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PubMed1997

Neonatal appendectomy impairs mucosal immunity in rabbits.

We compared the effects of neonatal appendectomy in rabbits on total Ig and antigen (Ag)-specific Ig levels in the serum and gut, and on plasma cell numbers in the small intestine in response to intraperitoneal (i.p.) and intraduodenal (i.d.) immunizations with ovalbumin (OVA). Animals were sacrificed after 9 weeks. Antibodies (Abs) in the duodenum were collected and quantified by enzyme-linked immunosorbent assay (ELISA) while plasma cells were quantified by double immunofluorescent staining. Appendectomy markedly reduced total intestinal IgA (P < 0.0006), IgM (P < 0.003), and IgG (P < 0.05) relative to controls, whereas total serum Ig levels were not lowered significantly. Moreover, appendectomy nearly ablated OVA-specific IgA (P < 0.007) in the gut and severely depleted OVA-specific IgG in the gut (P < 0.03) and serum (P < 0.007). The sharp decreases in total IgA and anti-OVA IgA were paralleled by decreases in total IgA+ plasma cells (P < 0.0005) and OVA-reactive IgA+ plasma cells (P < 0.05). These results support a major role of the rabbit appendix in seeding the intestinal lamina propria with plasma cell precursors, especially those producing IgA.

Animals↗
PubMed1986

[Preventive and simultaneous appendectomy].

75 patients underwent simultaneous appendectomy, when gall bladder, stomach or large bowel were chiefly operated. Complications of incision marks were observed in six cases, but only one of them being possibly due to appendectomy. Six common complications could not be explained by additional operation. Postoperative treatment was not extended. 5 patients died due to the severity of their main disease. Prophylactic or simultaneous appendectomy were conditionally recommended and subjected to a decision by a fully experienced surgeon.

Appendectomy↗
PubMed1993

Diagnostic laparoscopy: reducing the number of normal appendectomies.

A prospective, controlled study was conducted to determine whether a selective policy of diagnostic laparoscopy could reduce the number of unnecessary normal appendectomies in patients with acute right iliac fossa pain. The cohort consisted of patients admitted with acute right iliac fossa pain by the emergency department. Of 102 patients in the study group, 28 subsequently required a diagnostic laparoscopy when a definite diagnosis could not be reached after 8 to 12 hours of observation. Of these, only 18 had inflamed appendices, which were removed. In the rest of the patients (10), the appendices were normal and unnecessary laparotomies were avoided. In the control group, wherein equivocal cases were laparotomized after a similar period of observation, there was a normal appendectomy rate of 15.7 percent (P < 0.05). There was no significant difference in the incidence of perforation between the control and study groups. Diagnostic laparoscopy in equivocal cases could thus significantly reduce the number of unnecessary appendectomies without compromising on the rate of perforation.

Adolescent↗
PubMed1994

Rheumatoid arthritis is not associated with prior tonsillectomy or appendectomy.

To re-evaluate a reported association of rheumatoid arthritis (RA) with antecendent tonsillectomy or appendectomy, questionnaires were sent by post to 3673 patients who had been diagnosed as having either RA or osteoarthrosis (OA). Of those who responded 1524 were RA and 1194 OA patients. No significant differences were found between these groups with regard to the frequency of prior lymphoid surgery. This was also the case when the RA group was replaced by its rheumatoid factor (Rf) positive or Rf negative subgroup. A separate analysis of a subgroup consisting of 671 Rf positive RA patients for whom OA control subjects matched for sex and year of birth were available again showed no statistical differences in frequencies of tonsillectomy and appendectomy. Neither did partitioning the group according to the age at which lymphoid surgery was performed bring any association with an increased occurrence of RA to light. We therefore reject the hypothesis that RA is associated with antecedent tonsillectomy or appendectomy.

Adolescent↗
PubMed1991

Laparoscopic appendectomy using a clip applier.

