdominal pain at our Department between 1996 and 2000. In December 2002, a questionnaire with symptom-specific questions and procedure-specific questions was sent to all the patients. The response rate was 76% (53 out of 70). RESULTS: According to intraoperative findings there were 8 patients with adhesions, 12 with gynecological origin of pain, 27 with chronic inflammation or narrowed lumen of the appendix, and 6 with normal laparoscopic findings and innocent appendix. The most common intervention was appendectomy, performed in 41 out of 53 cases; cysts fenestration in 10 cases; and lysis of adhesions in 8. The average hospital stay was 3.6+/-2.6 days. Postoperative complications occurred in 10/53 patients. A serious complication involving bladder injury after lysis of adhesions occurred in a single patient. There was no mortality. 3 out of 53 patients were readmitted 1, 3, and 9 months postoperatively because of residual abdominal pain. Two of them had appendectomy. Long-term follow up showed that there were no differences in the overall satisfaction with diagnostic laparoscopy in the patients with (n=41) and without appendectomy (n=12). There was no difference in overall satisfaction between the patients having inflamed appendix (n=22) and those without inflamed appendix (n=19). CONCLUSION: Diagnostic laparoscopy is a diagnostic and therapeutic option in most fertile women with chronic abdominal right iliac fossa pain of unknown origin. Our results showed low postoperative complications and no mortality rate with laparoscopic appendectomy indicate removal of appendix as a part of diagnostic laparoscopy when the origin of pain is unknown. In some cases of persistent pain, the removal of appendix is beneficial by eliminating appendicitis in differential diagnosis.

Abdominal Pain↗
PubMed1992

[Fewer negative appendectomies thanks to improved clinical diagnosis].

108 consecutive patients presenting with suspected acute appendicitis were studied prospectively. To improve clinical performance, 19 clinical criteria were evaluated. For cases with unclear diagnostic situations laparoscopy was performed. With 10 of the above mentioned criteria the score published by de Dombal, which can reach a maximal value of 7 points, was calculated. For data processing the rate of negative appendectomies as well as the de Dombal score were used. 61 appendectomies with 7 (11.5%) perforations, 48 (78.7%) acute inflammations and 6 (9.8%) normal appendices have been performed. 39 (36.1%) patients with non-specific abdominal pain were observed for 3 +/- 2 days before discharge, while 7 (11.5%) had another surgical disease. In the appendectomized patients the score was 4.3 +/- 1.1 with perforation, 4.4 +/- 1.0 with acute inflammation and 3.8 +/- 1.3 with a normal appendix (p = ns). The score for non-specific abdominal pain in patients not undergoing surgery was significantly lower (2.2 +/- 1.2; p less than 0.01). Patients with other surgical diseases had a score of 3.1 +/- 1.1 with no significant difference from patients who had undergone appendectomy or from those with non-specific abdominal pain. Laparoscopy was performed in 16 (14.8%) patients. 9 patients had appendicitis, 4 non-specific abdominal pain and 3 another surgical disease. Improved clinical examination significantly (p less than 0.05) reduced negative appendectomies from 20.3% to 9.8% without a rise in the rate of perforation due to prolonged observation. The 6 patients with negative appendectomy could not be identified even by improved clinical examination.

Acute Disease↗
PubMed2005

Laparoscopic appendectomy in children.

