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PubMed2001

Sonographic appearance of appendicitis in a neutropenic pediatric patient after inversion appendectomy.

The technique of inversion-ligation appendectomy is used by some surgeons to eliminate the risk of peritoneal contamination as the result of incidental appendectomy during an otherwise clean surgical procedure. In most cases, the intussuscepted appendix necroses and sloughs into the cecum after several days. We present the first report of the ultrasonographic appearance of a retained, inflamed appendix, which occurred in a neutropenic pediatric patient 15 months after inversion appendectomy. Our case illustrates the importance of a complete surgical history for the interpretation of abnormal sonographic findings of the cecum.

Appendicitis↗
PubMed2001

Laparoscopic appendectomy in children with Enterobius vermicularis.

As surgeons gain more experience with laparoscopy in children, it is becoming apparent that one of the best applications of the technique is for appendicitis. The advantages of laparoscopic appendectomy include a better cosmetic result, particularly in young female patients, a shorter recovery time, and an early return to normal activities. In the differential diagnosis of appendicitis, the association of Enterobius vermicularis (pinworms) inflammation in the pediatric age group is not uncommon. The endo-loop technique for laparoscopic appendectomy is the standard technique used in our department. In three patients with E. vermicularis undergoing appendix removal using this technique, pinworms were found to be set free into the abdomen after dividing the appendix between the loop ligatures. Bipolar coagulating forceps were used carefully to thermally desiccate the worms, which were then removed using a blunt grasper. E. vermicularis being released into the abdomen in children undergoing laparoscopic appendectomy using the endo-loop technique has not been reported. Careful evaluation of the appendix stump and simple but careful thermal desiccation and removal of pinworms, if present, must be considered when using the endo-loop technique.

Appendicitis↗
PubMed1986

Effects of atrial appendectomy on circulating atrial natriuretic factor during volume expansion in the rat.

This study examined the changes in the circulating level of endogenous atrial natriuretic factor during diuresis and natriuresis produced by acute volume expansion in anesthetized rats with either bilateral atrial appendectomy (n = 9) or sham operation (n = 9). Following control measurements in the sham-operated rats, 1% body weight volume expansion with isotonic saline produced an increment in urinary sodium excretion of over 4 mueq/min (P less than 0.05) while urine volume increased by more than 20 microliter/min (P less than 0.05). These responses were associated with a significant increase in immunoreactive plasma atrial natriuretic factor from a baseline value of 82 +/- 10 pg/ml to a level of 120 +/- 14 pg/ml (P less than 0.05). In contrast, in the group of rats with bilateral atrial appendectomy an identical degree of volume expansion increased urinary sodium excretion and urine volume by only 0.61 mueq/min (P less than 0.05) and 3.07 microliter/min (P less than 0.05), respectively. In this group, immunoreactive plasma atrial natriuretic factor remained statistically unchanged from a control value of 70 +/- 12 pg/ml to a level of 82 +/- 16 pg/ml (P greater than 0.05). Comparison of the two groups indicates that the natriuresis, diuresis, and plasma atrial natriuretic factor levels during volume expansion were significantly reduced in the rats with bilateral atrial appendectomy. No differences in mean arterial pressure and heart rate were observed between the two groups. These data demonstrate that removal of both atrial appendages in the rat attenuated the release of atrial natriuretic factor during volume expansion; and this effect, in turn, was associated with a reduction in the natriuretic and diuretic responses.

Animals↗
PubMed1992

[Appendectomy: open or laparoscopic?].

Surgeons interest in laparoscopic surgery has grown considerably in the last years, mostly due to the explosive spread of laparoscopic cholecystectomy. Laparoscopic appendectomy is from a historical point of view the older procedure, since it was already performed 1982 by Semm. His technique was modified 1987 by Götz, who is also responsible for popularizing it in general surgery. Between April 1989 and April 1991 we have performed 107 laparoscopic appendectomies. 82 were completed successfully by laparoscopy, in 25 instances we had to convert to an open procedure, mostly as a result of the lack of proficiency in the learning period. There were 8 septic complication (9.7%), a rather high rate, which probably will be reduced with the increasing operative expertise. There were no deaths in this series. Further experience is demanded in order to establish laparoscopic appendectomy as the alternative to the conventional procedure.

Abdomen, Acute↗
PubMed2007

Post-appendectomy thrombotic thrombocytopenic purpura: a case report and review of the literature.

Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by microangiopathic hemolytic anemia and thrombocytopenia with varying degrees of renal dysfunction, neurologic signs and symptoms, and fever. Evidence has supported that a large proportion of cases of acquired TTP are due to the accumulation of ultralarge von Willebrand factor (vWF) multimers due to an acquired deficiency in the vWF cleaving protease, ADAMTS-13. TTP is rare in the post-surgical setting but is best described after cardiothoracic and vascular surgeries. We present a case of postoperative TTP first presenting with microangiopathic hemolytic anemia and thrombocytopenia 9 days after emergent appendectomy for a ruptured appendix. ADAMTS-13 and factor H levels returned normal and an ADAMTS-13 inhibitor was not identified. To our knowledge, this is the first case report of postoperative TTP after an appendectomy and the first report with correlative ADAMTS-13 data. Plasma exchange with fresh frozen plasma followed by cryopoor plasma, along with steroids resulted in eventual remission of TTP in our patient. Early postoperative diagnosis and aggressive management with consideration of initiation of plasma exchange is imperative to decrease the morbidity and morality associated with TTP.

ADAM Proteins↗
PubMed1975

Appendectomy, tonsillectomy, and neoplasia.

Reports in the literature that study the frequency of cancer in individual who have had their tonsils or appendix or both removed are reviewed. Some investigators found a high incidence of solid cancers - in particular, breast and colon neoplasms - in female patients who have had appendectomy, but others disagreed. The association of tonsillectomy and/or appendectomy with the later development of malignant lymphomas is not proven.

Acute Disease↗
PubMed1995

Intraperitoneal fluid collection after laparoscopic appendectomy. Sonographic analysis in asymptomatic patients.

The aim of this prospective study was to evaluate the frequency of postoperative fluid collection after laparoscopic appendectomy in patients with normal postoperative development. Twenty-eight patients were included. The surgical technique, histological data, and postoperative development during the first postoperative month were recorded. A sonographic analysis was performed on the 5th postoperative day by a radiologist who was not aware of the histological and surgical data. Ten cases of fluid collection were found (37%). The frequency was higher in cases of suppurated appendicitis and significantly higher with associated periappendicitis. Peritoneal irrigation or retrocecal dissection did not influence the occurrence of fluid collection. Postoperative serous fluid collection occurs with a high frequency after laparoscopic appendectomies, and one must be careful in interpreting sonographic analyses in looking for deep abscesses in patients with difficult postoperative development.

Adolescent↗
PubMed1990

Modified laparoscopic appendectomy in surgery. A report on 388 operations.

Laparoscopic appendectomy, introduced in gynecology by Semm in 1982, has been modified and practiced in our surgical ward since May 1987 in more than 450 patients suffering from all stages of acute and chronic vermix diseases. We report our data on the first series of 388 operations, in which we had the encouraging experience that laparoscopic appendectomy is a practicable and reasonable alternative to routine surgery.

Acute Disease↗
PubMed1994

Single-port laparoscopy assisted appendectomy under local pneumoperitoneum condition.

We describe herein a novel, simplified technique of laparoscope-assisted appendectomy under local pneumoperitoneum condition. A 12-mm-outer-diameter laparoscope fitted with a transparent plastic cap is inserted through a single, small, open laparotomy incision. This scope has a 5-mm working channel for insertion of the multifunctional metallic catheter which maintains the local pneumoperitoneum condition. When we have located the inflamed appendix by tracing the tenia of cecum, we use the grasping forceps protruding from the working channel of this laparoscope to grasp its tip or root on the cecum. This allows us to pull the appendix up and out through the small incision and to resect it in the conventional surgical way. This procedure permits the surgeon to perform appendectomy by making only one small incision under spinal anesthesia, and also eliminates development of the intracavitary concomitant diseases.

Appendectomy↗
PubMed1994

[Laparoscopic appendectomy. A review of the literature].

Laparoscopic methods are becoming increasingly popular in surgery. In the course of a review concerning laparoscopic appendectomy undertaken up to 31 December 1993 all publications were evaluated by computer-assisted research. Out of a total of 90 publications only 14 deal with the comparison of the laparoscopic versus open appendectomy. Two prospective randomized studies are published. Because of the low number of patients the evaluation of the laparoscopic method is not yet definite.

Adolescent↗
PubMedDate not supplied

Laparoscopic appendectomy.