The diagnostic worth and therapeutic value of laparoscopic surgery are known for ovarian cysts and ectopic pregnancies. Diagnosis of appendicitis is difficult, and laparoscopy is useful in these cases. The present study was done to assess the feasibility, efficacy, and advantages of a new laparoscopic appendectomy technique. Between August 1, 1989, and July 31, 1990, patients exhibiting right pelvic pain associated with fever were divided into three groups according to the pre-operative diagnosis: appendicitis, pelvic inflammatory disease (PID), and diagnostic doubt between appendicitis and PID. An intra-peritoneal appendectomy was performed if the diagnosis was not PID. Via three suprasymphyseal trocars, the appendix was exposed and the mesoappendix was coagulated. The appendix stump was closed using a clip applier (Ethnor T1300). In all, 20 patients underwent laparoscopic appendectomies. The mean duration of the procedure was 36.5 min; in no case was laparotomy necessary. There were no post-operative complications, and digestive transit returned on the 2nd day post-surgery. Both patients and nurses appreciated the technique. The subjects experienced comfortable post-operative periods and gained aesthetic advantages. The operative procedure could be completed on each attempt. We conclude that this technique is sure, quick, and easily reproducible in young patients presenting with right pelvic pain associated with fever.

Appendectomy↗
PubMed1997

[Appendectomy 1997--open or closed?].

Unlike laparoscopic cholecystectomy, laparoscopic appendectomy (LAE) has not yet become popular. Are there no significant advantages? Or is the poor acceptance of LAE related to its longer learning curve, longer operative times and the need for additional equipment, which lead to some inconvenience when the procedure is done on an emergency basis? LAE may be performed as safely as open appendectomy (OAE) with fewer wound complications. Superior laparoscopic exploration allows an accurate diagnosis and reduces the rate of negative appendectomies. In contrast, postoperative pain, recovery and the cosmetic result are equal to or at best slightly better than in open surgery. Therefore, in the routine patients, there is no need to replace OAE by LAE. In the case of an uncertain diagnosis, the laparoscopic approach is generally superior, allowing thorough abdominal exploration. This has to be considered in each individual case; however, women with lower abdominal pain and suspected appendicitis will certainly benefit from laparoscopy, as well as older patients with an unclear diagnosis. The lower rate of wound infections is beneficial to obese patients and to patients with gangrenous or perforated appendicitis. Furthermore, the decision for one procedure or the other is influenced by the patient's individual preference and cosmetic aspects. The verifiable benefit of the laparoscopic procedure for certain categories of patients and the potential advantages in the individual case suggest that competent handling of laparoscopic technology will be required in future. Therefore, experienced surgeons should take more active interest in instruction and training--even when surgery has to be performed after hours.

Appendectomy↗
PubMed2002

Antiseptic wick: does it reduce the incidence of wound infection following appendectomy?

The role of prophylactic antibiotics is well established for contaminated wounds, but the use of antiseptic wound wicks is controversial. The aim of this work was to study the potential use of wound wicks to reduce the rate of infection following appendectomy. This prospective randomized controlled clinical trial was conducted at a university hospital in the department of surgery. The subjects were patients undergoing appendectomy for definite acute appendicitis. They were randomized by computer to primary subcuticular wound closure or use of an antiseptic wound wick. For the latter, ribbon gauze soaked in povidone-iodine was placed between interrupted nylon skin sutures. Wicks were soaked daily and removed on the fourth postoperative day. All patients received antibiotic prophylaxis. They were reviewed while in hospital and 4 weeks following operation for evidence of wound infection. The main outcome measures were wound infection, wound discomfort, and cosmetic result. The overall wound infection rate was 8.6% (15/174). In patients with wound wicks it was 11.6% (10/86) compared to 5.6% (5/88) in those whose wounds were closed by subcuticular sutures (p = NS). We concluded that the use of wound wicks was not associated with decreased wound infection rates following appendectomy. Subcuticular closure is therefore appropriate in view of its greater convenience and safety.

Adolescent↗
PubMed2002

Laparoscopic appendectomy for perforated appendicitis.