OBJECTIVES: Laparoscopic appendectomy (LA) is rapidly becoming an alternative to open appendectomy for the treatment of appendicitis in children. We examined the efficacy, safety and complications of performing LA in children. METHODS: This is a critical review of the children who underwent LA between January 1999 and May 2003 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Demographic data, operative procedures, severity of appendicitis, histopathology, operative time, hospital stay, analgesia and complications were carefully analyzed. RESULTS: Laparoscopic appendectomy was attempted in 113 children. It was successfully completed in only 100 patients, 85 had uncomplicated appendicitis and 15 had complicated appendicitis. In 13 (11.5%) conversion to open appendectomy had to be carried out for complicated appendicitis. Their ages ranged between 2-12 years (average 8 years); 52 were males and 48 were females. Symptom duration average was 30 hours in uncomplicated appendicitis and 56 hours in complicated appendicitis. Operative time ranged between 35-80 minutes (average 53 minutes). Four patients with complicated appendicitis developed postoperative complications, 2 had wound infections and the other 2 had intra-abdominal collections. No intra-operative complications were encountered. The average hospital stay was 2 days for uncomplicated appendicitis and 6 days for complicated ones. Histopathological examination revealed 75 acutely inflamed appendices, 15 were perforated appendicitis with or without mass formation and 10 appendices reported to be normal. All patients were followed up for 6-12 months. CONCLUSION: Laparoscopic appendectomy is both a safe and effective method in managing children with acute uncomplicated appendicitis. In children with complicated appendicitis, LA should be carried out with caution and only by an experienced surgeon, as it is associated with a higher rate of conversion to open technique and more postoperative infectious complications.

Appendectomy↗
PubMed2005

Appendectomy during early pregnancy: what is the preferred surgical approach?

Appendectomy is the most common nongynecologic surgery performed during pregnancy. Although many surgeons offer laparoscopic appendectomy (LA) as an alternative to open appendectomy (OA) during early pregnancy, few studies have compared the effects of LA versus OA on the fetus and the outcome of the pregnancy. Twenty-eight consecutive females undergoing appendectomy for presumed appendicitis in the first two trimesters of pregnancy between January 2000 and December 2002 were identified retrospectively. Demographic information, weeks of pregnancy at operation, and surgical approach (LA or OA) were recorded. Study outcomes included operative and pregnancy-related complications, length of hospitalization, final outcome of pregnancy, and infant birth weight. Seventeen LA and 11 OA were performed. There were no significant differences in surgical or obstetrical complications, length of hospitalization, or birth weight between the two groups. Two cases of postoperative fetal demise were noted in the LA group. Although not statistically significant, the two fetal losses in the laparoscopic group are concerning. The current study did not demonstrate any advantages to the laparoscopic approach. Pending further investigation, the open approach may be preferred for appendectomy in pregnant patients during the first two trimesters of pregnancy.

Adult↗
PubMed2005

Parecoxib versus tramadol for post-appendectomy pain.

UNLABELLED: Open uncomplicated appendectomy is known for low to medium degree of postoperative pain and a short hospital stay. Based on multimodal pain therapy, non-opioid analgesics have widely been a part in pain control. Parecoxib and tramadol have advantages over traditional opioids that are causing less nausea or vomiting, respiratory depression and sedation. As a result, the authors aimed to compare parecoxib and tramadol regarding quality of pain control after open appendectomy. Fifty patients, underwent open appendectomy with spinal anesthesia, were randomized to receive either parecoxib or tramadol (n = 25 each). Parecoxib 40 mg and tramadol 50 mg IV were administered twice, when closing the peritoneum and at 12 h later Doses of rescued meperidine for 24 h were recorded. Pain score, sedation, nausea or vomiting and satisfaction scores were assessed at 6, 12 and 24 h after operation. The mean rescued doses of meperidine were 4.6 +/- 10.9 and 18.6 +/- 21.0 mg in parecoxib and tramadol groups respectively (p = 0.005). There was a significantly higher pain score at 24 h (p = 0.01) and sedation score at 6 h (p = 0.003) in the tramadol group. Parecoxib provided a lower pain and sedation scores and lesser meperidine consumption than tramadol for post-appendectomy pain. IMPLICATION: Parecoxib, as a primary analgesic, is better in analgesia and has less sedation than tramadolfor post-appendectomy pain.

Adult↗
PubMed2006

Advantages of laparoscopic appendectomy in the elderly.

