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management of uncomplicated appendicitis

Anna Maria Caruso, Alessandro Pane, Roberto Garau, Pietro Atzori, Marcello Podda, Alessandra Casuccio, Luigi Mascia
PURPOSE: An accurate diagnosis of acute appendicitis is important to avoid severe outcome or unnecessary surgery but management is controversial. The aim of study was to evaluate, in younger and older children, the efficacy of conservative management for uncomplicated appendicitis and the outcome of complicated forms underwent early surgery. METHODS: Children with acute appendicitis were investigated by clinical, laboratory variables and abdominal ultrasound and divided in two groups: complicated and uncomplicated...
August 25, 2016: Journal of Pediatric Surgery
Gérard Grelpois, Charles Sabbagh, Cyril Cosse, Brice Robert, Emilie Chapuis-Roux, Alexandre Ntouba, Thierry Lion, Jean-Marc Regimbeau
BACKGROUND: Day case surgery (DCS) for uncomplicated acute appendicitis (NCAA) is under evaluation. The objective of this prospective, single-center, descriptive, non-randomized, intention-to-treat (ITT) cohort study was to assess the feasibility of DCS for NCAA with a critical analysis of the reasons for exclusion and treatment failures and a focus on patients discharged to home and admitted for DCS on the following day. STUDY DESIGN: From April 2013 to December 2015, NCAA patients meeting the inclusion criteria were included in the study...
August 17, 2016: Journal of the American College of Surgeons
Dani O Gonzalez, Katherine J Deans, Peter C Minneci
Appendectomy is currently considered the standard of care for children with acute appendicitis. Although commonly performed and considered a safe procedure, appendectomy is not without complications. Non-operative management has a role in the treatment of both uncomplicated and complicated appendicitis. In uncomplicated appendicitis, initial non-operative management appears to be safe, with an approximate 1-year success rate of 75%. Compared to surgery, non-operative management is associated with less disability and lower costs, with no increase in the rate of complicated appendicitis...
August 2016: Seminars in Pediatric Surgery
Salomone Di Saverio, Arianna Birindelli, Micheal D Kelly, Fausto Catena, Dieter G Weber, Massimo Sartelli, Michael Sugrue, Mark De Moya, Carlos Augusto Gomes, Aneel Bhangu, Ferdinando Agresta, Ernest E Moore, Kjetil Soreide, Ewen Griffiths, Steve De Castro, Jeffry Kashuk, Yoram Kluger, Ari Leppaniemi, Luca Ansaloni, Manne Andersson, Federico Coccolini, Raul Coimbra, Kurinchi S Gurusamy, Fabio Cesare Campanile, Walter Biffl, Osvaldo Chiara, Fred Moore, Andrew B Peitzman, Gustavo P Fraga, David Costa, Ronald V Maier, Sandro Rizoli, Zsolt J Balogh, Cino Bendinelli, Roberto Cirocchi, Valeria Tonini, Alice Piccinini, Gregorio Tugnoli, Elio Jovine, Roberto Persiani, Antonio Biondi, Thomas Scalea, Philip Stahel, Rao Ivatury, George Velmahos, Roland Andersson
Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued...
2016: World Journal of Emergency Surgery: WJES
Grace Zee Mak, Deborah S Loeff
Acute appendicitis is the most common cause of emergent surgery in children. Historically, surgical dogma dictated emergent appendectomy due to concern for impending perforation. Recently, however, there has been a paradigm shift in both the understanding of its pathophysiology as well as its treatment to more nonoperative management. No longer is it considered a spectrum from uncomplicated appendicitis inevitably progressing to complicated appendicitis over time. Rather, uncomplicated and complicated appendicitis are now considered two distinct pathophysiologic entities...
July 1, 2016: Pediatric Annals
Rowan Ousley, Laura L Burgoyne, Nicola R Crowley, Warwick J Teague, David Costi
BACKGROUND: Patient-controlled analgesia (PCA) is commonly used after appendicectomy in children. AIM: The aim of this study was to characterize the analgesic use of children prescribed PCA after appendicetomy, in order to rationalize future use of this modality. METHODS: We retrospectively audited all cases of acute appendicitis over a 4-year period in a single pediatric hospital, recording demographics, surgical approach, pathology, analgesia use, pain scores, and duration of PCA...
