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PubMed2006

Comparison of therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of periappendiceal abscess: is appendectomy always necessary after perforation of appendix?

BACKGROUND: The present study was designed to compare the therapeutic effectiveness of percutaneous drainage with antibiotics versus antibiotics alone in the treatment of appendicitis complicated by periappendiceal abscess. METHODS: In a prospective study, 50 patients with acute appendicitis complicated by periappendiceal abscess > or = 3 cm in size were randomly assigned to two groups. The first group received treatment with ultrasound guided-percutaneous drainage and i.v. antibiotics (ampicillin, cefuroxime, and metronidazole), and the other group received antibiotics only. Patient's baseline characteristics, duration of hospital stay, and treatment outcome and complications were analyzed. RESULTS: Appendectomy was avoided in 16/25 patients in the drainage group and 2/25 patients in the non-drainage group during follow-up with RR of 0.39 (95% CI = 0.22-0.62; p < 0.05). One patient in the drainage group and 8 patients in the non-drainage group underwent surgery in the first month after the beginning of treatment. Eight patients in the drainage group and 15 in the non-drainage group underwent interval appendectomy. There was no statistically significant difference between the two groups regarding patient demographics, abscess size, and pretreatment clinical symptoms. Hospital stay up to the subsidence of clinical and sonographic signs was significantly shorter (p < 0.001) in the drainage group, with a mean difference of 6.4 days (95% CI = 5.0-7.9; p < 0.05). CONCLUSIONS: Percutaneous drainage with antibiotics is a safe and effective way of treating acute perforated appendicitis. The recurrence rate for these patients is relatively low, and very often interval appendectomy is not required. For patients with periappendiceal abscess > or = 3 cm in diameter, antibiotic therapy alone is insufficient and the recurrence rate is high.

Abscess↗
PubMed1996

Laparoscopic stapler appendectomy. A prospective study of 267 consecutive cases.

BACKGROUND: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure. METHODS: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively. RESULTS: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%. CONCLUSIONS: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.

Acute Disease↗
PubMed1998

Incidental laparoscopic appendectomy for acute right lower quadrant abdominal pain. Its time has come.

BACKGROUND: Removing the normal appendix when operating for suspected acute appendicitis is the standard of care. The use of laparoscopy should not alter this practice. METHODS: Retrospective review of 72 patients found to have grossly normal appendices while undergoing laparoscopy for suspected appendicitis. Twenty-eight patients underwent diagnostic laparoscopy (DL) alone while 44 patients underwent diagnostic laparoscopy with incidental laparoscopic appendectomy (ILA). RESULTS: There was no difference in length of hospitalization (DL = 44 h, ILA = 43 h, p = 0.49) or morbidity (DL = 11%, ILA = 5%, p = 0.37). One patient required appendectomy 11 days after diagnostic laparoscopy for recurrent acute right lower quadrant abdominal pain. Five percent of resected appendices (2/44) demonstrated acute inflammation upon pathologic review. CONCLUSIONS: Laparoscopic removal of the normal appendix produces no added morbidity or increase in length of hospitalization as compared to diagnostic laparoscopy. It demonstrates cost effectiveness by preventing missed and future appendicitis. Incidental laparoscopic appendectomy is the preferred treatment option.

Abdomen, Acute↗
PubMed1998

Appendiceal mucocele. Contraindication to laparoscopic appendectomy.

Indications and contraindications to laparoscopic surgery continue to be refined. Laparoscopic appendectomy for acute appendicitis is frequently selected by patients and surgeons, and clinical studies show it to be a reasonable alternative. In this case study, laparoscopic surgery was used to resect an appendiceal mucocele caused by a nonperforated mucinous adenocarcinoma. Implants of mucinous tumor were found widely disseminated on peritoneal surfaces at laparotomy 9 months later. As a result of this case study, the authors suggest that when an appendiceal mucinous tumor is encountered at laparoscopy, a special situation requiring totally atraumatic appendectomy is indicated. This clinical situation should be considered an indication for conversion to open appendectomy. All appendiceal tumors, including the most benign-appearing adenomas, can result in diffuse peritoneal implantation. This is the first report of an appendiceal mucinous tumor resected by laparoscopy associated with subsequent diffuse peritoneal carcinomatosis. This patient presentation reaffirms that dissemination of cancer may be associated with laparoscopic resection of structures containing a malignancy.