Laparoscopic appendectomy (LA) has gained in popularity in recent years. The number of elderly patients undergoing appendectomy has increased as that segment of the population has increased in number; however, the utility and benefits of LA in the elderly population are not well established. We hypothesized that LA in the elderly has distinctive advantages in perioperative outcomes over open appendectomy (OA). We queried the 1997 to 2003 North Carolina Hospital Association Patient Data System for all patients with the primary ICD-9 procedure code for OA and LA. Patients > or = 65 years of age (elderly) were identified and reviewed. Outcomes including length of stay (LOS), charges, complications, discharge location, and mortality were compared between the groups. There were 29,244 appendectomies performed in adult patients (>18 years old) with 2,722 of these in the elderly. The annual percentage of LA performed in the elderly increased from 1997 to 2003 (11.9-26.9%, P < 0.0001). When compared with OA, elderly patients undergoing LA had a shorter LOS (4.6 vs 7.3 days, P = 0.0001), a higher rate of discharge to home (91.4 vs 78.9%, P = 0.0001) as opposed to a step-down facility, fewer complications (13.0 vs 22.4%, P = 0.0001), and a lower mortality rate (0.4 vs 2.1%, P = 0.007). When LA was compared with OA in elderly patients with perforated appendicitis, LA resulted in a shorter LOS (6.8 vs 9.0 days, P = 0.0001), a higher rate of discharge to home (86.6 vs 70.9%, P = 0.0001), but equivalent total charges (dollars 22,334 vs dollars 23,855, P = 0.93) and mortality (1.0 vs 2.98%, P = 0.10). When elderly patients that underwent LA were compared with adult patients (18-64 years old), they had higher total charges (dollars 16,670 vs dollars 11,160, P = 0.0001) but equivalent mortality (0.37 vs 0.15%, P = 0.20). The use of laparoscopy in the elderly has significantly increased in recent years. In general, the safety and efficacy of LA is demonstrated by a reduction in mortality, complications, and LOS when compared with OA. The laparoscopic approach to the perforated appendix in the elderly patient has advantages over OA in terms of decreased LOS and a higher rate of discharge to home as opposed to rehabilitation centers, nursing homes, or skilled nursing care. When compared with all younger adults, the laparoscopic approach in the elderly was associated with equal mortality rates even though hospitalization charges were higher. Laparoscopy may be the preferred approach in elderly patients who require appendectomy.

Aged↗
PubMedDate not supplied

[Laparoscopic appendectomy. Present situation. ABC medical center experience during the last five years].

OBJECTIVE: To compare the diagnostic and therapeutic accuracy of laparoscopic appendectomy versus open appendectomy. BACKGROUND DATA: Appendectomy is the treatment of choice for acute appendicitis. Open Appendectomy (OA) has its complications rates (10-20%) and negative explorations in young women are about 25-30%. Acute appendicitis has a 3.1% morbidity and with perforation up to 47.2% and a mortality rate less than 1%. Advantages of laparoscopic appendectomy (LA) has been shown in many studies with lower intraoperatory and postoperatory complications, less hospitalization days, lower pain and faster return to daily activities when its compared with OA. METHODS: We perform a retrospective and descriptive trial with 1,883 patients with acute appendicitis between January 2000 to September 2004. Patients smaller than 15 years old and with other postoperatory diagnosis were excluded. Ji2 and t Student statistic tests were performed. RESULTS: We obtained 1,272 patients with acute appendicitis, 49% male and 51% female. LA was performed in 732 patients, 46.1% male and 53.9% female and OA was performed in 541 patients, 52.6% male and 47.3% female. Similar midage patients in both groups. LS was performed in 180 patients with complicated appendicitis and 116 patients by OA. LA was converted to open surgery in 4.5% patients. Morbidity was lower for laparoscopic group with statistical difference. There were no difference in fasting and hospitalization days. CONCLUSIONS: This procedure is a good choice for differential diagnosis overall in young women and complicated appendicitis with lower morbidity than the OA.

Adolescent↗
PubMed1991

The use of an automatic stapling device for laparoscopic appendectomy.