October 2016: Paediatric Anaesthesia
Matthew P Kronman, Assaf P Oron, Rachael K Ross, Adam L Hersh, Jason G Newland, Adam Goldin, Shawn J Rangel, Scott J Weissman, Danielle M Zerr, Jeffrey S Gerber
BACKGROUND AND OBJECTIVES: Appendicitis guidelines recommend either narrower- or extended-spectrum antibiotics for treatment of complicated appendicitis. The goal of this study was to compare the effectiveness of extended-spectrum versus narrower-spectrum antibiotics for children with appendicitis. METHODS: We performed a retrospective cohort study of children aged 3 to 18 years discharged between 2011 and 2013 from 23 freestanding children's hospitals with an appendicitis diagnosis and appendectomy performed...
July 2016: Pediatrics
Katherine A Anderson, Stephen W Abernathy, Daniel Jupiter, Richard C Frazee
BACKGROUND: Outpatient laparoscopic appendectomy has been shown to be safe, with low morbidity and readmission rates, but whether outpatient appendectomy produces poorer patient satisfaction has been questioned. MATERIALS AND METHODS: Preoperatively, patients with uncomplicated appendicitis were counselled regarding outpatient management and instructed on postoperative care, follow-up appointments, and contact information. Telephone surveys of patients who underwent an outpatient laparoscopic appendectomy for uncomplicated appendicitis from January through October 2013 were performed...
June 10, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Katie E Rollins, Krishna K Varadhan, Keith R Neal, Dileep N Lobo
BACKGROUND: Uncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated with fewer complications than appendicectomy. The aim of this study was to compare outcomes of antibiotic therapy with appendicectomy for uncomplicated acute appendicitis. METHOD: This meta-analysis of randomised controlled trials included adult patients presenting with uncomplicated acute appendicitis treated with antibiotics or appendicectomy...
October 2016: World Journal of Surgery
Justin B Mahida, Daniel L Lodwick, Kristine M Nacion, Jason P Sulkowski, Karen L Leonhart, Jennifer N Cooper, Erica J Ambeba, Katherine J Deans, Peter C Minneci
BACKGROUND: The purpose of this study was to investigate the feasibility of nonoperative management of acute appendicitis in children with an appendicolith identified on preoperative imaging. STUDY DESIGN: We performed a prospective nonrandomized trial of nonoperative management of uncomplicated acute appendicitis with an appendicolith in children aged 7 to 17years. The primary outcome was the failure rate of nonoperative management, defined as having undergone an appendectomy...
June 2016: Journal of Pediatric Surgery
Robert C Gandy, Frank Wang
Appendicitis is one of the most commonly encountered emergency presentations to the general surgical services. The operative management of this condition is associated with significant financial costs and represents a significant workload on the emergency surgical services. Negative appendicectomy rates remain high (20-25%) despite advancements in laboratory testing and imaging techniques. Recent data from randomized controlled trials suggests that non-operative management in patients presenting with uncomplicated or non-perforated acute appendicitis is a viable alternative, with only 23% of patients requiring an appendicectomy at 1 year and an overall reduction in complications...
April 2016: ANZ Journal of Surgery
Richard C Frazee, Stephen W Abernathy, Claire L Isbell, Travis Isbell, Justin L Regner, Randall D Smith
BACKGROUND: Laparoscopic appendectomy is typically associated with inpatient hospitalization averaging between 1 and 2 days. In July 2010, a prospective protocol for outpatient laparoscopic appendectomy was adopted at our institution. Patients were dismissed from the post-anesthesia recovery room or day surgery if they met certain predefined criteria. Patients admitted to a hospital room as either full admission or observation status were considered failures of outpatient management. STUDY DESIGN: An IRB-approved, retrospective review of a prospective database was performed on all patients having laparoscopic appendectomy for uncomplicated appendicitis from July 2010 through December 2014...
April 2016: Journal of the American College of Surgeons
Itzhak Brook
A nonsurgical approach using antimicrobial agents has been advocated as the initial treatment of uncomplicated appendicitis. Several studies and meta-analyses explored this approach. Because many of these studies included individuals with resolving appendicitis, their results were biased. Antimicrobials, however, are warranted and needed for the management of surgical high-risk patients with perforated appendicitis and those with localized abscess or phlegmon. Randomized placebo-controlled trials that focus on early identification of complicated acute appendicitis patients needing surgery and that prospectively evaluate the optimal use of antibiotic treatment in patients with uncomplicated acute appendicitis are warranted...