Although laparoscopic appendectomy for uncomplicated appendicitis is feasible and safe, its application to perforated appendicitis is uncertain. A retrospective study of all patients with perforated appendicitis from 1992 to 1999 in a university hospital was performed. A series of 231 patients were diagnosed as having perforated appendicitis. Of these patients, 85 underwent laparoscopy (LA), among whom 40 (47%) required conversion to an open procedure. An open appendectomy (OA) was performed in 146 patients. The operating time was similar for the two groups. Return of fluid and solid diet intake were faster in LA than OA patients (p < 0.01). Postoperative infections including wound infections and abdominal abscesses occurred in 14% of patients in the laparoscopy group and in 26% of those with OA (p < 0.05). The surgeon's experience correlated with the conversion rate. Laparoscopic appendectomy is associated with a high conversion rate for perforated appendicitis. If successful, it offers patients faster recovery and less risk of infectious complications.

Adolescent↗
PubMed2004

Efficacy of pre-incisional bupivacaine infiltration on postoperative pain relief after appendectomy: prospective double-blind randomized trial.

Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre-incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double-blinded study was conducted on 123 patients aged 13-45 years with a preoperative and-postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients' request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower ( p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre-incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.

Adolescent↗
PubMed1999

Laparoscopic versus open appendectomy: time to decide.

Although widely practiced, laparoscopic appendectomy (LA) has not met with universal approval. Several controlled trials have been conducted, some in favor, others not. The goal of this review was to ascertain (1) if laparoscopy was capable of improving the diagnostic and therapeutic difficulties encountered during open appendectomy (OA) and (2) if the introduction of laparoscopy in the overall management of acute appendicitis has changed anything in practice. Analysis and criticism of 17 controlled studies (nearly 1800 patients) on laparoscopic appendectomy and 2 randomized studies dealing with diagnostic laparoscopy are reported. Because of the questionable quality of randomized controlled trials (number of patients, exclusions, withdrawals, blinding, intention-to-treat analysis), publication biases, local practice variations (hospital stay, rate of enrollment), results regarding analgesia requirements, return to activity and work, duration of hospital stay, outcome, follow-up, and antibiotic prophylaxis the studies must be interpreted with caution. The real world of appendicitis probably differs greatly from the atmosphere under which controlled trials comparing LA and OA have been performed. Statistical significance is contrary to the clinical significance of the results. Consistently longer operating times [the difference ranging from 8 minutes (NS) to 29 minutes (p < 0.0001)], a minimal reduction in hospital stay [0. 1 day (NS) to 2.1 days (p < 0.007)], and, somewhat more controversial, an earlier return to normal activity were reported for LA. Data on analgesic requirements were confusing, but wound complications were more frequent after OA [pooled odds ratio for 10 studies: 2.6 (95% CI 1.3-5.2)]. Unsolved problems include national behavioral problems, age and experience of operating surgeons (LA or OA), and emergency conditions (availability of staff, instruments). Results of cost analysis vary according to the standpoint of disease, the patient, the surgeon, the treatment center, industry, and society. Three questions remain: Because of the competition of LA versus OA, OA has improved greatly. Can it be improved any more? Is there a place or need for further randomized controlled trials? Should we not conclude once and for all that LA is out?

Appendectomy↗
PubMed2003

Is it justified to obtain routine peritoneal fluid cultures during appendectomy in children?

