Routine diagnostic laparoscopy reduces the rate of unnecessary appendicectomies in young women

Garbarino, Stephanie; Shimi, S. M.

doi:10.1007/s00464-008-9855-6

Cited by 24 publications

(19 citation statements)

References 26 publications

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“…It is possible that episodes of pelvic inflammatory disease resulting from liberal sexual activity or inflammatory bowel disease, necessitated hospital admission with lower abdominal pain which eventually lead to removal of the appendix. Indeed prior to the widespread adoption of laparoscopy for young women with right iliac fossa pain, 10 approximately a third of appendices removed were histologically normal 16 . By the same rationale a similar group of females developed recurrent throat infections as a result of intimate contact with males, which led to recurrent episodes of tonsillitis necessitating surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, the majority of young females with suspected acute appendicitis were referred for surgery and a third of appendices removed were normal 35 . Over the past 15 years, the majority of surgeons recommend a diagnostic laparoscopy to confirm the diagnosis 16 . If appendicitis was confirmed, appendicectomy was usually carried out laparoscopically at the same time.…”

Section: Discussionmentioning

confidence: 99%

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Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study

Wei

MacDonald

Shimi

2016

Fertility and Sterility

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CapsuleIn a population-based study, previous appendicectomy and /or tonsillectomy were associated with an increase in subsequent pregnancy rates and shorter time to pregnancy after surgery. 1 ABSTRACTObjective: To study pregnancy rates after appendicectomy and /or tonsillectomy.Design: A population based cohort study using the UK primary health care based Clinical Practice Research Datalink (CPRD). Setting: UK Primary CarePatients: Female patients who underwent appendicectomy, tonsillectomy or both between 1987 and 2012 and appropriate comparators.Intervention: Timed follow up until first pregnancy after surgery. The association between prior surgery and subsequent pregnancy was determined by Cox regression models. Main Outcome Measures:Pregnancy rate and time to first pregnancy after surgery. Results:The analyses included 54,675 appendicectomy only patients, 112,607 tonsillectomy only patients, 10,340 patients who had both appendicectomy and tonsillectomy with 355,244 comparators matched for exact age and practice from the rest of female patients in the database. There were 29,732 (54.4%), 60,078 (53.4%) and 6,169 (59.7%) pregnancies in the appendicectomy only, tonsillectomy only and both appendicectomy tonsillectomy cohorts respectively vs 155,079 (43.7%) in the comparator cohort during a mean follow up of 14.7 (SD, 9.7) years. Adjusted hazard ratios (HRs) for subsequent birth rates were 1.34 (95% CI 1.32 to 1.35), 1.49 (95%CI 1.48 to 1.51) and 1.43 (95%CI 1.39 to 1.47), respectively. Time to pregnancy was shortest after both appendicectomy and tonsillectomy followed by appendicctomy only and then tonsillectomy only in comparison to the rest of the population. Conclusions:Appendicectomy and /or tonsillectomy were associated with increased subsequent pregnancy rates and shorter time to pregnancy. The effect of the surgical procedures on the pregnancy outcome was cumulative.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study

Wei

MacDonald

Shimi

2016

Fertility and Sterility

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“…However, studies have shown laparoscopic appendectomy (LA) for the treatment of acute appendicitis to be a safe and useful alternative for certain populations such as morbidly obese patients and women of reproductive age [2][3][4]. Although LA is associated with a shorter hospital length of stay (LOS) and lower complication rates, its high cost precludes it from replacing OA as the mainstream treatment for acute appendicitis in the general population [5][6][7][8][9][10].…”

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confidence: 99%

Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study

Yeh

Liao

et al. 2011

Surg Endosc

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“…[2][3][4][5][6][7] Cross-sectional imaging with computed tomography (CT) may help in diagnostic dilemmas but this is expensive and involves a large radiation dose to a predominantly younger population, and it is not the routine method of diagnosis in the UK. [8][9][10][11][12][13] As with a number of other centres, our hospital actively uses laparoscopy to diagnose suspected appendicitis in cases with a high clinical index of suspicion for acute appendicitis 14 and laparoscopic appendicectomy is routine if the laparoscopy is positive. Conversion to an open procedure is dependent on the surgical findings but may occur if there is significant contamination, if the procedure is difficult (eg difficult retrocaecal appendix, appendicular abscess) or with unexpected complications.…”

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confidence: 99%

Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy

Shelton

Brown

Young

2014

annals

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INTRODUCTION Diagnostic laparoscopy with appendicectomy (LA) has become the accepted method of investigation and treatment of appendicitis. However, concerns remain in cases of complicated appendicitis when many advocate conversion to an open procedure (LCOA) owing to the risk of complications. The aim of this study was to look for factors that could predict complications occurring in patients undergoing appendicectomy. METHODS Data inclusive of all consecutive appendicectomies over a two-year period were retrieved from the computerised theatre database. Clinical details including admission inflammatory markers, complications, severity (final pathology) and length of stay were collected from the discharge letter. Readmissions were identified as those hospital identifiers had a second set of admission dates and/or a second discharge letter. RESULTS During the 2-year study period, 517 appendicectomies were performed. Of these, 429 patients (83%) had LA and the remaining 88 (17%) had LCOA. The LA group had a mean age of 28 years (range: 2-86 years) and a mean C-reactive protein (CRP) level of 71mg/l (range: 0-480mg/l) while the LCOA group had a mean age of 46 years (range: 11-92 years) and a mean CRP level of 162mg/l (range: 3-404mg/l). These differences in age and CRP were significant (p<0.001). LA patients were less likely to have complications overall (22% vs 52%, p=0.015). Complications were independently more than twice as common with established inflammation with a CRP level of >150mg/l (p<0.05). CONCLUSIONS A high preoperative CRP level predicts an increased rate of postoperative complication due to established inflammation and/or infection. This raises the question of whether we should be offering primary open appendicectomies to patients with a CRP level of >150mg/l.

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Routine diagnostic laparoscopy reduces the rate of unnecessary appendicectomies in young women

Cited by 24 publications

References 26 publications

Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study

Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study

Laparoscopic appendectomy for acute appendicitis is more favorable for patients with comorbidities, the elderly, and those with complicated appendicitis: a nationwide population-based study

Preoperative C-reactive protein predicts the severity and likelihood of complications following appendicectomy

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