March 2016: American Journal of Emergency Medicine
Peter C Minneci, Justin B Mahida, Daniel L Lodwick, Jason P Sulkowski, Kristine M Nacion, Jennifer N Cooper, Erica J Ambeba, R Lawrence Moss, Katherine J Deans
IMPORTANCE: Current evidence suggests that nonoperative management of uncomplicated appendicitis is safe, but overall effectiveness is determined by combining medical outcomes with the patient's and family's perspective, goals, and expectations. OBJECTIVE: To determine the effectiveness of patient choice in nonoperative vs surgical management of uncomplicated acute appendicitis in children. DESIGN, SETTING, AND PARTICIPANTS: Prospective patient choice cohort study in patients aged 7 to 17 years with acute uncomplicated appendicitis presenting at a single pediatric tertiary acute care hospital from October 1, 2012, through March 6, 2013...
May 1, 2016: JAMA Surgery
Carlos Augusto Gomes, Massimo Sartelli, Salomone Di Saverio, Luca Ansaloni, Fausto Catena, Federico Coccolini, Kenji Inaba, Demetrios Demetriades, Felipe Couto Gomes, Camila Couto Gomes
Advances in the technology and improved access to imaging modalities such as Computed Tomography and laparoscopy have changed the contemporary diagnostic and management of acute appendicitis. Complicated appendicitis (phlegmon, abscess and/ or diffuse peritonitis), is now reliably distinguished from uncomplicated cases. Therefore, a new comprehensive grading system for acute appendicitis is necessary. The goal is review and update the laparoscopic grading system of acute appendicitis and to provide a new standardized classification system to allow more uniform patient stratification...
2015: World Journal of Emergency Surgery: WJES
Kumiko Kitaoka, Kazuhiro Saito, Koichi Tokuuye
Identification of complicated appendicitis (CA) is critical to the management of appendicitis. However, previous studies have not investigated indicators of CA among patients with HIV or whether it is safe to use conservative treatment for appendicitis in these patients. Among 322 patients with appendicitis, we identified 14 who had HIV. Six of them were operated and 8 were treated with antibiotics; CA was diagnosed in 4. Patients with HIV and CA had a significantly lower CD4+ T-cell count than those with uncomplicated appendicitis...
December 2015: Canadian Journal of Surgery. Journal Canadien de Chirurgie
James X Wu, Aaron J Dawes, Greg D Sacks, F Charles Brunicardi, Emmett B Keeler
BACKGROUND: Appendectomy remains the gold standard in the treatment of acute, uncomplicated appendicitis in the United States. Nonetheless, there is growing evidence that nonoperative management is safe and efficacious. METHODS: We constructed a decision tree to compare nonoperative management of appendicitis with laparoscopic appendectomy in otherwise healthy adults. Model variables were abstracted from a literature review, data from the Healthcare Cost and Utilization Project data, the Medicare Physician Fee schedule, and the American College of Surgeons Surgical Risk Calculator...
September 2015: Surgery
Michael E Kelly, Asif Khan, Jameel Ur Rehman, Ronan M Waldron, Waqar Khan, Kevin Barry, Iqbal Z Khan
INTRODUCTION: The management approach for acute appendicitis has been challenged in recent years, with numerous randomized controlled trials demonstrating that antibiotics/conservative management is an efficacious treatment, with lower complication rates. METHODS: A national survey of all consultant general surgeons evaluating their practices was performed. Reasons for changed practices, choice of antibiotics and follow-up investigations were evaluated. In addition, the role of interval appendicectomy and conservative management in the pediatric population was also assessed...
2015: Digestive Surgery
J J Atema, C C van Rossem, M M Leeuwenburgh, J Stoker, M A Boermeester
BACKGROUND: Non-operative management may be an alternative for uncomplicated appendicitis, but preoperative distinction between uncomplicated and complicated disease is challenging. This study aimed to develop a scoring system based on clinical and imaging features to distinguish uncomplicated from complicated appendicitis. METHODS: Patients with suspected acute appendicitis based on clinical evaluation and imaging were selected from two prospective multicentre diagnostic accuracy studies (OPTIMA and OPTIMAP)...
July 2015: British Journal of Surgery
Dimitrios S Kyziridis, Styliani N Parpoudi, Nikolaos D Antoniou, Dimitrios Ch Konstantaras, Moysis G Moysidis, Emmanuel Ch Christoforidis, Konstantinos G Tsalis
BACKGROUND: Cecal diverticulitis is an uncommon cause of acute abdominal pain and presents clinically similar to acute appendicitis. There are many perspectives concerning the management of this condition, ranging from different types of surgical resections to conservative treatment with antibiotics. CASE REPORT: We present 3 cases of cecal diverticulitis. One of the patients was treated conservatively with intravenous antibiotics and the other 2 were treated with surgical resection...
2015: American Journal of Case Reports
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