More than one-third of successfully nonoperatively treated patients with complicated appendicitis experienced recurrent appendicitis: Is interval appendectomy necessary?

Tanaka, Yujiro; Uchida, Hiroo; Kawashima, Hiroshi; Fujiogi, Michimasa; Suzuki, Keisuke; Takazawa, Shinya; Deie, Kyoichi; Amano, Hodaka; Iwanaka, Tadashi

doi:10.1016/j.jpedsurg.2016.09.017

Cited by 23 publications

(33 citation statements)

References 14 publications

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“…Ohno and Kang et al showed the safety and feasibility of SLIA without comparison with EA for appendicitis with a peri‐appendiceal abscess in pediatric and adult patients, respectively, and reported that the complication rate was 8.0%. The morbidity rate reported in other reports on IA for complicated appendicitis without single‐site laparoscopic appendectomy was 12.4%‐15%, which is similar to our morbidity rate . Our data suggest that SLIA may provide the advantages of minimally invasive surgery, including improved cosmetic outcome, even if the appendicitis is severe.…”

Section: Discussionsupporting

confidence: 88%

“…Recurrence of appendicitis occurred in only three patients (13.0%) after successful CT, all of whom underwent CT again and responded to antibiotics. Other studies on complicated appendicitis with different observation periods have reported that the risk of recurrence is 7%‐34% . Our follow‐up periods were short (median 88 days, range 34‐2106 days) because 16 patients (69.6%) with successful CT underwent SLIA approximately 3 months after diagnosis.…”

Section: Discussionmentioning

confidence: 96%

“…The standard management for these cases is conservative treatment (CT) with antibiotics and drainage for the peri‐appendiceal abscess, followed by interval appendectomy (IA) . The need for IA remains controversial because of the rate of recurrence and possible underlying malignancy, as well as perioperative risk …”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Miyo

Urabe

Hyuga

et al. 2019

Annals of Gastroent Surgery

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Aim Single‐site laparoscopic interval appendectomy (SLIA) for severe complicated appendicitis after conservative treatment (CT) to ameliorate inflammation and eradicate the abscess should be safer and less invasive than emergency appendectomy (EA). However, only a few reports have been published regarding SLIA. Methods We retrospectively collected data on 264 consecutive patients admitted to Kinan Hospital for treatment of appendicitis between 2012 and 2018. The safety and feasibility of SLIA and its perioperative outcomes for severe complicated appendicitis were investigated. Results A total of 61 patients were included in this study, 25 of whom underwent CT and 36 EA. Among the 25 patients who underwent CT, 23 (92.0%) succeeded; a total of 16 patients (69.5%) underwent SLIA. Compared to the EA group, the SLIA group had less bleeding (median volume 8.5 vs 50 mL, P = .005) and lower rate of expansion surgery (0% vs 27.8%, P = .022). Although the postoperative hospital stay was shorter in the SLIA group than in the EA group (9 vs 12 days, P = .008), the total hospital stay, including the CT period, was longer in the SLIA group than in the EA group (24 vs 12 days, P < .001). Conclusion SLIA is safe, feasible, and less invasive than EA and may provide the advantages of minimally invasive surgery even if appendicitis is severe. SLIA may be a promising option for complicated appendicitis in select cases despite its disadvantage of prolonging the hospital stay.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

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Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Miyo

Urabe

Hyuga

et al. 2019

Annals of Gastroent Surgery

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“…The necessity of interval appendectomy has recently been questioned by several authors. 61 , 83 , 84 , 92 , 99 , 101 – 106 Early studies of non-operative management routinely included interval appendectomy, 59 , 69 , 75 , 89 and this trend has continued for several decades. 49 , 64 , 78 , 79 , 81 , 82 , 86 , 88 , 90 , 95 , 96 , 100 , 107 , 108 Proponents of interval appendectomy cite low morbidity 70 , 85 , 91 , 109 and decreased risk of appendicitis recurrence.…”

Section: Managementmentioning

confidence: 99%

Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

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Perforated appendicitis, as defined by a visible hole in the appendix or an appendicolith free within the abdomen, carries significant morbidity in the pediatric population. Accurate diagnosis is challenging as there is no single symptom or sign that accurately predicts perforated appendicitis. Younger patients and those with increased duration of symptoms are at higher risk of perforated appendicitis. Elevated leukocytosis, bandemia, high C-reactive protein, hyponatremia, ultrasound, and CT are all useful tools in diagnosis. Distinguishing patients with perforation from those without is important given the influence of a perforation diagnosis on the management of the patient. Treatment for perforated appendicitis remains controversial as several options exist, each with its indications and merits, illustrating the complexity of this disease process. Patients may be managed non-operatively with antibiotics, with or without interval appendectomy. Patients may also undergo appendectomy early in the course of their index hospitalization. Factors known to predict failure of non-operative management include appendicolith, leukocytosis greater than 15,000 white blood cells per microliter, increased bands, and CT evidence of disease beyond the right lower quadrant. In this review, the indications and benefits of each treatment strategy will be discussed and an algorithm to guide treatment decisions will be proposed.

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“…Recently, studies comparing immediate surgery and nonsurgical approach have been published. The nonsurgical approach was recommended by several systematic reviews and meta-analysis, as it was associated with lower complication rate and lower morbidity rate, [ 6 , 7 ] whereas, in children, one prospective nonrandomized study 6 showed that early surgical intervention was beneficial over nonoperative management. [ 8 ] Other studies did not find significant differences between the 2 approaches.…”

Section: Introductionmentioning

confidence: 99%

Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients

Han²,

Yang³

et al. 2017

Medicine

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Laparoscopic appendectomy (LA) has become well accepted, but the role of LA for appendicitis upon presentation with an abscess remains undefined. This study was to assess the postoperative recovery and complications following LA in pediatric patients with appendiceal abscess in comparison with open appendectomy (OA).We conducted a retrospective review of patients presented with appendiceal abscess between 2005 and 2016. Propensity score matching (PSM) was conducted to adjust for any potential selection bias for the surgical approaches. In 108 matched patients, operative outcomes and surgical complications were evaluated based on LA or OA.The patients with LA experienced prompt postoperative gastrointestinal function recovery, like first bowel movement (risk ratio [RR], 0.52; 95% confidence interval [CI], 0.44–0.69; P < .001), so spend the lower mean length of hospitalization (RR, 0.53; 95% CI, 0.41–0.76; P < .001) in comparison with patients with OA. Furthermore, the immunologic and inflammatory variable white blood cell (WBC) (RR, 0.56; 95% CI, 0.46–0.73; P < .001) and C-reactive protein (CRP) (RR, 0.58; 95% CI, 0.43–0.86; P = .011) on postoperative days (POD) 5 was reduced in patients undergone LA compared with that of OA. A lower overall postoperative complication rate, including surgical wound infection (odds ratio [OR], 0.38; 95% CI, 0.18–0.81; P = .008) and incision dehiscence (OR, 0.06; 95% CI, 0.01–0.45; P < .001) was noted in patients with LA compared with OA.LA was feasible and effective for appendicitis upon presentation with an abscess and associated with beneficial clinical effects, such as postoperative gastrointestinal function recovery and reduced postoperative complications. LA should be seriously considered as the first line procedure of choice.

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More than one-third of successfully nonoperatively treated patients with complicated appendicitis experienced recurrent appendicitis: Is interval appendectomy necessary?

Cited by 23 publications

References 14 publications

Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy

Perforation risk in pediatric appendicitis: assessment and management

Retrospective review of laparoscopic versus open surgery in the treatment of appendiceal abscess in pediatric patients

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