Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis

Leite, Rodrigo Moisés de Almeida; Seo, Dong Joo; Gómez-Eslava, Bárbara; Hossain, Shawkat; Lesegretain, Arnaud; Souza, Alexandre Venâncio de; Bay, Camden; Zilberstein, Bruno; Marchi, Evaldo; Machado, Rogério Bonassi; Barchi, Leandro Cardoso; Ricciardi, Rocco

doi:10.1001/jamasurg.2022.2937

Cited by 43 publications

(39 citation statements)

References 30 publications

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“…Appendectomy has always been the preferred treatment for acute appendicitis, but clinical studies in recent years have shown that antibiotic therapy alone is satisfactory for the treatment of acute appendicitis as well, especially for uncomplicated appendicitis. [45][46][47][48][49] Antibiotic therapy has also been included in the guidelines for the diagnosis and treatment of acute appendicitis developed by the World Society of Emergency Surgery (WSES) as a safe alternative treatment option for uncomplicated acute appendicitis without appendicolith in 2020. 50 Therefore, we suggest that we should retain the appendix as much as possible when conditions permit.…”

Section: Discussionmentioning

confidence: 99%

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Liu

Zhu

et al. 2023

J of Gastro and Hepatol

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Background and Aim Appendectomy is associated with various diseases, but whether it increases the risk of colorectal cancer (CRC) remains uncertain. We conducted a systematic review and meta‐analysis aimed at investigating the suggested correlation between appendectomy and CRC. Methods Systematic retrieval was performed using the PubMed, Embase, Cochrane library, Web of Science, and http://ClinicalTrials.gov databases up to May 4, 2022, for studies reported the influence of appendectomy on CRC, colon cancer (CC) or rectal cancer (RC). Odd ratios (ORs) and 95% confidence intervals (CIs) of CRC after appendectomy were pooled using the random effects model. Subgroup analyses were carried on by region, sex, and tumor location. Results Our search identified 1743 articles, of which 22 studies from three continents published between 1964 and 2022 were eligible for inclusion. Overall, people with appendectomy had a higher risk of CRC (OR = 1.31; 95% CI [1.05, 1.62]). But the risk for Europeans was not significant (OR = 0.94; 95% CI [0.87, 1.02]; I2 = 0%), while for Americans and Asians, appendectomy would increase the risk of CRC (OR = 1.68; 95% CI [1.15, 2.44]; I2 = 65% and OR = 1.46; 95% CI [1.04, 2.05]; I2 = 98%), especially in females and in developing countries. It is worth noting that appendectomy might be a protective factor for CC in European women (OR = 0.87; 95% CI [0.77, 0.98]; I2 = 0%). Conclusions Appendectomy may be a risk factor for CRC, with varying degrees in different populations. More high‐quality cross‐regional studies are needed for better clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Liu

Zhu

et al. 2023

J of Gastro and Hepatol

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“…The first cornerstone is thereby the control of foci of infection within the shortest delay possible, especially in critically ill patients [ 115 ]. Elsewise, the optimal timing of IAI SC has long been debated [ 116 ].…”

Section: The Management Of Infections In Acute Care Surgerymentioning

confidence: 99%

Antimicrobial Challenge in Acute Care Surgery

Schena¹,

de’Angelis

Carra

et al. 2022

Antibiotics

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The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.

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“…To the Editor We read with the great interest the systematic review and meta-analysis by de Almeida Leite and colleagues, who suggest that nonoperative management of acute uncomplicated appendicitis (AUA) is comparable with surgery without an increase in major complications, albeit with a longer hospital stay and a cumulative appendicitis recurrence rate of 18%, highlighted by the authors as 2 major limitations of this treatment approach.…”

mentioning

confidence: 99%

Management of Acute Uncomplicated Appendicitis

2023

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To the Editor We read with the great interest the systematic review and meta-analysis by de Almeida Leite and colleagues, 1 who suggest that nonoperative management of acute uncomplicated appendicitis (AUA) is comparable with surgery without an increase in major complications, albeit with a longer hospital stay and a cumulative appendicitis recurrence rate of 18%, highlighted by the authors as 2 major limitations of this treatment approach.The efficacy of antibiotic therapy in adults with AUA ranges from 63% to 85%. 2,3 Appendicitis is often a consequence of obstruction by an appendicolith or appendiceal lumen narrowing, which creates a milieu for microbial proliferation. In such a setting, antibiotics alone cannot achieve source control, which may explain the high recurrence rate seen with nonoperative management of AUA.A 5-year follow-up of the Appendicitis Acuta (APPAC) trial 3 showed a 39% probability of late recurrence in patients initially treated with antibiotics. Beyond recurrent appendicitis, there remains the risk of abscess formation and perforation. The notable inconsistency in the studies included in the current systematic review and meta-analysis is also worth highlighting, which undoubtedly impacts the certainty of the findings supporting the adoption of antibiotic therapy. Consequently, the population of patients with AUA that can truly benefit from antibiotics alone may be limited.Endoscopic retrograde appendicitis therapy (ERAT) is a promising noninvasive treatment modality for AUA. 4 The pooled technical and clinical success of ERAT for AUA from 7 studies (298 patients) was as high as 99%, with a 6% (range, 2.9%-9.9%) recurrence rate. This is likely a projection of achieving source control, either by repeated flushing of the appendiceal lumen or by stent deployment. 5 In our experience, recurrent appendicitis had been noted in patients who did not undergo stent placement with ERAT, highlighting the need for standardization of indications for appendiceal stent deployment. 4 Furthermore, ERAT can be extended to perform appendicoscopy, which allows direct visualization of the appendiceal mucosa and carries diagnostic and therapeutic implications.It is pivotal to follow established principles of achieving source control in addition to antibiotic therapy for obstructive pathologies such as appendicitis. ERAT should be considered an efficacious and safe modality while approaching management of AUA as a therapeutic alternative and for diagnostic evaluation of the appendix as part of a noninvasive management strategy. With appropriate patient selection, ERAT can be performed as an outpatient procedure, which should incentivize training and adoption of this approach in the US Western countries.

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Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis

Cited by 43 publications

References 30 publications

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Risk of colorectal cancer after appendectomy: A systematic review and meta‐analysis

Antimicrobial Challenge in Acute Care Surgery

Management of Acute Uncomplicated Appendicitis

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