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1.
Afr J Paediatr Surg ; 20(1): 28-33, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36722566

RESUMO

Background: A very short hospital length of stay following an open appendectomy in children with acute simple appendicitis has never been mentioned yet in the literature. The authors reviewed the outcome of these paediatric patients who were treated with the open technique. Materials and Methods: In this analytical cohort observational study, we retrospectively reviewed the medical records of the 115 consecutive patients who underwent open appendectomy from June 2017 to July 2021. Results: There were 84 patients whose appendices were inflammatory or suppurative and appendectomies were done only through McBurney's point. Of these, the average age was 9.11 ± 2.67 years. The mean length of the incision was 1.95 ± 0.48 cm. Nearly one-third (25/85) were discharged within 3 h following surgery. Of the remaining cases, nine patients were discharged within the same day. There were increased percentages of patients who were eligible for early discharge in each consecutive year. Conclusion: The idea of immediate discharge within 3 h seems to be feasible for children with acute simple appendicitis who were treated with open appendectomy. We believe that the practice will be widely acknowledged and proceed to reduce the resources and the expenses in the hospital.


Assuntos
Apendicectomia , Apendicite , Humanos , Criança , Apendicite/cirurgia , Estudos Retrospectivos , Hospitalização , Hospitais
2.
An. pediatr. (2003. Ed. impr.) ; 98(1): 12-18, ene. 2023. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-214782

RESUMO

Introducción: El índice neutrófilo-linfocito (INL) es un biomarcador inflamatorio fácilmente calculable a partir del recuento diferencial de leucocitos. El objetivo de este estudio es analizar el papel del INL en la detección de apendicetomías negativas, y comparar su utilidad con otros factores clínicos, ecográficos y de laboratorio previamente descritos. Métodos: Estudio retrospectivo en pacientes menores de 16 años con sospecha de apendicitis aguda intervenidos en nuestra institución entre 2017-2020, que fueron divididos en 2 grupos según hallazgos histológicos apendiculares: Grupo AN: apendicitis negativa; ausencia de inflamación y grupo AP: apendicitis positiva; presencia de inflamación en la pared apendicular. Se analizaron las características demográficas, clínicas, ecográficas y de laboratorio. Resultados: Se incluyeron 1.269 pacientes (1.244 en el grupo AP; 25 en el grupo AN), sin diferencias demográficas entre ellos. Los pacientes del grupo AN presentaron un porcentaje significativamente menor de náuseas y vómitos en comparación con el grupo AP (p<0,001) y menor diámetro ecográfico apendicular (8,1±2,1 vs. 9,7±2,8mm; p<0,001). Los recuentos de leucocitos, neutrófilos e INL fueron significativamente superiores en el grupo AP (p<0,001), así como la proteína C reactiva (18,6 vs. 2,6; p=0,005). El análisis mediante curva ROC mostró que el INL fue el parámetro con mayor AUC (0,879) para el diagnóstico de apendicitis negativa, con un punto de corte de 2,65 con una sensibilidad del 84,2% y una especificidad del 83,8% máximas. Conclusiones: El INL es el parámetro preoperatorio que mejor distingue a los pacientes sin apendicitis aguda. Los valores inferiores a 2,65 deben hacernos sospechar otra causa diferente a la apendicitis. (AU)


Introduction: The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory biomarker that is easily calculated with data from the differential white blood cell count. The aim of our study was to analyse the role of the NLR in the detection of negative appendectomies and to compare its usefulness with other clinical, sonographic and laboratory factors previously described. Methods: We conducted a retrospective study in patients aged less than 16 years who underwent appendectomy in our hospital between 2017 and 2020. We divided patients into 2 groups based on appendiceal histological findings: NA group (negative appendicitis: absence of appendiceal inflammation) and PA group (positive appendicitis: presence of inflammation in any layer of the appendiceal wall). We analysed demographic, clinical, sonographic and laboratory characteristics. Results: We included a total of 1269 patients, 1244 in the PA group and 25 in the NA group, with no differences between groups in demographic characteristics. The proportion of patients that presented with nausea and vomiting was significantly smaller in the NA group compared to the PA group (P<.001), and there were no other differences in symptoms. The appendiceal diameter on ultrasound was significantly smaller in the NA group (8.1±2.1 vs. 9.7±2.8mm; P<.001). The white blood cell and neutrophil counts and the NLR were significantly higher in the PA group (P<.001), as was the level of C-reactive protein (18.6 vs. 2.6; P=.005). The ROC curve analysis revealed that the NLR was the parameter with the highest AUC (0.879) for the diagnosis of negative appendicitis, with a cut-off point of 2.65 for a maximum sensitivity of 84.2% and specificity of 83.8%. Conclusion: The NLR is the preoperative parameter that best discriminates patients without acute appendicitis. Values of less than 2.65 should make clinicians contemplate diagnoses other than appendicitis. (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Neutrófilos , Linfócitos , Apendicite , Biomarcadores , Estudos Retrospectivos , Apendicectomia
3.
J Matern Fetal Neonatal Med ; 36(1): 2160629, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36617668

