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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
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
Ming Chien, Arie Habis, Loretto Glynn, Ann O'Connor, Tracie L Smith, Francis Prendergast
PURPOSE: Despite significant radiation exposure involved with computed tomography (CT) in evaluation of pediatric appendicitis, its use is still widespread. The goal of this study was to assess the effect of a staged imaging pathway for appendicitis to significantly decrease CT use while maintaining diagnostic accuracy. METHODS: Chart review was performed for patients evaluated for appendicitis over a 12-month period prior to and after pathway implementation. RESULTS: There was a significant decrease in CT use as initial imaging after implementation of the pathway; 87...
July 2016: Pediatric Surgery International
James K Hamill, Andrew G Hill
During the latter half of the 19th century, surgeons increasingly reported performing appendicectomies. Fitz from Harvard, Groves from Canada and Tait from Britain all recorded successful removal of the appendix. McBurney described the point of maximal tenderness in classic appendicitis and also the muscle-splitting incision centred on this point. Priority is given to McArthur in describing the lateral muscle-splitting incision. The direction of the cutaneous incision was later modified by Elliott and Lanz...
April 26, 2016: ANZ Journal of Surgery
Zachary I Willis, Eileen M Duggan, Brian T Bucher, John B Pietsch, Monica Milovancev, Whitney Wharton, Jessica Gillon, Harold N Lovvorn, James A O'Neill, M Cecilia Di Pentima, Martin L Blakely
IMPORTANCE: Complicated appendicitis is a common condition in children that causes substantial morbidity. Significant variation in practice exists within and between centers. We observed highly variable practices within our hospital and hypothesized that a clinical practice guideline (CPG) would standardize care and be associated with improved patient outcomes. OBJECTIVE: To determine whether a CPG for complicated appendicitis could be associated with improved clinical outcomes...
May 18, 2016: JAMA Surgery
V Sallinen, E A Akl, J J You, A Agarwal, S Shoucair, P O Vandvik, T Agoritsas, D Heels-Ansdell, G H Guyatt, K A O Tikkinen
BACKGROUND: For more than a century, appendicectomy has been the treatment of choice for appendicitis. Recent trials have challenged this view. This study assessed the benefits and harms of antibiotic therapy compared with appendicectomy in patients with non-perforated appendicitis. METHODS: A comprehensive search was conducted for randomized trials comparing antibiotic therapy with appendicectomy in patients with non-perforated appendicitis. Key outcomes were analysed using random-effects meta-analysis, and the quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach...
March 17, 2016: British Journal of Surgery
Ville Sallinen, Kari A O Tikkinen
No abstract text is available yet for this article.
March 2016: Scandinavian Journal of Surgery: SJS
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