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management of uncomplicated appendicitis

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https://www.readbyqxmd.com/read/29370051/a-protocol-for-non-operative-management-of-uncomplicated-appendicitis
#1
Tyler J Loftus, Camille G Dessaigne, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Scott C Brakenridge, Alicia M Mohr, Janeen R Jordan
BACKGROUND: We developed a protocol to identify candidates for non-operative management (NOM) of uncomplicated appendicitis. Our objective was to evaluate protocol efficacy with the null hypothesis that clinical outcomes, hospital readmission rates, and hospital charges would be unchanged after protocol implementation. METHODS: We performed a single-center 4-year propensity score matched retrospective cohort analysis of 406 patients with acute uncomplicated appendicitis...
February 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29365029/association-of-the-affordable-care-act-medicaid-expansion-with-access-to-and-quality-of-care-for-surgical-conditions
#2
Andrew P Loehrer, David C Chang, John W Scott, Matthew M Hutter, Virendra I Patel, Jeffrey E Lee, Benjamin D Sommers
Importance: Lack of insurance coverage has been associated with delays in seeking care, more complicated diseases at the time of diagnosis, and decreased likelihood of receiving optimal surgical care. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansion has increased coverage among millions of low-income Americans, but its effect on care for common surgical conditions remains unknown. Objective: To evaluate the association of the ACA's Medicaid expansion with access to timely and recommended care for common and serious surgical conditions...
January 24, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29344678/conservative-antibiotic-treatment-for-acute-uncomplicated-appendicitis-is-feasible
#3
Zvi Steiner, Genady Buklan, Michael Gutermacher, Ita Litmanovitz, Tal Landa, Shmuel Arnon
PURPOSE: Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center's experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria. METHODS: Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA...
January 17, 2018: Pediatric Surgery International
https://www.readbyqxmd.com/read/29340826/single-port-laparoscopic-surgery-in-uncomplicated-acute-appendicitis-a-randomized-controlled-trial
#4
Byung Mo Kang, Sung Il Choi, Bum-Soo Kim, Suk-Hwan Lee
BACKGROUND: Single-port laparoscopic surgery (SPLS) is an alternative, minimally invasive surgical approach for managing appendicitis. The aim of this randomized trial was to evaluate the safety and efficacy of SPLS in uncomplicated appendicitis. METHODS: Between December 2009 and November 2010, 194 patients with radiologically diagnosed acute appendicitis were randomly allocated to undergo either SPLS or multiport laparoscopic surgery (MPLS). Patients with intraoperative findings of perforated appendicitis were excluded from the analysis...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29322168/patient-preferences-for-surgery-or-antibiotics-for-the-treatment-of-acute-appendicitis
#5
Alexis L Hanson, Ross D Crosby, Marc D Basson
Importance: Studies have compared surgical with nonsurgical therapy for acute uncomplicated appendicitis, but none of these studies have a patient-centered perspective. Objectives: To evaluate how patients might choose between surgical and nonsurgical therapy for acute uncomplicated appendicitis and to identify targets to make antibiotic treatment more appealing. Design, Setting, and Participants: This study comprised an online survey and an in-person sensitivity analysis survey...
January 10, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29190038/closure-methods-of-the-appendix-stump-for-complications-during-laparoscopic-appendectomy
#6
REVIEW
Gurdeep S Mannu, Maria K Sudul, Joao H Bettencourt-Silva, Elspeth Cumber, Fangfang Li, Allan B Clark, Yoon K Loke
BACKGROUND: Laparoscopic appendectomy is amongst the most common general surgical procedures performed in the developed world. Arguably, the most critical part of this procedure is effective closure of the appendix stump to prevent catastrophic intra-abdominal complications from a faecal leak into the abdominal cavity. A variety of methods to close the appendix stump are used worldwide; these can be broadly divided into traditional ligatures (such as intracorporeal or extracorporeal ligatures or Roeder loops) and mechanical devices (such as stapling devices, clips, or electrothermal devices)...