Controversy exists regarding obtaining routine peritoneal cultures during appendectomy. The aim of the study was to determine the impact of obtaining routine peritoneal fluid cultures during appendectomy on the treatment and clinical outcome in children. The charts of 269 children who were operated with the diagnosis of appendicitis between January 1996 and January 2001 were reviewed. The microorganisms in peritoneal cultures, selection of antibiotics and clinical outcome were evaluated. Average age was 10.1+/-3.3 (range, 1 to 17 years) years with a male to female ratio of 1.7 (170/99). There were two groups of patients; Group 1: uncomplicated appendicitis (201/269=75%), and Group 2: complicated (perforated) appendicitis (49/269=18%). In the series, 19 patients were found to have a normal appendix in histopathological examination (7%). Cultures were obtained from 95 (35.3%) patients (group 1: 59/95, group 2: 36/95). In patients with uncomplicated appendicitis, 6.7% of the cultures (4/59) were positive while in group 2, the rate was 47.2% (17/36) ( p<0.05). Only in four patients who were in group 2, antibiotics were re-adjusted according to the cultures. Escherichia coli and Klebsiella pneumoniae were the most common microorganisms. There were no complications in group 1, while wound infection (18.3%) and intra-abdominal abscess (2%) were the two most common complications in group 2. Intra-operative peritoneal cultures during appendectomy do not add much to the treatment of children. Therefore, it is not necessary to get peritoneal swab cultures during the procedures, and empiric use of wide spectrum antibiotics when necessary is generally sufficient in the management of this group of children.

Adolescent↗
PubMed2001

Scrotal abscess following appendectomy.

Postoperative infectious complications in children following perforated appendicitis present in diverse ways. We present two unusual complications of appendectomy for perforated appendicitis: an acute scrotum after open and laparoscopic appendectomy. A retrospective review of two cases of scrotal abscess following appendectomy at our hospital as well as a MEDLINE search was performed to review the clinical presentation, etiology, type of treatment, and outcome of these patients. Although scrotal inflammation occurring postoperatively in a patient with perforated appendicitis may be due to an incarcerated hernia, it is much more likely to be due to a scrotal abscess. Patients without a patent processus vaginalis or inguinal hernia at initial presentation of peritonitis must be carefully followed in the postoperative period and explored early if testicular or scrotal pain becomes manifest.

Abscess↗
PubMed2003

Meralgia paresthetica as a complication of laparoscopic appendectomy.

Laparoscopy is becoming a current approach for appendectomy. The technique is considered safe with few complications. We observed a young woman affected by meralgia paresthetica that developed after laparoscopic appendectomy. The femorocutaneous lateral nerve probably was damaged by insertion of a trocar in the right abdominal quadrant too close to the nerve course. Although meralgia paresthetica is not considered a frequent complication of laparoscopic appendectomy, it should be taken into account to avoid nerve lesion.

Adult↗
PubMed2003

Open and laparoscopic appendectomy are equally safe and acceptable in children.

BACKGROUND: The aim of this study was to evaluate prospectively whether laparoscopic (LA) and open appendectomy (OA) are equally safe and feasible in the treatment of pediatric appendicitis. METHODS: A total of 517 children with acute appendicitis were randomly assigned to undergo LA or OA appendectomy, based on the schedule of the attending surgeon on call. Patient age, sex, postoperative diagnosis, operating time, level of training of surgical resident, length of postoperative hospitalization, and minor and major postoperative complications were recorded. Chi-square analysis and the Student t-test were used for statistical analysis. RESULTS: In all, 376 OA and 141 LA were performed. The two groups were comparable in terms of patient demographics and the incidence of perforated appendicitis. The operative time was also similar (47.3 +/- 19.7 vs 49.9 +/- 12.9 min). The overall incidence of minor or major complications was 11.2% in the OA group and 9.9% in the LA group. CONCLUSION: Pediatric patients with appendicitis can safely be offered laparoscopic appendectomy without incurring a greater risk for complications. Nevertheless, a higher (but not significantly higher) abscess rate was found in patients with perforated appendicitis who underwent laparoscopy.

Abdominal Abscess↗
PubMed2005

Fear for the intraabdominal abscess after laparoscopic appendectomy: not realistic.