Laparoscopic appendectomy, for years performed only occasionally, is becoming more common with the increasing interest by both general surgeons and gynecologists in "minimally invasive surgery." A recently available automatic laparoscopic stapling system (the MULTI-FIRE ENDO GIA 30) claims to make laparoscopic appendectomy technically easier to perform. The technique of laparoscopic appendectomy using this automatic stapling device was evaluated in ten patients and compared with our previous laparoscopic techniques. The MULTI-FIRE ENDO GIA passes through a 12-mm trocar and allows placement of two triple-staggered lines of titanium staples with a simultaneous cut. Using this technique, operating time for laparoscopic appendectomy was reduced from an average of 30 to a minimum of 5 minutes. With this technique, no appendiceal contents leaked intraperitoneally. The larger trocar allowed easier removal of the separated appendix with minimal dissection of the mesoappendix. Indications for appendectomy included endometriosis of the appendix (three), fixation to the right tube or ovary (three), early acute appendicitis (two), and elective removal (two). There were no immediate or late complications. Our preliminary experience with the MULTI-FIRE ENDO GIA 30 stapler suggests that it is a safe, easy, and rapid method of removing the appendix laparoscopically.

Adult↗
PubMed1989

[Late sequelae of appendectomy with special reference to adhesions in the lower abdomen, chronic abdominal pain and sterility].

Analyzing the medical history and operation protocols of 2,465 female patients undergoing pelviscopy for different reasons we found that 1,743 patients (71%) reported a previous appendectomy in their anamnesis. 657 patients presented adhesions after previous appendectomy. In 41.5% these adhesions were located in the middle right abdomen. In comparison to a collective of 308 patients without adhesions there were no correlations between the occurrence of adhesions post appendectomy and chronic lower abdominal pain. In conclusion it is to point out that laparotomy--especially appendectomy--correlates in 70% with postoperative adhesions. These adhesions correlate in 30% of cases with chronic abdominal pains and in 40 to 50% we were able to prove periovarian and peritubal adhesions in cases of sterility. In order to prevent unnecessary appendectomy or other unnecessary laparotomies with later formation of adhesion it is very important to use laparoscopy in all questionable cases.

Abdominal Pain↗
PubMed1987

Incidental appendectomy with cholecystectomy: is the increased risk justified?

To evaluate the advisability of incidental appendectomy relative to patient age, a retrospective chart review of 905 patients undergoing elective cholecystectomy between 1979 and 1983 was undertaken. A total 377 of these patients underwent incidental appendectomy. The overall complication rate in the two groups was the same. Wound infection occurred in 1.5 per cent of patients undergoing cholecystectomy alone, compared with 3.7 per cent in those patients undergoing incidental appendectomy as well. Patients over the age of 50 who underwent incidental appendectomy had a wound infection rate of 5.9 per cent, compared with 0.9 per cent in those patients over 50 who underwent cholecystectomy alone, a difference found to be statistically significant (P less than .05). Therefore, incidental appendectomy cannot be recommended for patients over the age of 50.

Adolescent↗
PubMed1982

Post appendectomy mechanical sterility.

The incidence of female sterility due to pelvic adhesions following appendectomy was evaluated. Two groups of women were investigated: the first group consisted of girls who underwent appendectomy under the age of ten. Of this group, we were able to detect 24 women of whom 9 were still single and 13 have delivered one or more children. The second group was selected from women in whom mechanical sterility was confirmed by laparoscopy or laparotomy. The rate of appendectomy in this group was found to be 29 percent compared to 7-10 percent in the general population. Seventy one percent of the women who underwent appendectomy were above the age of seventeen when operated. It is concluded that women undergoing appendectomy, particularly after adolescence, are at higher risk for subsequently developing mechanical sterility.

Adult↗
PubMed1995

Incidental appendectomy during urological surgery.