Adenocarcinoma, Mucinous↗
PubMed1998

Cost-effective appendectomy. Open or laparoscopic? A prospective randomized study.

BACKGROUND: The aim of this study was to compare the outcome and cost-effectiveness of laparoscopic (LA) and open appendectomy (OA). METHODS: Forty consecutive patients were randomized to either the LA (n = 19) or OA (n = 21) group. RESULTS: The medians of operative times in the LA and OA groups were 31.5 and 41 min, respectively. The total operation room times were 91 and 82 min, respectively. There was no significant difference in postoperative pain or fatigue, but return to normal life was faster in the LA group (14 versus 26. 5 days). The median hospital costs per patient were 8,538 and 6,788 FIM ($1 US = 4.6 FIM) in the LA and OA groups, respectively; but the total costs among working patients were lower in the LA group (20, 963 versus 27,778 FIM) due to faster return to work. CONCLUSIONS: Laparoscopic appendectomy is as safe as open appendectomy. The hospital costs are higher, but LA offers significant cost savings to the payer for working patients.

Adolescent↗
PubMed2003

Stump appendicitis and generalized peritonitis due to incomplete appendectomy.

Stump appendicitis is a rare clinical situation when there is incomplete appendectomy. A wide spectrum of diseases in the differential diagnosis of right lower quadrant pain of the abdomen and presence of appendectomy operation in a patient's history delay the diagnosis. We report such a case of perforated stump appendicitis and generalized peritonitis occurring eight months after appendectomy.

Abdomen, Acute↗
PubMed2003

The use of autologous fibrin glue for the treatment of postoperative fecal fistula following an appendectomy: report of a case.

We herein report a case of postoperative fecal fistula following an appendectomy which was successfully treated by the use of autologous fibrin glue. An 82-year-old man had acute appendicitis and underwent an appendectomy. Later, a fecal fistula developed and he underwent drainage treatment twice. After 4 weeks of drainage and during the third recurrence, the remaining fistula was successfully treated using autologous fibrin glue, instead of surgery, due to potential complications and the risks of associated with advanced age. No recurrence has been observed for 5 months. In conclusion, autologous fibrin gluing for fecal fistula was found to be a safe, economical, and effective treatment. A search of Medline from 1980 until 2002 revealed no other report of this treatment for postoperative fecal fistula following an appendectomy.

Aged↗
PubMed1991

Incidental appendectomy during videolaseroscopy.

One hundred incidental appendectomies were performed in patients undergoing operative laparoscopy (videolaseroscopy) for evaluating and treating various major diseases of the reproductive organs. Except for a fever resolving within 24 hours in one case and mild periumbilical ecchymosis, there were no intraoperative or postoperative complications. All patients were discharged within 24 hours of surgery. Average hospital stay was 14 hours. All cases have been followed up for a minimum of 8 months. We believe any risk associated with elective appendectomy as reported here is minimal and outweighed by the benefits of eliminating future emergency appendectomy, simplifying future differential diagnosis of pelvic pain and removing unsuspected abnormality found in the appendix.

Adolescent↗
PubMed1977

The cul-de-sac approach for appendectomy.

Appendectomy through the peritoneal cul-de-sac by a low transverse incision as described herein is perfectly safe and practical. It is also easier and esthetically superior to appendectomy through other surgical approaches and could be routinely used in patients suspected of having acute appendicitis. It is particularly valuable in female patients in whom the pelvic organs may need exploration during appendectomy and for whom the postoperative esthetic result may be most gratifying.

Abscess↗
PubMed1987

Effect of incidental appendectomy on the development of wound infection in patients undergoing staging laparotomy for Hodgkin's disease.