November 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29148199/five-lessons-in-uncomplicated-appendicitis-can-we-remove-the-surgery
#7
Andrew Read, Jane Xu, Susan Adams, Jonathan Karpelowsky
Appendicectomy has remained the treatment of choice for appendicitis for over a century and is the most commonly performed emergency operation in children. However, emerging evidence suggests that appendicectomy may not always be necessary in uncomplicated appendicitis, with early paediatric trials demonstrating that antibiotic-only therapy can be safe and effective. Further rigorously designed and appropriately powered studies are necessarily to establish the place of non-operative management of uncomplicated appendicitis in the future...
November 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29146647/initial-non-operative-management-of-uncomplicated-appendicitis-in-children-a-protocol-for-a-multicentre-randomised-controlled-trial-apac-trial
#8
Max Knaapen, Johanna H van der Lee, Roel Bakx, Sarah-May L The, Ernst W E van Heurn, Hugo A Heij, Ramon R Gorter
INTRODUCTION: Based on epidemiological, immunological and pathology data, the idea that appendicitis is not necessarily a progressive disease is gaining ground. Two types are distinguished: simple and complicated appendicitis. Non-operative treatment (NOT) of children with simple appendicitis has been investigated in several small studies. So far, it is deemed safe. However, its effectiveness and effect on quality of life (QoL) have yet to be established in an adequately powered randomised trial...
November 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/29146455/successful-nonoperative-management-of-uncomplicated-appendicitis-predictors-and-outcomes
#9
Tyler J Loftus, Scott C Brakenridge, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Janeen R Jordan
BACKGROUND: Our objective was to identify predictors of successful nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that the absence of diabetes, absence of an appendicolith, short duration of symptoms, absence of systemic inflammation, and low modified Alvarado score would predict successful NOM. METHODS: We performed a retrospective cohort analysis of 81 consecutive patients who underwent NOM of uncomplicated appendicitis. Successful NOM was defined as resolution of appendicitis with antibiotics alone and no recurrent appendicitis within 180 days...
November 13, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29103784/expanding-the-inclusion-criteria-for-nonoperative-management-of-uncomplicated-appendicitis-outcomes-and-cost
#10
Steven L Lee, Lara Spence, Kyle Mock, James X Wu, Huan Yan, Daniel A DeUgarte
BACKGROUND: Carefully selected children with early appendicitis may be managed nonoperatively. However, it is unknown whether nonoperative management (NOM) is applicable to all patients with uncomplicated appendicitis. The purpose of this study was to evaluate the outcomes of NOM of uncomplicated appendicitis with expanded inclusion criteria. METHODS: A prospective, nonrandomized patient-preference study comparing NOM versus laparoscopic appendectomy (LA) was performed in children with radiographic/clinical evidence of uncomplicated appendicitis...
October 9, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29075315/the-current-management-of-acute-uncomplicated-appendicitis-should-there-be-a-change-in-paradigm-a-systematic-review-of-the-literatures-and-analysis-of-treatment-performance
#11
REVIEW
Samuel Ho Ting Poon, Jennifer Wah Yan Lee, Ka Man Ng, Gloria Wing Yan Chiu, Brian Yung Kong Wong, Chi Chung Foo, Wai Lun Law
INTRODUCTION: Appendectomy has long been the mainstay of intervention for acute appendicitis, aiming at preventing perforation, peritonitis, abscess formation and recurrence. With better understanding of the disease process, non-operative management (NOM) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis. This article aimed at systematically reviewing the available literatures and discussing the question whether NOM should replace appendectomy as the standard first-line treatment for uncomplicated appendicitis...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28943063/outpatient-laparoscopic-appendectomy-can-be-successfully-performed-for-uncomplicated-appendicitis-a-southwestern-surgical-congress-multicenter-trial
#12
Richard Frazee, Clay Cothren Burlew, Justin Regner, Robert McIntyre, Erik Peltz, Chris Cribari, Julie Dunn, Larry Butler, Paul Reckard, Sharmila Dissanaike, Karen Karimi, Charles Behnfield, Nic Melo, Daniel Margulies
BACKGROUND: Many laparoscopic procedures are now performed on an outpatient basis. We hypothesize laparoscopic appendectomy can be safely performed as an outpatient procedure. METHODS: Seven institutions adopted a previously described outpatient laparoscopic appendectomy protocol for uncomplicated appendicitis. Patients were dismissed unless there was a clinical indication for admission. Patient demographics, success with outpatient management, time of dismissal, morbidity, and readmissions were analyzed...
