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management of uncomplicated appendicitis

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https://www.readbyqxmd.com/read/29190038/closure-methods-of-the-appendix-stump-for-complications-during-laparoscopic-appendectomy
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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...
September 18, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28939636/non-operative-management-of-uncomplicated-acute-appendicitis-in-children-where-is-the-evidence
#9
EDITORIAL
Katie E Rollins, Dileep N Lobo
No abstract text is available yet for this article.
September 22, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/28925502/randomized-clinical-trial-of-antibiotic-therapy-for-uncomplicated-appendicitis
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/28654543/extended-versus-narrow-spectrum-antibiotics-in-the-management-of-uncomplicated-appendicitis-in-children-a-propensity-matched-comparative-effectiveness-study
#16
Danielle B Cameron, Patrice Melvin, Dionne A Graham, Charity C Glass, Stephanie K Serres, Matthew P Kronman, Jacqueline M Saito, Shawn J Rangel
OBJECTIVE: The aim of this study was to compare the effectiveness of extended versus narrow spectrum antibiotics in preventing surgical site infections (SSIs) and hospital revisits in children with uncomplicated appendicitis. SUMMARY OF BACKGROUND DATA: There is a paucity of high-quality evidence in the pediatric literature comparing the effectiveness of extended versus narrow-spectrum antibiotics in the prevention of SSIs associated with uncomplicated appendicitis...
June 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28637573/laparoscopic-appendectomy-protocol-expedites-management-of-uncomplicated-acute-appendicitis
#17
COMPARATIVE STUDY
Alvaro M Bada, Joseph A Ibrahim, Karen Safcsak, Andrew C Gratzon, Chadwick P Smith, Michael L Cheatham
Bed availability remains a constant struggle for tertiary care centers resulting in the use of management protocols to streamline patient care and reduce length of stay (LOS). A standardized perioperative management protocol for uncomplicated acute appendicitis (UA) was implemented in April 2014 to decrease both CT scan usage and LOS. Patients who underwent laparoscopic appendectomy for UA from April 2012 to May 2013 (PRE group) and April 2014 to May 2015 (POST group) were compared retrospectively. There were no differences in patient demographics or clinical findings between the groups...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28614043/antibiotics-vs-appendectomy-for-acute-uncomplicated-appendicitis-in-adults-review-of-the-evidence-and-future-directions
#18
REVIEW
Jared M Huston, Lillian S Kao, Phillip K Chang, James M Sanders, Sara Buckman, Charles A Adams, Christine S Cocanour, Sarah E Parli, Julia Grabowski, Jose Diaz, Jeffrey M Tessier, Therese M Duane
BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis. METHODS: Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial...
July 2017: Surgical Infections
https://www.readbyqxmd.com/read/28610706/ultrasound-guided-bilateral-rectus-sheath-block-vs-conventional-local-analgesia-in-single-port-laparoscopic-appendectomy-for-children-with-nonperforated-appendicitis
#19
Caroline Maloney, Michelle Kallis, Ibrahim Abd El-Shafy, Aaron M Lipskar, John Hagen, Michelle Kars
INTRODUCTION: Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge...
June 2, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28602871/outcomes-of-antibiotic-therapy-for-uncomplicated-appendicitis-in-pregnancy
#20
Jeong Il Joo, Hyoung-Chul Park, Min Jeong Kim, Bong Hwa Lee
OBJECTIVE: The aim of the present study is to determine the feasibility and safety of antibiotics for uncomplicated simple appendicitis in pregnancy. METHOD: We conducted a 6-year prospective observational study on 20 pregnant women in whom uncomplicated simple appendicitis (appendiceal diameter ≤11 mm and with no signs of appendicoliths, perforation, or abscess) was radiologically verified and managed with a 4-day course of antibiotics. Treatment failure rate, defined as the need for an appendectomy during hospitalization and recurrence in the follow-up period (median 25 months), and maternal or fetal complications during the pregnancy were evaluated...
June 9, 2017: American Journal of Medicine
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