Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

Burini, Gloria; Cianci, Maria Chiara; Coccetta, Marco; Spizzirri, Alessandro; Saverio, Salomone Di; Coletta, Riccardo; Sapienza, Paolo; Mingoli, Andrea; Cirocchi, Roberto; Morabito, Antonino

doi:10.1186/s13017-021-00391-y

Cited by 15 publications

(6 citation statements)

References 57 publications

(84 reference statements)

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“…Further, these patients also had faster postoperative recovery and lower hospital charges [ 24 ]. However, other studies denied the superiority of peritoneal lavage [ 26 , 27 ]. One of the major problems is that the methods of peritoneal lavage are not standardized.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

et al. 2023

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Purpose The treatment strategies for acute appendicitis differ depending on the facility, and various studies have investigated the usefulness of conservative treatment with antibiotics, laparoscopic surgery, and interval appendectomy (IA). However, although laparoscopic surgery is widely used, the clinical strategy for acute appendicitis, especially complicated cases, remains controversial. We assessed a laparoscopic surgery-based treatment strategy for all patients diagnosed with appendicitis, including those with complicated appendicitis (CA). Methods We retrospectively analysed patients with acute appendicitis treated in our institution between January 2013 and December 2021. Patients were classified into uncomplicated appendicitis (UA) and CA groups based on computed tomography (CT) findings on the first visit, and the treatment course was subsequently compared. Results Of 305 participants, 218 were diagnosed with UA and 87 with CA, with surgery performed in 159 cases. Laparoscopic surgery was attempted in 153 cases and had a completion rate of 94.8% (145/153). All open laparotomy transition cases (n = 8) were emergency CA surgery cases. No significant differences were found in the incidence of postoperative complications in successful emergency laparoscopic surgeries. In univariate and multivariate analyses for the conversion to open laparotomy in CA, only the number of days from onset to surgery ≥ 6 days was an independent risk factor (odds ratio: 11.80; P < 0.01). Conclusion Laparoscopic surgery is preferred in all appendicitis cases, including CA. Since laparoscopic surgery is difficult for CA when several days from the onset have passed, it is necessary that surgeons make an early decision on whether to operate.

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Section: Discussionmentioning

confidence: 99%

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

et al. 2023

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“…Nonetheless, it is crucial to distinguish between patients with localized peritonitis and those with diffuse purulent peritonitis. Under this context, an extensive washout until achieving a completely clean abdomen may still be a viable option, as was done in this patient ( 17 ).…”

Section: Discussionmentioning

confidence: 90%

Case Report: A rare instance of acute appendicitis induced by Balantidium Coli parasitic infection

Alzate-Ricaurte,

Garcia Moreno,

Serna Lorza

et al. 2024

Front. Pediatr.

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IntroductionAcute appendicitis secondary to parasitic infections is uncommon, being detected in less than 1% of cases. Balantidium coli is a parasite found in pigs and primates with zoonotic potential. To date, only three cases of acute appendicitis induced by this parasite have been documented globally.CaseA 7-year-old female patient, who consumed pork daily, presented to the emergency department with a one-day history of abdominal pain in the lower quadrants, described as colic-like, alongside abdominal distension. Initial abdominal radiography led to a diagnosis of intestinal obstruction. Conservative management without therapeutic response necessitated referral to a higher complexity center. Upon admission, an abdominal computed tomography scan diagnosed acute appendicitis and secondary ileus. During surgical intervention, an appendiceal phlegmon formed by loops of the small intestine was mechanically released, revealing a perforated appendix with extensive fecal peritoneal contamination. Pathological analysis identified an inflammatory infiltrate and the presence of Balantidium coli trophozoites. Medical treatment included Piperacillin-Tazobactam and Metronidazole. The patient was discharged after 10 days of medical treatment.DiscussionAcute appendicitis caused by Balantidium coli is a rare occurrence. It is crucial to identify parasites in pathological samples due to their impact on postoperative management. The close contact between humans and pigs, especially in developing countries, suggests that the prevalence of parasitic infection and colonization by Balantidium coli may be higher than currently recognized. Regarding the identification of this patient's specific exposure, the regular consumption of pork suggests the hypothesis that improper processing is linked to the acquisition of the parasitic infection.

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“…Interestingly, the incidence of the post-appendicectomy collection was found to be higher in laparoscopic appendicectomy when compared to the open approach in the Cochrane meta-analysis that was performed in 2002; however, in the subsequent update of the same review in 2004 and 2010, the likelihood of intra-abdominal collection decreased from OR=2.77 in 2002 to OR=1.87 in 2010 [ 48 , 49 ].…”

Section: Reviewmentioning

confidence: 99%

Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

Abu¹,

Mohamedahmed²,

Alamin³

et al. 2022

Cureus

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This meta-analysis aims to evaluate the comparative outcomes of drain insertion versus no drain after appendicectomy for complicated appendicitis. A systematic search of PubMed, Cochrane Library and Scopus was conducted, and all studies comparing drain versus no drain after appendicectomy for complicated appendicitis were included. Abdominal collection, surgical site infection (SSI), bowel obstruction, faecal fistula, paralytic ileus, length of hospital stay (LOS) and mortality were the evaluated outcome parameters for the meta-analysis. Seventeen studies reporting a total number of 4,255 patients who underwent appendicectomy for complicated appendicitis with (n=1,580) or without (n=2,657) drain were included. There was no significant difference between the two groups regarding abdominal collection (odds ratio (OR)=1.41, P=0.13). No-drain group was superior to the drain group regarding SSI (OR=1.93, P=0.0001), faecal fistula (OR=4.76, P=0.03), intestinal obstruction (OR=2.40, P=0.04) and paralytic ileus (OR=2.07, P=0.01). There was a difference regarding mortality rate between the two groups (3.4% in the drain group vs 0.5% in the no-drain group, risk difference (RD)=0.01, 95% CI (-0.01, 0.04), P=0.36). In conclusion, this metaanalysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of postoperative complications such as fistula, surgical site infection (SSI), bowel obstruction, ileus and length of hospital stay.

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Aspiration versus peritoneal lavage in appendicitis: a meta-analysis

Cited by 15 publications

References 57 publications

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

Therapeutic strategy for acute appendicitis based on laparoscopic surgery

Case Report: A rare instance of acute appendicitis induced by Balantidium Coli parasitic infection

Evaluation of Drain Insertion After Appendicectomy for Complicated Appendicitis: A Systematic Review and Meta-Analysis

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