Background The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis. Method A retrospective analysis was conducted from a single pediatric surgery department of all children 5 years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020. Results 728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5 years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS ( P < .05). Conclusions C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5 years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.
Purpose: Emergency colectomy of the left colon and sigma carries a higher risk of complication than elective colectomy. The aim of our study was to evaluate our results and to compare the outcome of these two operations. Methods Each patient included in this retrospective analysis underwent laparoscopic or open colectomy for malignant neoplasms with curative intent between 2011 and 2019. Surgical techniques were defined as emergency or elective depending on the timing of the operation, regardless of operational technique. Results A total of 242 patients were recruited, of which 125 had had emergency colectomies. Comparatively, 117 such patients underwent elective colectomies. There were no differences between the groups in factors such as age, gender, demographics and co-morbidities. The main reason for emergency operation included perforation in 105 patients (84%), and obstruction in 20 patients (16%). No difference in the number of lymph nodes harvested (LNH) were found between the 2 groups (mean of 17 LNH, SD +-8). The length of stay (LOH) and time to first flatulence was different between the groups (8.72 +-4.17 days for the elective surgery vs. 19.28+-23.5 days for the emergency surgery for LOH, and 3+-1 days for the elective group Vs. 9+-11.5 days for the emergency group for time to first flatulence, p<0.001 in both). The emergency group exhibited more serious complications (G III IV) than the elective group in the Clavien-Dindo classification. No difference was noted with regards to 30 days' survivals, length of operation and blood loss. Conclusion Our study suggests that the outcome of emergency colectomy of the left colon demonstrated excellent oncologic results compared to that of the elective group. However, emergency operation carries some degree of higher complication rate that need to be taken into account. Best results will be achieved by tailoring each patient’s status with the utilization of the best operation and operative team experience.
Purpose we compare MtL to LtM surgical approach for laparoscopic right hemicolectomy, with regards to number of lymph node harvested, operation duration, and length of hospitalization (LOH). Methods A retrospective analysis of patients who underwent laparoscopic right hemicolectomy resections for malignant neoplasms, curative-intent, between 2013 to 2020 at Edith Wolfson Medical Center. Surgical techniques were defined as Medial to lateral if the first stage included blood vessel ligation. Lateral to Medial was defined if the first step included mobilization of the lateral attachments. Results 133 patients who were diagnosed with colon cancer (mean age 72 ± 5.8 years, 46% males) were selected for laparoscopic right hemicolectomy. 54 were treated with the MtL approach, and 79 were treated with the LtM approach. Lymph nodes harvested were similar between the 2 groups (mean of 17, SD +-11). LOH and time of first flatulence were similar between the groups (11.78 ± 1.8 for the LtM group vs. 10.56 ± 1.4 for the MtL group for LOH, and 3.75 ± 0.8 days for the LtM group vs. 4 ± 0.9 days for the MtL group for time of first flatulence, p = 0.30 and p = 0.69 respectively). No difference in patient's survival rate within 30 days. Patients after LtM approach had a shorter operation time (2.18H). Conclusion The laparoscopic approach performing right hemicolectomy resection can be performed safely with the same results using the two methods compared. It showed no oncological benefits, and no significant differences in the LOH or short term survival. The LtM approach was associated with a shorter surgery time.
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