Surgical Audit: A Prospective Study of the Morbidity and Mortality of Acute Appendicitis

Malatani, Tarek; Latif, Abdulbasit A.; Al-Saigh, Abdulaziz; Cheema, M A; Abu-Eshy, Saeed

doi:10.5144/0256-4947.1991.209

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…[5][6][7]11,12,16 Specifically, topical ampicillin was shown to reduce wound infection after colonic, 19 biliary and gastrointestinal surgery 20 and after appendectomy. 21,22 Ampicillin effectiveness is based on its activity against streptococci, enterococci and 30% of the E. coli isolates in our study.…”

Section: Discussionmentioning

confidence: 99%

“…1 The significantly longer hospital stay in our study of the infected group is in agreement with previous studies. [4][5][6][7] Prophylactic use of systemic antibiotics, many of which have been used either alone or in combination, has resulted in a significant reduction in wound infection rate. [2][3][4] Gentamicin is effective against E. coli, which was the most common aerobic organism cultured from the wound and abdomen in our study and this is in agreement with previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms.…”

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Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

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A total of 249 patients, undergoing appendectomy for acute appendicitis, were prospectively randomized into two groups. Group I, comprising 132 patients, received sterile normal saline irrigation to the surgical wound at closure. Alternatively, Group II included 117 patients, who received intraoperative topical ampicillin irrigation of the wound. Both groups were comparable with regard to age, sex, duration of symptoms, and severity of appendicitis. All patients additionally received preoperative systemic gentamicin and Flagyl. Wound infection occurred in 5.3% of Group I compared to only 0.9% of Group II (P<0.05). The reduction in infection rate was significant (P<0.05) in histologically proven appendicitis. We conclude that the addition of intraoperative topical ampicillin to systemic gentamicin and Flagyl augments prophylaxis against wound infection in acute appendicitis. Ann Saudi Med 1994;14(3):233-236. A considerable morbidity following appendectomy is caused by wound infection, 1-5 the rate of which ranges from 9% to 30% in early appendicitis and may reach up to 70% in advanced appendicitis.3-6 Systemic antibiotics were shown to reduce the wound infection rate significantly. 3,4,7 In vitro studies demonstrated 100% kill rates with clinically usable concentrations of antimicrobials in irrigating solutions after only 60-second exposure of the organisms. 8,9 Unlike parenterally administered antimicrobials, topical usage was found to attain prolonged effective local concentrations when used in the powder form. 10Experimental studies have shown that the combined use of systemic and topical antibiotics is better in advanced appendicitis than systemic antibiotics alone.11 Similarly, Seco et al. 12 have concluded in a clinical study that prophylaxis with a combination of systemic clindamycin and topical ampicillin solution, when compared with systemic clindamycin alone, was more effective in preventing wound infection after appendectomy, especially in patients with high wound contamination. However, the study of Seco et al. was criticized because the control group wounds were not irrigated with normal saline and clindamycin may not be the systemic antibiotic of choice for many surgeons. This communication aims at investigating the efficacy of the addition of topical ampicillin to systemic antimicrobials in reducing post appendectomy wound infection rate in a properly controlled randomized prospective study. Material and MethodsAll patients who underwent appendectomy through gridiron incision for clinically suspected acute appendicitis were considered for the study. Exclusion criteria were allergy to ampicillin and other systemic diseases requiring systemic antibiotic administration and therefore three patients who were allergic to ampicillin were excluded from the study, as well as another two patients who had valvular heart disease warranting preoperative prophylactic systemic ampicillin in addition to the systemic gentamicin and Flagyl. A total of 254 patients fulfilled the criteria of the study and were random...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Topical Ampicillin for Prophylaxis Against Wound Infection in Acute Appendicitis

Alshehri

Saif

Aliyu

et al. 1994

Annals of Saudi Medicine

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“…In 1980, German gynecologist Kurt Semm performed the first laparoscopic appendectomy (3,4). The management of acute appendicitis ranges from non-operative treatment in early non-complicated appendicitis (5) to the gold standard appendectomy with low morbidity worldwide (6)(7)(8)(9)(10)(11). In children, morbidity ranges from 2.7% in non-complicated appendicitis to 16% in perforated appendicitis (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Hindi¹,

Aradi²,

Mubarak³

et al. 2021

Ann Afr Surg.

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Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent. Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy

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