Two hundred ten patients were retrospectively studied to evaluate the risk of appendectomy performed during laparotomy for staging of Hodgkin's disease. Seventy-nine patients did not have their appendix removed, and a wound infection developed in 1. One hundred thirty-one patients had an appendectomy, and 7 wound infections occurred in this group. This difference was not statistically significant. No patient died as a consequence of their wound infection, and no intraabdominal infections occurred. Our data suggest that the risk for development of a wound infection after a staging laparotomy for Hodgkin's disease is increased by performing an incidental appendectomy as part of the procedure. Although the differences noted were not statistically significant, this was probably due to the sample size. Based on our data, we do not routinely remove the appendix at the time of staging laparotomy.

Adolescent↗
PubMed1983

Appendectomy and subsequent cancer risk.

Although earlier epidemiologic studies reported a positive association between appendectomy and certain cancers, interest was limited due to lack of confidence in the study findings. However, recent morphologic studies on the immune structure of the vermiform appendix in the rabbit and man argue for a reevaluation of the appendectomy--cancer association. This paper reviews briefly the morphologic and epidemiologic literature on the subject to date. The validity of the earlier epidemiologic findings is discussed and avenues for further research assessing the relationship of appendectomy to subsequent cancer risk are proposed.

Animals↗
PubMed1994

Is routine appendectomy beneficial in the management of ovarian cancer?

A retrospective analysis of 136 patients with ovarian carcinoma subjected to appendectomy as a part of surgical procedure was carried out to assess the importance of appendectomy in patients with ovarian cancer. Of the 136 patients studied, 94 had epithelial and 38 had non-epithelial type of primary ovarian carcinoma. In the remaining 4 patients, the primary operation was performed with an intraoperative diagnosis of ovarian carcinoma but the final pathological examination revealed appendiceal carcinoma metastatic to ovaries. The overall appendiceal involvement in the study group with primary ovarian cancer was found to be 32.5% (43/132). This figure was 15.7% and 39.3% for non-epithelial and epithelial tumors, respectively. Involvement of the appendix ranged from 8.8% for patients with stage I disease to 46.0% for patients with stage III-IV disease. Four of the appendices found to be inflamed during the surgical explorations were later reported as acute appendicitis. The frequent occurrence of metastatic disease in the appendix in patients with ovarian cancer suggests routine appendectomy is appropriate for staging early cases and for contributing to maximal cytoreduction in advanced cases.

Appendectomy↗
PubMed1976

Rationale of incidental appendectomy.

In an effort to settle the controversy regarding use of incidental appendectomy, we have reviewed the literature regarding the function of the appendix and its role in the development of cancer, incidence of acute appendicitis, pathologic findings in incidentally removed appendices, and morbidity of incidental appendectomy. Considering all parameters we conclude that incidental appendectomy is a service to the patient and should be done except where specifically contraindicated.

Adolescent↗
PubMed1992

The role of appendectomy in surgical procedures for ovarian cancer.

To assess the role of appendectomy in the surgical procedures for ovarian cancer, we evaluated retrospectively the clinical charts of 435 patients who underwent surgery after diagnosis of ovarian cancer. The appendix was removed in 160 cases and pathological examination revealed 37 with metastatic implants (23%). All the patients with appendiceal metastases showed advanced disease (stages III-IV) with an incidence of 43%. Ninety-one percent (31/34) of the tumors with appendiceal involvement at the staging operation were of the serous cell type and grade II or III. No case with early stage, right ovary carcinoma showed appendiceal metastatic foci, denying the existence of a preferential lymphatic pathway. Microscopic involvement was found only in 4 patients with advanced disease (11.7%). No intra- or postoperative complication directly related to the appendectomy was recorded. We conclude, with these results, that appendectomy should be part of the cytoreductive operation for ovarian cancer.

Appendectomy↗
PubMed2004

Are negative appendectomies still acceptable?

