Treatment of Perforated Appendicitis: An Analysis of 362 Patients Treated during 8 Years

Styrud, Johan; Eriksson, S; Granström, L

doi:10.1159/000018678

Cited by 24 publications

(20 citation statements)

References 7 publications

(7 reference statements)

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“…This is in accordance with a recent large population based study from Sweden [19], as well as a perforation rate of 20% [20]. These reports reflect a more conservative attitude to the decision as to operate or not in patients with suspected acute appendicitis, resulting in a decreased appendectomy rate.…”

Section: Discussionsupporting

confidence: 91%

Stability in Incidence of Acute Appendicitis

Kørner

Søreide²,

Pedersen

et al. 2001

Dig Surg

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Background/Aim of the Study: During the past 50 years, a decrease in incidence of appendicitis has been reported. The various studies were retrospective and based on different data sources. In the present study, we analyze prospectively the incidence of acute appendicitis during a 10-year period in a well defined population of 265,000. Methods: Prospective registration of all operations performed in patients with suspected acute appendicitis in the catchment area of a single institution. The diagnosis of acute appendicitis was based on histology in all cases. The annual incidence of acute appendicitis was calculated with regard to nonperforated and perforated acute appendicitis. Main Results: Between 1989 and 1998, 2,861 patients underwent surgery for suspected acute appendicitis. In 2,232 (78%) patients, acute appendicitis was confirmed histologically. Mean annual incidence was 84/100,000 (95% confidence interval 80 to 88/100,000). Crude incidence remained stable during the study period, with the exception of a significant increase in 1991 followed by a significant decrease the next year. Nonperforated acute appendicitis showed a different incidence pattern as compared to perforated acute appendicitis. Conclusion: In our prospective study, the incidence of acute appendicitis remained stable in our well-defined study population during the study period of 10 years. This is in contrast to the majority of studies during the last decades.

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Section: Discussionsupporting

confidence: 91%

Stability in Incidence of Acute Appendicitis

Kørner

Søreide²,

Pedersen

et al. 2001

Dig Surg

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“…On the other hand, about one fifth of the patients who underwent converted laparoscopic and primarily open operations developed the well-known complication of subcutaneous infection, with an even greater risk for the subgroup of obese patients. Nevertheless, the latter results were still within the lower range of published infection rates, which reach up to 45% [10, 11, 12]. As has been substantiated elsewhere, this could be explained by the systematic application of antibiotic prophylaxis and therapy [13, 14].…”

Section: Discussionmentioning

confidence: 55%

Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Stöltzing

Thon²

2000

Dig Surg

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Aims: A retrospective study was used to compare laparoscopic appendectomy for perforated appendicitis to open operation. Methods: Between July 1991 and June 1999 a total of 734 patients, all over 14 years of age, underwent operation for acute appendicitis. Of these patients, 125 (17%) displayed perforated appendicitis and were treated with either a laparoscopic appendectomy (n = 80; total conversion rate 36/80, 45%) or a primary open procedure (n = 45). Results: Due to selection, the 3 treatment groups (laparoscopic, laparoscopy with conversion, open operation) showed differences with respect to gender, duration of symptoms, proportion of obese patients and patients with generalized peritonitis. The median operating time was 75 min for the laparoscopic procedure, 90 min for a converted procedure and 70 min for open operation. Only 1 of 44 (2%) patients who had a laparoscopic operation, but 8 of 36 (22%) who had a converted operation, and 8 of 45 (18%) who had an open operation developed wound infection. A similar frequency of intra-abdominal abscess formation was observed in the 3 treatment groups (2/44, 5%; 3/36, 8%; 2/45, 5%). Fatal outcome occurred only in patients who underwent an open operation and presented with severe peritonitis (5/45, 11%). Conclusions: Despite limitations in comparability of patient groups, laparoscopic appendectomy was associated with a significantly lower rate of septic wound complications (p < 0.05). This was especially true for the subgroup of obese patients (BMI >26). Therefore, for patients with perityphlitic abscess or fresh purulent lower abdominal peritonitis, but not for patients with generalized peritonitis, laparoscopic appendectomy is not only justifiable but even recommended as the procedure of choice.

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“…Length of hospital stay is directly related to postoperative complications which present with a higher frequency in perforated appendicitis [7,9,17,18]. The length of hospital stay has decreased, and currently patients with non-perforated appendicitis have a median hospital stay of 2 days [3], and patients with perforated appendicitis a median of 7.5 ± 3 days [1,3].…”

Section: Length Of Hospital Stay and Postoperative Complicationsmentioning

confidence: 99%

“…Postoperative complications are the main cause of prolonged hospital stays, however late complications account for a small but important morbidity leading to even other surgical procedures [8]. Nevertheless, perforation in patients with appendicitis is the main cause of postoperative morbidity and prolonged hospital stays [1,3,9].…”

Section: Length Of Hospital Stay and Postoperative Complicationsmentioning

confidence: 99%

“…The risk of rupture was negligible within the fi rst 24 hours, climbed to 6% after 36 hours from the onset of symptoms and remained steady at approximately 5% for each ensuing 12 hours period, establishing a 36 hours period from the onset of symptoms to surgery as a low risk period for appendiceal perforation [3,6,7], consequently in-hospital delay is not an independent factor of perforation although delays may contribute if patients are left to wait unduly [3,4,6]. Perforated appendicitis has been associated to early [6][7][8][9] and long-term complications [8], hence the importance of its accurate diagnosis and early treatment. Moreover, the removal of normal appendices has known ethic, economic, and legal implications [10].…”

Section: Introductionmentioning

confidence: 99%

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Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

Beltrán¹,

Méndez²,

Barrera³

et al. 2009

Indian J Surg

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Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

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Treatment of Perforated Appendicitis: An Analysis of 362 Patients Treated during 8 Years

Cited by 24 publications

References 7 publications

Stability in Incidence of Acute Appendicitis

Stability in Incidence of Acute Appendicitis

Perforated Appendicitis: Is Laparoscopic Operation Advisable?

Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein? — a prospective study

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