BACKGROUND: The risk for intraabdominal abscess (IAA) after laparoscopic appendectomy (LA) is still a matter of debate. The aim of the present study was to evaluate postoperative complications after open (OA) and laparoscopic appendectomy, in particular in perforated appendicitis (PA). METHODS: In the period 1999-2002, 331 appendectomies were performed for histological proven appendicitis, 144 by the open and 187 by the laparoscopic technique. Parameters were conversion rate, perforation, wound infection, and IAA. RESULTS: Conversion to OA was done in 20 cases (10.7%). Perforated appendicitis led more frequently to conversion than simple appendicitis (23.5 vs 7.8%; p = 0.007). Perforated appendicitis was equally seen in the open and laparoscopic technique (15 vs 18%). Wound infections after OA, converted and LA for acute appendicitis were 3 of 144 (2.1%), 1 of 20 (5.0%) and 1 of 167 (0.6%), respectively (NS). IAA formation did not differ among the three procedures (3.5 vs 0 vs 3.6%). In PA the rate of IAA formation was increased. However, the risk was not influenced by the technique: Two patients after the OA, none after a converted procedure, and two patients after LA formed an abscess (9.5 vs 0 vs 7.7% [NS]). CONCLUSION: LA does not lead to more intraabdominal abscesses than the open technique; even for perforated appendicitis the laparoscopic technique can be used safely.

Abdominal Abscess↗
PubMed2005

Laparoscopic versus open appendectomy in acute appendicitis: a randomized prospective study.

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.

Acute Disease↗
PubMed2006

Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis.

INTRODUCTION: Though ruptured appendicitis is not a contraindication to laparoscopic appendectomy (LA), most surgeons have not embraced LA as the first-line approach to ruptured appendicitis. In fact, in 2002, the Cochrane Database Review concluded: 1) the clinical effects of LA are "small and of limited clinical relevance," and 2) the effects of LA in perforated appendicitis require further study. OBJECTIVE: To study the effects of LA vs open appendectomy (OA) among adults with appendicitis. METHODS: In 2003, 272 adults underwent appendectomy at a large County hospital, and were enrolled in a prospective clinical pathway that detailed their hospital course from time of diagnosis to discharge. Data included patient demographics, time elapse from diagnosis to surgery, surgical technique (LA vs. OA), operative diagnosis (acute vs perforated appendicitis) and post-operative length of stay (LOS). RESULTS: Complete data was obtained for 264 (97%) patients. Patient demographics were similar in the LA and OA groups (p > 0.05). Patients with LA had a significantly shorter LOS than OA by 1.6 days (p < 0.05). This LOS was significantly shorter among those with ruptured appendicitis vs. non-ruptured appendicitis (2.0 days vs. 0.3 day reduction, p = 0.0357). Rank-order multiple regression analysis, controlling for all other factors, showed laparoscopy to have a significant effect on postoperative LOS in all appendicitis cases, especially ruptured appendicitis. CONCLUSIONS: The two-day reduction in LOS among those with ruptured appendicitis who underwent LA was significant enough to overcome the smaller benefit of LA in acute appendicitis. From a hospital utilization point of view, LA should be considered as the first-line approach for all patients with appendicitis.

Adult↗
PubMed2006

Laparoscopic appendectomy in the elderly.

BACKGROUND: This study aimed to compare the outcomes of laparoscopic and open appendectomy among the elderly. METHODS: Data on 53 elderly patients with a diagnosis of suspected appendicitis were prospectively collected and retrospectively reviewed. Among these patients, 24 had undergone laparoscopic appendectomy (LA) and 29 had undergone open appendectomy (OA). The indications for either method were based on the patient's choice. RESULTS: No statistically significant difference in operative time was found between the LA (70 +/- 28 min) and OA (60 +/- 22 min) groups. There was no statistically significant difference in lengths of hospital stay between the LA (4.8 +/- 3.0 days) and OA (5.0 +/- 3.1 days) groups, and there was a statistically significant difference in the postoperative analgesic doses between the LA (0.5 +/- 0.3 doses) and OA (1.7 +/- 1.5 doses) groups. No conversion of laparoscopic to open surgery was necessary, and no intraabdominal abscesses developed. CONCLUSION: According to this study, LA is as safe and effective as OA for the elderly. Furthermore, it significantly reduces postoperative wound pain.

Aged↗