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management of uncomplicated appendicitis

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https://www.readbyqxmd.com/read/27894435/pediatric-appendicitis
#1
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
#2
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
#3
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
#4
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
#5
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
https://www.readbyqxmd.com/read/27521709/role-of-non-operative-management-in-pediatric-appendicitis
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/27199000/antibiotics-versus-appendicectomy-for-the-treatment-of-uncomplicated-acute-appendicitis-an-updated-meta-analysis-of-randomised-controlled-trials
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/26689849/treating-appendicitis-with-antibiotics
#16
REVIEW
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
https://www.readbyqxmd.com/read/26676711/effectiveness-of-patient-choice-in-nonoperative-vs-surgical-management-of-pediatric-uncomplicated-acute-appendicitis
#17
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
https://www.readbyqxmd.com/read/26640515/acute-appendicitis-proposal-of-a-new-comprehensive-grading-system-based-on-clinical-imaging-and-laparoscopic-findings
#18
REVIEW
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
https://www.readbyqxmd.com/read/26424690/significance-of-cd4-t-cell-count-in-the-management-of-appendicitis-in-patients-with-hiv
#19
REVIEW
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
https://www.readbyqxmd.com/read/26195106/cost-effectiveness-of-nonoperative-management-versus-laparoscopic-appendectomy-for-acute-uncomplicated-appendicitis
#20
COMPARATIVE STUDY
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
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