Comparison between AIR, Alvarado and RIPASA scores in the diagnosis of acute appendicitis in a Western population. A retrospective cohort study.

AIM: The aim of this retrospective study is to evaluate raja isteri pengiran anak saleha appendicitis (RIPASA) score in the italian population with histopathologic diagnosis of acute appendicitis (AA) compared to appendicitis response inflammatory (AIR) and Alvarado scores. MATERIAL AND METHODS: Included were patients who had undergone appendectomy for AA from 01/01/2017 to 31/12/2019 in the General and Emergency Surgery of the San Giovanni Addolorata Hospital (Rome, Italy) in whome it was possible to calculate AIR, Alvarado and RIPASA scores at admission. RESULTS: We retrospectively analyzed 369 patients; a total of 320 patients (86.7%) were histologically confirmed. At a cut-off ≥7.5, the RIPASA score showed a sensitivity of 90.9%, a specificity of 63.3%, a positive predictive value (PPV) of 94.2%, a negative predictive value (NPV) of 51.7% and a diagnostic accuracy of 87.3%; the area under curve values for RIPASA was greater than that of AIR and Alvarado scores (0.851 vs 0.796 vs 0.766, respectively). DISCUSSION: The pre-operative diagnosis of AA is often a challenge for the surgeon. To reduce negative appendectomies, many preoperative diagnostic scores have been designed: the RIPASA score has shown better sensitivity and specificity in asian and middle-eastern populations better sensitivity and specificity. CONCLUSIONS: The RIPASA score is a useful tool to aid in the diagnosis of AA in the Italian population. At a value of ≥7.5, RIPASA demonstrated a high-sensitivity, a PPV and diagnostic accuracy in our cohort and was more accurate than AIR and Alvarado scores. KEY WORDS: AIR score, Alvarado score, RIPASA score.

A new minimally invasive technique for the repair of diastasis recti: a pilot study.

BACKGROUND: Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa's technique that combines Rives-Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. METHODS: It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. RESULTS: Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. CONCLUSIONS: This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

Open abdomen closure methods for severe abdominal sepsis: a retrospective cohort study.

PURPOSE: The open abdomen (OA) procedure as part of damage control surgery represents a significant surgical advance in severe intra-abdominal infections. Major techniques used for OA are negative pressure wound therapy (NPWT) and non-NPWT. The aim of this retrospective study is to evaluate the effects of different abdominal closure methods and their outcomes in patients presenting with abdominal sepsis treated with OA. MATERIALS AND METHODS: We retrospectively analyzed clinical outcomes of patients affected by severe intra-abdominal sepsis treated with OA. Demographic features, mortality prediction score, abdominal closure methods, length of hospital stay, complications and mortality rates of patients were determined and compared. RESULTS: This study included 106 patients, of whom 77 underwent OA with NPWT and 29 with non-NPWT. OA duration was longer in NPWT patients (p = 0.007). In-hospital mortality rates in NPWT and in non-NPWT patients were 40.3% and 51.7%, respectively (p = 0.126), with an overall 30-day mortality rate of 18.2% and 51.7%, respectively (p = 0.0002). After emergency colorectal surgery, patients who underwent OA with NPWT had a lower rate of colostomy (p = 0.025). CONCLUSIONS: NPWT is the best temporary abdominal closure technique to decrease mortality and colostomy rates in patients managed with OA for severe intra-abdominal infections.