PURPOSE: To investigate the issue of incidental appendectomy during urological surgery we retrospectively studied its consequences in 2 groups of urological patients. MATERIALS AND METHODS: We studied 147 patients undergoing cystectomy and urinary diversion (group 1) and 200 undergoing primary retroperitoneal lymphadenectomy (group 2). Incidental appendectomy was performed in 122 (83%) and 114 (57%) patients, respectively. RESULTS: The incidence of infectious complications in group 2 was significantly higher among patients who underwent incidental appendectomy compared to those without appendectomy (9.6% and 2.3%, respectively, p = 0.032). No difference was noted among the patients in group 1 (10.6% and 12.0%, respectively, p = 0.51). CONCLUSIONS: When evaluating the prophylactic merits, incidental appendectomy can be performed safely during radical cystectomy and urinary diversion. It is probably contraindicated in patients undergoing retroperitoneal lymphadenectomy for testis cancer due to the apparent added risk of infectious complications.

Adolescent↗
PubMed1995

Laparoscopic is not better than open appendectomy.

Laparoscopic appendectomy is increasingly being used by general surgeons. The advantages of the procedure over open appendectomy are not as obvious as the advantages of laparoscopic cholecystectomy over open cholecystectomy. This study was a retrospective review of nonrandomized patients of two attending surgeons over the time period 4/11/91 to 2/15/93. Parameters examined included patient age, gender, operating room time, hospital cost, hospital stay, negative appendectomy rate, and wound infection rate. Results showed that there was no difference in the patient age. Gender was significantly different, with the laparoscopic group containing 68% females, whereas the open group contained only 39% (P < 0.01). Operating room time was significantly longer for the laparoscopic group by approximately 18 minutes (P < 0.05). Hospital cost was $1400.00 more expensive for the laparoscopic group (P < 0.05). Hospital stay and wound infection rates were not significantly different. The negative appendectomy rate was 37% for the laparoscopic group and 12% for the open group (P < 0.05). We conclude that laparoscopic is not superior to open appendectomy.

Adult↗
PubMed1994

[The importance and role of laparoscopic appendectomy].

Inspite of earlier beginning the laparoscopic appendectomy is in the shadow of laparoscopic cholecystectomy. In connection with laparoscopic appendectomy some problems are discussed--his significance or substantiality, techniques, advantages or disadvantages in contrast to classical appendectomy. The authors discussed these questions on the base of their own experiences with 56 laparoscopic appendectomies. These were done from 21. October 1992 to 7. February 1994. Known advantages of laparoscopic procedures are expressed--shorter hospital stay after the operation (in average 2.3 days), better view in the operating field with possibility of the treatment of gynecological pathology. Technical aspects are also discussed. The equipment with staplers according their opinion is needed. The time of the operations--average 44 minutes--is acceptable. The complication and conversion rate, which were noted in 3.6% resp. 5.3%, is quite good. There is a possibility to lower these numbers with increasing experience. The possibility for training in the laparoscopic field is great opportunity especially for young surgeons. In the end there is stated, that the authors consider laparoscopic appendectomy as an important step to the advanced procedures. The broad acceptance is recommended.

Adolescent↗
PubMed1994

Experience with laparoscopic and open appendectomies in a surgical residency program.

Laparoscopic appendectomy represents another challenge for residency training. This retrospective study was conducted to determine the efficacy of this operation, to contrast it to conventional appendectomy, and to describe experience in teaching residents. We examined the case records of 151 patients who underwent appendectomies performed by residents between September 1990 and September 1992. Surgery was performed laparoscopically in 26% of the cases, by conventional means in 65%, and converted to an open procedure in 9% of the total patients. Acute appendicitis was confirmed in 56% of laparoscopic patients, 85% of conventional patients, and 86% of converted patients. Age, sex, signs and symptoms, complications, and operative times were similar in laparoscopic and conventional groups. Mean hospital stay was 3.5 days in the laparoscopic group, 4.5 days in the conventional group, and 8.5 days in the converted group. Operating room charges were highest in the laparoscopic group. Surgical procedure depended on the experience and bias of the attending surgeon. Laparoscopic appendectomy appears to be easily learned by surgical residents and to be associated with an outcome similar to that of conventional appendectomy.

Adult↗