Laparoscopic management of appendicular mass

Shindholimath, Vishwanath V; Thinakaran, K; Rao, T. Ramamohana; Veerappa, Yenni Veerabhadrappa

doi:10.4103/0972-9941.78345

Cited by 23 publications

(20 citation statements)

References 18 publications

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“…The sex ratio of 2 in our study is comparable to studies conducted by Bahram [2], Okafor & al [11] and Shinholimath & al. [13]. The average age in our study was 29 and it was similar to that of the 24 [11].…”

Section: Discussionsupporting

confidence: 61%

Management of inflammatory appendiceal mass: a retrospective study

Fihri¹,

Elguazzar²,

Ramraoui³

et al. 2017

IJMSCI

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The appendiceal mass is a common complication in the natural evolution of acute appendicitis, often manifested by a mass in the right quadrant, ranging from the appendiceal phlegmon to the collected abscess. Our study consist on determining the epidemiological, clinical, diagnostic and therapeutic aspects in the care of the appendiceal plastron, as well as the role of surgery in this special care. This is a retrospective study including 30 cases of appendiceal mass, excluding appendicular abscesses, collected to the general surgery department of the military hospital Avicenne of Marrakesh, over a period of 5 years,

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Section: Discussionsupporting

confidence: 61%

Management of inflammatory appendiceal mass: a retrospective study

Fihri¹,

Elguazzar²,

Ramraoui³

et al. 2017

IJMSCI

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“…Early surgical intervention has been known to be an effective alternative to conservative therapy for a long time, as it considerably reduces the morbidity and total hospital stay, and obviates the need for a second admission. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Early laparoscopic management of appendicular mass in children: Still a taboo, or time for a change in surgical philosophy?

et al. 2016

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INTRODUCTION:Early appendicectomy has been found to be a safe and better alternative for management of appendicular mass in various studies in adults, while very few studies report such advantages in the paediatric population. We conducted this study to assess the safety, efficacy and need of early laparoscopic appendicectomy (ELA) in child patients with appendicular mass.MATERIALS AND METHODS:All patients with appendicular mass who underwent ELA at our institute between September 2011 and August 2014 were retrospectively reviewed. Appendicular mass was defined as a right iliac fossa mass in a case of acute appendicitis, diagnosed by clinical, laboratory and radiological evaluation, and palpation under anaesthesia, the patient being subjected to laparoscopic treatment.RESULTS:Forty-eight (48) patients were confirmed to have appendicular mass intraoperatively and were included in the analysis. There were 30 males and 18 females, with ages ranging 7-13 years (mean 9 years). In the present study, appendicular complications included appendicular abscess (62.5%), gangrenous appendicitis (25%), sloughed-out appendix (8.33%) and appendicular perforation (4.16%). The average operative time was 72 min (range 45-93 min). One case (1.92%) required conversion to open procedure due to failure of identification of the appendicular base of a sloughed-out appendix. Post-operative complications were found in 4 (7.69%) patients, of whom 3 (5.76%) had minor wound infection at the umbilical port site and 1 (1.92%) had post-operative pelvic abscess, which was managed with percutaneous aspiration.DISCUSSION:ELA avoids misdiagnosis, treats complicated appendicitis at its outset, and avoids complications and/or failure of non-operative treatment of a potentially lethal, diseased appendix. This approach is associated with minimal complications in experienced hands and is a safe and feasible option in children with appendicular mass.

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“…[25] [26] [27] However, the controversy between laparoscopic appendectomy and open appendectomy for complicated appendicitis persists. [6] [27] A recent meta-analysis concluded that laparoscopic appendectomy requires signi cant resources and surgical expertise to reach maximum e ciency. Therefore, if these technical and surgical criteria cannot be met, open appendectomy should be the surgical treatment of choice.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

Sugiura

Suzuki²,

Umeyama

et al. 2020

Preprint

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Background: Although evidence regarding the safety and efficacy of nonoperative management is growing, the best treatment strategy for acute complicated appendicitis remains controversial. In this study, we performed a cost-effectiveness analysis of operative management with emergency laparoscopic appendectomy (ELA) alone as the first-line therapy in complicated appendicitis patients in a municipal hospital in Japan.Methods: We constructed a Markov model to compare treatment strategies for complicated appendicitis with emergency laparoscopic appendectomy in otherwise-healthy adults. Health outcomes were measured in quality-adjusted life years (QALYs) gained, and cost-effectiveness was evaluated using an incremental cost effectiveness ratio (ICER). Model variables were abstracted from a literature review, and from data from the hospital records of Tochigi Medical Center. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization's criterion of ¥12 million.Results: Operative management cost ¥677,570 per patient. Nonoperative management without interval laparoscopic appendectomy (ILA) cost ¥109,257 more than operative management and produced only 0.005 more QALYs. Nonoperative management without ILA cost ¥26,049 more than operative management, and also yielded only 0.005 additional QALYs. The ICER for both nonoperative managements were > ¥12 million/QALY in the probabilistic sensitivity analysis.Conclusions : Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Operative management remains the standard of care, but nonoperative management deserves serious consideration as a treatment option in complicated appendicitis.

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Laparoscopic management of appendicular mass

Cited by 23 publications

References 18 publications

Management of inflammatory appendiceal mass: a retrospective study

Management of inflammatory appendiceal mass: a retrospective study

Early laparoscopic management of appendicular mass in children: Still a taboo, or time for a change in surgical philosophy?

Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis in Japan

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