BACKGROUND: The goal was to ascertain if there was a significant change in the negative appendectomy (NA) rate in our community hospital with the increased use of computed tomography (CT). METHODS: This was a retrospective chart review of all appendectomies for acute disease performed at our institution from January 2000 to December 2002. There is no established protocol; therefore, CT scans were performed at the discretion of the involved physicians. The results of the physical exams, CT scans and pathology were recorded. RESULTS: Three hundred eighty-nine appendectomies were performed for appendicitis. There was a progressive increase in the use of CT: 52% in 2000, 74% in 2001, and 86% in 2002. There was also a decrease in the NA rate over the 3 years: 17% in 2000, 9% in 2001 and 2% in 2002. The perforated appendicitis rate decreased from 25% in 2000 to 9% in 2002. CONCLUSION: The appropriate utilization of CT scan as an aid in the diagnosis of acute appendicitis should decrease the NA rate to 2%.

Acute Disease↗
PubMed2005

Laparoscopic versus standard appendectomy outcomes and cost comparisons in the private sector.

Minimally invasive surgery has been proposed as the preferred treatment strategy for various gastrointestinal disorders due to shorter hospital stay, less pain, quicker return to normal activities, and improved cosmesis. However, these advantages may not be straightforward for laparoscopic appendectomy, and optimal management of remains controversial. One hundred forty-eight patients with clinical and radiologic diagnoses of acute appendicitis treated in two different hospitals were retrospectively reviewed. Seventy-eight patients underwent laparoscopic appendectomy in hospital A and 70 patients underwent standard appendectomy in hospital B. Patients treated by either type of surgery were compared in terms of clinical and pathologic features, operation characteristics, complications, and costs. There were no significant differences between both groups in terms of clinical features, radiologic studies, complications, and final pathology findings (P > .05). Hospital stay was significantly shorter and bowel movements recovered quicker in the laparoscopy group. However, overall and operating room costs were significantly higher in patients treated by laparoscopy (P < .01). Our series show a subtle difference in terms of hospital stay and bowel movement recovery, favoring patients treated by laparoscopy. However, these results have to be carefully examined and weighed, because overall costs and operating room costs were significantly higher in the laparoscopy group.

Adult↗
PubMed2006

Laparoscopic versus open appendectomy for perforated appendicitis.

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean +/- SD = 96.1 +/- 43.1 vs. 67.8 +/- 32.2 minutes, P < 0.01). Return of oral intake was faster in the LA group (3.2 +/- 2.4 vs. 5.0 +/- 7.0 days, P < 0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4 +/- 2.8 vs. 6.3 +/- 7.1 days, P < 0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P < 0.01). Hospital stay days were shorter for the LA group (6.3 +/- 2.9 vs. 9.3 +/- 8.6 days, P < 0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.

Adult↗
PubMed2006

Factors affecting innovation in pediatric surgery: hospital type and appendectomies.

BACKGROUND: There are little data on whether patient or hospital characteristics affect utilization of innovative surgical techniques in children, especially with respect to laparoscopic appendectomy (LA), whose benefit over existing treatment remains unproven. This study examines the patterns of LA using a national database, focusing on variations in care between children's and general hospitals. METHODS: Using data from the 2000 Healthcare Costs and Utilization Project Kid's Inpatient Database for patients aged 5 to 20 years with a discharge diagnosis of appendectomy, we analyzed the relationship between LA and patient demographic and hospital characteristic variables. RESULTS: The Healthcare Costs and Utilization Project Kid's Inpatient Database included 50,825 pediatric appendectomies (26% LA) representing 97,205 cases in the nation. Children's hospitals and children's units were significantly more likely to provide LA (36% and 28%, respectively) than general hospitals (25%). Higher LA rates were also associated with greater patient age, female sex, nonperforated appendicitis, private insurance, and white patient race. The children's hospital effect compared to general hospitals (adjusted odds ratio, 2.11; 95% confidence interval, 1.88-2.38) and all other relationships remained significant in the multivariate model. CONCLUSION: Utilization of LA is significantly higher in children's hospitals. Children's hospitals appear more likely to adopt innovative surgical procedures, such as LA, even when clear benefit over standard treatment has not yet emerged.

Adolescent↗