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management of uncomplicated appendicitis

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https://www.readbyqxmd.com/read/28306630/nonoperative-management-of-appendicitis-in-children
#1
Joseph J López, Katherine J Deans, Peter C Minneci
PURPOSE OF REVIEW: The aim of this review is to summarize the recent literature investigating nonoperative management of uncomplicated and complicated appendicitis and highlight recent data establishing its safety and efficacy. RECENT FINDINGS: Recent studies and clinical trials have demonstrated the efficacy of nonoperative treatment of both uncomplicated and complicated appendicitis, defined as perforated appendicitis with or without formed abscess or phlegmon...
March 16, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28284517/antibiotics-first-strategy-for-uncomplicated-acute-appendicitis-in-adults-is-associated-with-increased-rates-of-peritonitis-at-surgery-a-systematic-review-with-meta-analysis-of-randomized-controlled-trials-comparing-appendectomy-and-non-operative-management
#2
REVIEW
Mauro Podda, Nicola Cillara, Salomone Di Saverio, Antonio Lai, Francesco Feroci, Gianluigi Luridiana, Ferdinando Agresta, Nereo Vettoretto
BACKGROUND: Acute appendicitis is the most common surgical diagnosis in young patients, with lifetime prevalence of about 7%. Debate remains on whether uncomplicated AA should be operated or not. Aim of this meta-analysis of randomized controlled trials was to assess current evidence on antibiotic treatment for uncomplicated AA compared to standard surgical treatment. METHODS: Systematic literature search was performed using PubMed, EMBASE, Medline, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated AA...
March 8, 2017: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/28003294/acute-uncomplicated-appendicitis-study-rationale-and-protocol-for-a-multicentre-prospective-randomised-controlled-non-inferiority-study-to-evaluate-the-safety-and-effectiveness-of-non-operative-management-in-children-with-acute-uncomplicated-appendicitis
#3
Jane Xu, Yingrui Cyril Liu, Susan Adams, Jonathan Karpelowsky
INTRODUCTION: This article presents an overview of a prospective randomised controlled non-inferiority study designed to evaluate the safety and effectiveness of non-operative management (NOM) with operative management in children with acute uncomplicated appendicitis (AUA). Here, we present the study protocol for this APRES study, a multicentre Australian study. The rationale and details of future analysis, in particular, non-inferiority calculations, cost-effectiveness, feasibility and acceptability of each intervention...
December 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27974169/antibiotics-first-versus-surgery-for-appendicitis-a%C3%A2-us-pilot-randomized-controlled-trial-allowing-outpatient-antibiotic-management
#4
David A Talan, Darin J Saltzman, William R Mower, Anusha Krishnadasan, Cecilia M Jude, Ricky Amii, Daniel A DeUgarte, James X Wu, Kavitha Pathmarajah, Ashkan Morim, Gregory J Moran
STUDY OBJECTIVE: Randomized trials suggest that nonoperative treatment of uncomplicated appendicitis with antibiotics-first is safe. No trial has evaluated outpatient treatment and no US randomized trial has been conducted, to our knowledge. This pilot study assessed feasibility of a multicenter US study comparing antibiotics-first, including outpatient management, with appendectomy. METHODS: Patients aged 5 years or older with uncomplicated appendicitis at 1 US hospital were randomized to appendectomy or intravenous ertapenem greater than or equal to 48 hours and oral cefdinir and metronidazole...
December 11, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27942727/quantifying-the-burden-of-interhospital-cost-variation-in-pediatric-surgery-implications-for-the-prioritization-of-comparative-effectiveness-research
#5
Danielle B Cameron, Dionne A Graham, Carly E Milliren, Charity C Glass, Christina Feng, Feroze Sidhwa, Hariharan Thangarajah, Matthew Hall, Shawn J Rangel
Importance: Practice variation is believed to be a driver of excess health care spending, although few objective data exist to guide the prioritization of comparative effectiveness research (CER) in pediatric surgery. Objective: To identify high-priority general pediatric surgical procedures for CER on the basis of the following 2 complementary measures: the magnitude of interhospital cost variation as a surrogate for the need for and potential effect of CER at the patient level and the cumulative fiscal burden of this cost variation when considering the case volume from all hospitals as a surrogate for public health relevance...