Appendectomy was performed using a laparoscopic approach in 915 patients. The collected data show that the technique is as feasible, rapid, and safe as open surgery. Few wound infections, minimal pain, and rapid postoperative mobilization are the main arguments in favor of laparoscopic appendectomy. The most important potential benefit, a lower incidence of long-term complications such as adhesive intestinal obstruction, remains to be confirmed by prolonged follow-up of our patients.

Adolescent↗
PubMed1993

Initial experience with laparoscopic appendectomy.

As experience with laparoscopy increases, new applications in general surgery are being identified. Treatment of acute appendicitis through the laparoscope has been proposed. We present our initial experience with this new technique. Over a 12-month period, laparoscopic appendectomy was attempted in 29 patients. There were no intraoperative complications. Two cases required conversion to the open technique owing to gangrene at the appendiceal base. The average operating time was 64 minutes. Two of nine patients with perforated appendicitis developed a pelvic abscess, and one patient developed wound cellulitis. Pain medication requirements were minimal, bowel function returned rapidly, and half of the patients were discharged on postoperative day one or two and returned to normal activity within one week. Based on our initial experience, it appears that laparoscopic appendectomy is a safe and effective technique for managing acute appendicitis and offers advantages in terms of decreased pain, decreased hospital stay, and a rapid return to normal activities.

Acute Disease↗
PubMed1976

Appendectomies in patients with nephritis.

A retrospective study of 150 records of patients attending a renal clinic revealed a high (10 per cent) incidence of history of appendectomy. The possibility that an acute exacerbation of pyelonephritis, especially on the right side, might be misdiagnosed in some cases as appendicitis is discussed. Acute renal failure following unnecessary appendectomy in a patient with previously unrecognized and asymptomatic chronic renal disease may occur if this possibility is not borne in mind before operating on an atypical case of appendicitis.

Acute Kidney Injury↗
PubMed1989

[Incidence of appendectomy and length of hospital stay in a region of West Germany].

Based on public health routine data, a study on the incidence of appendectomies was carried out in the Federal Republic of Germany. The result of 130 appendectomies per 100,000 inhabitants per annum comes very close to the findings made in England and Wales though it only represents one fifth of the figure, Lichtner and Pflanz had established for some other region about 20 years ago. Duration of hospitalization averaged 10.6 days, thus showing a reduction of 2 days compared to the earlier study. In England and Wales however, the average length of stay in hospital came up to only 5.6 days. The length of stay, standardized by age and sex, showed differences of more than 4 days on the various wards. The possible influences of institution inherent factors on the frequency of operations and on the duration of hospitalization are discussed.

Adolescent↗
PubMed1984

Ileocolic intussusception in an adult. A postoperative complication of appendectomy.

Two weeks after appendectomy a right hemicolectomy was performed on a 35-year-old man because of an ileocolic intussusception. The appendiceal stump was the leading point of the intussusception. Ileocolic intussusception is a very rare complication after appendectomy. The clinical symptoms, diagnostic features, and mode of treatment are discussed.

Adult↗
PubMed2006

Training in laparoscopic appendectomy.

BACKGROUND: The role of laparoscopic appendectomy (LA) in surgical training is unclear. Although LA as a therapeutic modality is potentially superior to open surgery, it has failed to become established as standard in training hospitals. The aim of the present study was to evaluate the outcome of LA performed by inexperienced surgeons in a training environment. MATERIALS AND METHODS: A retrospective analysis of all attempted LA performed over a 12-month period was undertaken. Data collected included operator grade (experienced and inexperienced), conversion rate and duration of surgery, complications, and postoperative stay. RESULTS: During the study period, 169 appendectomies were performed. The conversion rate to open surgery declined significantly from 28% in the first quarter to 9% in the last quarter, with no difference in the conversion rate between experienced and inexperienced surgeons. Operative time shortened significantly in the inexperienced group. Postoperative complications occurred in 8% of patients, independent of operative grade. CONCLUSIONS: Our findings demonstrate that LA may be safely introduced as a teaching procedure. Time-to-train should not preclude institutions from adopting the laparoscopic approach in the treatment of acute appendicitis.

Adult↗
PubMed1996

Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial.

We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12-month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4-0 sutures. Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected. Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days. All patients were assessed for complications resulting from the technique of wound closure. No intraabdominal abscesses or serious complications were recorded. The overall incidence of wound infection was 1.8%. Among children with a perforated appendix the rate of superficial wound infection was 5.7%. There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary. We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.

Adolescent↗