September 19, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28941724/operative-versus-non-operative-management-in-the-care-of-patients-with-complicated-appendicitis
#13
COMPARATIVE STUDY
Thomas S Helling, Douglas F Soltys, Samantha Seals
BACKGROUND: The approach to complicated appendicitis is unclear. We have sought to determine factors which may persuade surgeons to non-operative management and whether such treatment affects outcome. METHODS: All adult patients admitted over a five-year period 2009-2014 with a diagnosis of appendicitis were reviewed. Patients were grouped into uncomplicated and complicated presentations and stratified by age, gender, ethnicity, socio-economic status, and time to presentation...
December 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28939636/non-operative-management-of-uncomplicated-acute-appendicitis-in-children-where-is-the-evidence
#14
EDITORIAL
Katie E Rollins, Dileep N Lobo
No abstract text is available yet for this article.
December 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28925502/randomized-clinical-trial-of-antibiotic-therapy-for-uncomplicated-appendicitis
#15
RANDOMIZED CONTROLLED TRIAL
H C Park, M J Kim, B H Lee
BACKGROUND: Uncomplicated appendicitis may resolve spontaneously or require treatment with antibiotics or appendicectomy. The aim of this randomized trial was to compare the outcome of a non-antibiotic management strategy with that of antibiotic therapy in uncomplicated appendicitis. METHODS: Patients presenting to a university teaching hospital with CT-verified uncomplicated simple appendicitis (appendiceal diameter no larger than 11 mm and without any signs of perforation) were randomized to management with a no-antibiotic regimen with supportive care (intravenous fluids, analgesia and antipyretics as necessary) or a 4-day course of antibiotics with supportive care...
December 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28818844/conservative-treatment-versus-surgery-for-uncomplicated-appendicitis-in-children-a-systematic-review-and-meta-analysis
#16
REVIEW
Ulf Kessler, Selim Mosbahi, Benedict Walker, Eva M Hau, Michael Cotton, Barbara Peiry, Steffen Berger, Bernhard Egger
OBJECTIVES: To compare conservative treatment with index admission appendicectomy in children with acute uncomplicated appendicitis. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase and the Cochrane Library (CENTRAL) from 1950 to 18 February 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that assessed both appendicectomy and non-operative management of acute uncomplicated appendicitis in children of less than 18 years of age...
December 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28814624/outcomes-of-nonoperative-management-of-uncomplicated-appendicitis
#17
Richard G Bachur, Susan C Lipsett, Michael C Monuteaux
BACKGROUND AND OBJECTIVES: Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. METHODS: Retrospective analysis of administrative data from 45 US pediatric hospitals...
June 2, 2017: Pediatrics
https://www.readbyqxmd.com/read/28812175/a-prospective-non-randomized-controlled-multicenter-trial-comparing-appendectomy-and-conservative-treatment-for-patients-with-uncomplicated-acute-appendicitis-the-actuaa-study
#18
Mauro Podda, Fernando Serventi, Lorenzo Mortola, Stefano Marini, Danilo Sirigu, Michela Piga, Marcello Pisano, Massimiliano Coppola, Ferdinando Agresta, Francesco Virdis, Salomone Di Saverio, Nicola Cillara
PURPOSE: Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan...
November 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28759405/outcomes-of-nonoperative-management-of-uncomplicated-appendicitis
#19
MULTICENTER STUDY
Richard G Bachur, Susan C Lipsett, Michael C Monuteaux
BACKGROUND AND OBJECTIVES: Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. METHODS: Retrospective analysis of administrative data from 45 US pediatric hospitals...
July 2017: Pediatrics
https://www.readbyqxmd.com/read/28699771/comparative-effectiveness-of-surgery-versus-antibiotics-in-acute-appendicitis-a-systematic-review
#20
Stephanie D Talutis, Frederick Thurston Drake
AIM: To review outcomes of surgical and antibiotic management of acute appendicitis. METHODS: 11 prospective studies comparing surgical versus antibiotic management of acute appendicitis over a 21-year period were reviewed. RESULTS: Antibiotic management is successful in most cases of uncomplicated acute appendicitis. The need for crossover in management and recurrent appendicitis were low among all studies. For those patients who ultimately required surgery, no increased complications were observed...
July 2017: Journal of Comparative Effectiveness Research
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