February 6, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/27894435/pediatric-appendicitis
#6
REVIEW
Rebecca M Rentea, Shawn D St Peter
Appendicitis is one of the most common surgical pathologies in children. It can present with right lower quadrant pain. Scoring systems in combination with selective imaging and surgical examination will diagnose most children with appendicitis. Clinical pathways should be used. Most surgical interventions for appendicitis are now almost exclusively laparoscopic, with trials demonstrating better outcomes for children who undergo index hospitalization appendectomies when perforated. Nonoperative management has a role in the treatment of both uncomplicated and complicated appendicitis...
February 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/27836368/the-cost-effectiveness-of-nonoperative-management-versus-laparoscopic-appendectomy-for-the-treatment-of-acute-uncomplicated-appendicitis-in-children
#7
James X Wu, Greg D Sacks, Aaron J Dawes, Daniel DeUgarte, Steven L Lee
BACKGROUND: Several studies have demonstrated the safety and short-term success of nonoperative management in children with acute, uncomplicated appendicitis. Nonoperative management spares the patients and their family the upfront cost and discomfort of surgery, but also risks recurrent appendicitis. METHODS: Using decision-tree software, we evaluated the cost-effectiveness of nonoperative management versus routine laparoscopic appendectomy. Model variables were abstracted from a review of the literature, Healthcare Cost and Utilization Project, and Medicare Physician Fee schedule...
October 20, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27779999/appendicitis-in-cancer-patients-is-often-observed-and-can-represent-appendiceal-malignancy
#8
David Santos, Yi-Ju Chiang, Brian Badgwell
Appendectomy is standard of care for uncomplicated appendicitis, but cancer patients may not be optimal surgical candidates. Interval appendectomy is controversial, and appendiceal malignancy is rare. Study objectives were to review the role of surgery, observation, and interventional radiology (IR)-guided drainage in patients with appendicitis and advanced malignancy. Retrospective review was performed on cancer patients presenting to a tertiary academic cancer center from January 1, 2001 to December 31, 2014...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27612631/acute-appendicitis-in-children-not-only-surgical-treatment
#9
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
https://www.readbyqxmd.com/read/27544690/management-of-uncomplicated-acute-appendicitis-as-day-case-surgery-feasibility-and-a-critical-analysis-of-exclusion-criteria-and-treatment-failure
#10
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 evaluated. The objective of this prospective, single-center, descriptive, nonrandomized, intention-to-treat 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...
November 2016: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27521709/role-of-non-operative-management-in-pediatric-appendicitis
#11
REVIEW
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
https://www.readbyqxmd.com/read/27437029/wses-jerusalem-guidelines-for-diagnosis-and-treatment-of-acute-appendicitis
#12
REVIEW
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
https://www.readbyqxmd.com/read/27403670/paradigm-shifts-in-the-treatment-of-appendicitis
#13
REVIEW
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
https://www.readbyqxmd.com/read/27373867/an-audit-of-patient-controlled-analgesia-after-appendicectomy-in-children
#14
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
https://www.readbyqxmd.com/read/27354453/extended-versus-narrower-spectrum-antibiotics-for-appendicitis
#15
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
https://www.readbyqxmd.com/read/27285316/patient-satisfaction-after-outpatient-appendectomy
#16
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...
December 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/27199000/antibiotics-versus-appendicectomy-for-the-treatment-of-uncomplicated-acute-appendicitis-an-updated-meta-analysis-of-randomised-controlled-trials
#17
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
https://www.readbyqxmd.com/read/27018085/high-failure-rate-of-nonoperative-management-of-acute-appendicitis-with-an-appendicolith-in-children
#18
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
https://www.readbyqxmd.com/read/26991357/should-the-non-operative-management-of-appendicitis-be-the-new-standard-of-care
#19
REVIEW
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
https://www.readbyqxmd.com/read/26920990/outpatient-laparoscopic-appendectomy-is%C3%A2-it%C3%A2-time-to-end-the-discussion
#20
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
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