Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women

Larsson, Per‐Göran; Henriksson, Gunnel; Olsson, Marita; Boris, Jane; Ströberg, Peter; Tronstad, S. E.; Skullman, S.

doi:10.1007/s004640000255

Cited by 100 publications

(73 citation statements)

References 8 publications

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“…As expected, a gynecologic disorder was most commonly diagnosed in this group of patients except in one who had Meckel's diverticulites. This finding is consistent with study of Larsson et al (11). They reported that a gynecologic diagnosis was found in 73% after laparoscopy, as compared with 17% after open surgery among the fertile women with a healty appendix and explained this difference by the more complete vision of the deep pelvis by laparoscopy.…”

Section: Discussionsupporting

confidence: 92%

Laparoskopi negatif apendektomilerde beklenmeyen bulguları saptamada açık cerrahiye göre üstün müdür?

Yaşar¹,

Uylaş²,

Ateş³

et al. 2017

Bakirkoy

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Laparoskopi negatif apendektomilerde beklenmeyen bulguları saptamada açık cerrahiye göre üstün müdür?Amaç: Laparoskopik apendektomilerin avantaj ve dezavantajları halen araştırılmaktadır. Bu çalışmanın amacı negatif apendektomilerde alternatif tanı açısında açık cerrahi ile laparoskopinin karşılaştırılmasıdır. Gereç ve Yöntem: Ocak 2010 ile Nisan 2014 tarihleri arasında, tek merkezde açık apendektomi uygulanan 397 hasta ile Nisan 2014 ile Aralık 2014 tarihleri arasında aynı merkezde yapılan laparoskopik apendektomiler çalışmaya dahil edildi. Ortalama yaş, cinsiyet dağılımı, preoperatif bulgular (Alvarado skorları ve ultrasonografi bulguları), negatif apendektomi oranları ve negatif apendektomilerde saptanan alternatif tanılar karşılaştırıldı. Bulgular: Hastaların demografik özellikleri, preoperatif bulguları ve negatif apendektomi oranları laparoskopik ve açık cerrahi gruplarında benzerdi (p>0.05) ancak negatif apendektomilerde saptanan alternatif tanı oranları laparoskopik grupta daha yüksekti (%40.0'a kıyasla %19.6, p<0.05). Sonuç: Laparoskopi negatif apendektomi vakalarında alternatif tanının ortaya konulmasında ilave bir tanı aracıdır.Anahtar kelimeler: Açık apendektomi, laparoskopik apendektomi, negatif apendektomi, alternatif tanı ABSTRACT Is laparoscopy superior than open surgery in finding unexpected pathologies in negative appendectomies?Objective: Advantages and disadvantages of laparoscopy in appendectomy is still being investigated. The aim of this study is to investigate open and laparoscopic appendectomies in terms of alternative diagnosis in negative appendectomies. Material and Methods: A total of 397 patients who underwent open appendectomy between January 2010-April 2014 and 120 patients who underwent laparoscopic surgery between April 2014-December 2014 in a single institution were included in the study. Average age and gender distribution, preoperative findings (average Alvarado scores and ultrasonographic findings), rate of negative appendectomies and alternative diagnoses were compared. Results: Patient demographics, preoperative findings and rate of negative appendectomies were all similar in laparoscopic and open groups but the rate of the alternative diagnoses in negative appendectomies in laparoscopic group was significantly greater than in open group. Conclusion: Laparoscopy is an additional diagnotic tool to diagnose alternative pathologic findings in negative appendectomies.

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Section: Discussionsupporting

confidence: 92%

Laparoskopi negatif apendektomilerde beklenmeyen bulguları saptamada açık cerrahiye göre üstün müdür?

Yaşar¹,

Uylaş²,

Ateş³

et al. 2017

Bakirkoy

View full text Add to dashboard Cite

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“…During laparoscopy, was appendicitis misdiagnosed in only 7% of the women, from whom the appendix unnecessarily removed, whereas 34% in the open surgery group had a healthy appendix removed. 12 Ultrasonogram findings supportive of the diagnosis of appendicitis include. a peristaltic, no compressible, dilated appendix (>6 mm outer diameter)…”

mentioning

confidence: 98%

KIMS modification of Alvarado’s score for acute appendicitis

Premkumar¹

2017

Int Surg J

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Background: Abdominal pain is one of the most frequent presentations to the emergency department (ED). Acute appendicitis is by no means an easy diagnosis to make and can baffle the best. Problems related to the diagnosis of appendicitis are evidenced by the significant negative laparotomy rate. A scoring system described by Alvarado was designed to reduce the negative appendicectomy rate without increasing morbidity and mortality. Alvarado's score does not include ultrasonogram which is most commonly done investigation before any abdominal surgery. Methods: The study included the ultrasonography and modified the scoring system and retrospectively we analyzed 153 patients who were admitted as acute appendicitis. When interpreted considering the clinical examination, sonography and modified scoring system and it significantly reduced the rate of false-negative appendectomies. The use of diagnostic imaging tests such as CT scan or ultrasonography should be selective in those with atypical presentation or findings. Laparoscopy, barium enema, ultrasonography and computer assistance have all been shown to improve accuracy, but no one method is of proven superiority. Results: By using KIMS modification of Alvarado's score it was found that unnecessary appendectomy can be avoided in 11 out of 132 patients. Conclusions: Such diagnostic aids or intensive in-hospital observation must be used to reduce the 15-30 per cent negative laparotomy rate when acute appendicitis is suspected, without increasing the incidence of appendiceal perforation.

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“…6 The association between the elevated SB levels and the variety of infectious diseases has been noted in few studies. [7][8][9][10][11][12][13][14][15] Some bacteria including E. Coli have been associated with increased levels of total serum bilirubin levels. 16 Amongst the patients diagnosed with Acute appendicitis pre-operatively (n=70), 47 patients (47%) were found to have increased bilirubin (>1.2 mg/dL) while 53 patients (53%) has normal bilirubin levels (≤1.2 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia: a new diagnostic marker for perpendicular perforation

et al. 2017

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Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.

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Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women

Abstract: Laparoscopy reduces unnecessary appendectomies and improves diagnosis in fertile women.

Cited by 100 publications

References 8 publications

Laparoskopi negatif apendektomilerde beklenmeyen bulguları saptamada açık cerrahiye göre üstün müdür?

Laparoskopi negatif apendektomilerde beklenmeyen bulguları saptamada açık cerrahiye göre üstün müdür?

KIMS modification of Alvarado’s score for acute appendicitis

Hyperbilirubinemia: a new diagnostic marker for perpendicular perforation

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