RESUMO

INTRODUCTION: Appendicitis is the most common acute abdominal complication during pregnancy. If appendix perforation occurs there is an increasing risk of preterm delivery and other pregnancy complications. OBJECTIVE: To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates, and complications. METHODS: A prospective cohort study of pregnant women with, or without, appendectomy at South Stockholm General Hospital, December 2015 to February 2021 in a setting where pregnant women are prioritized for surgery and laparoscopic surgery was standard of care in first half of pregnancy. Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. A non-pregnant control group was gathered comprising women of fertile age in the same study interval. RESULTS: During the study period 50 pregnant women, of whom 44 gave birth, underwent appendectomy of 38 199 women giving birth. There were no differences between women with or without appendectomy in proportion of preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or Cesarean delivery (18.2% vs. 20.4%). The rate of appendix perforation was 19% in non-pregnant control group compared to 12% among pregnancy. There was no case of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an unaffected appendix compared to those operated ≤ 20 gestational weeks (4/11 vs. 2/39, p = .005). Laparoscopic surgery was used in 97% of non-pregnant control group, 92% of appendectomies ≤ 20 weeks gestation, and in 27% >20 weeks. As compared to first half, the appendectomy rate was three times lower during the second half of pregnancy. Pregnant women had priority for surgery < 6 h compared to < 24 h among non-pregnant women, this resulted in a shorter time-to-surgery among pregnant women (p < .001). CONCLUSION: Routine laparoscopic surgery and time priority for pregnant surgery is associated with a low risk of perforation, preterm birth and other complications. However, a low threshold for surgery may increase the risk of a negative exploration.


Assuntos
Apendicite , Laparoscopia , Complicações na Gravidez , Nascimento Prematuro , Gravidez , Humanos , Recém-Nascido , Feminino , Lactente , Seguimentos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/cirurgia , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Estudos Prospectivos , Estudos Retrospectivos , Complicações na Gravidez/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Parto , Apendicite/epidemiologia , Apendicite/cirurgia , Apendicite/complicações , Hospitais
4.
Pediatr Ann ; 52(1): e36-e38, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36625800

RESUMO

We present an 11-year-old pediatric patient with acute-on-chronic abdominal pain found to have a large intra-abdominal abscess with a concomitant dermoid cyst. Acute-on-chronic abdominal pain has one of the broadest and, in our case, ever-changing differential diagnoses. Exploratory laparoscopy revealed a severe pelvic inflammatory process with a large abscess and extensive omental and bowel adhesions, a left ovarian cyst, a shortened appendix with thickened tip, and purulent fluid in the cul-de-sac. These findings suggested a ruptured appendix leading to a large abscess with adjacent ovarian dermoid cyst, and an appendectomy was performed. Our patient responded well to continued intravenous antibiotics, and her drain was removed on the day of discharge. She was sent home with an additional 2 weeks of oral cefdinir and metronidazole. Follow-up ultrasound showed dramatic cyst resolution, and no further intervention was needed. [Pediatr Ann. 2023;52(1):e36-e38.].


Assuntos
Abscesso , Cisto Dermoide , Feminino , Humanos , Adolescente , Criança , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Antibacterianos , Apendicectomia
5.
Obstet Gynecol ; 141(2): 354-360, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36649317

RESUMO

OBJECTIVE: To assess whether concomitant appendectomy in patients who undergo laparoscopic surgery for benign gynecologic indications is associated with increased rates of complications in the 30-day postoperative period. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent laparoscopic surgery by a gynecologist. Patients were excluded if they underwent open abdominal surgeries, bowel resections, urogynecologic surgeries, or if diagnoses of cancer or appendicitis were present. There were 246,987 patients included in the population cohort from 2010 to 2020. Demographic information and postoperative outcomes of patients who underwent concomitant appendectomy were compared with patients who did not undergo appendectomy. A matched cohort was created by computing propensity scores, and outcomes were again compared between groups. All patients undergoing appendectomy were 1:1 matched to a unique patient who did not undergo appendectomy using a greedy matching based on the propensity score calculated from demographic and surgical characteristics. RESULTS: A total of 1,760 patients (0.7%) underwent concomitant appendectomy. There was an 8.0% complication rate in the appendectomy group, compared with 5.5% in the group of those without appendectomy ( P <.001), and this was similar to the results in the propensity-matched sample. Patients who underwent appendectomy had significantly higher rates of readmission (4.3% vs 2.3%), which remained significant in the propensity-matched sample. There were no differences in the rates of postoperative thromboembolic events, blood transfusion, or reoperation. CONCLUSION: Patients who are undergoing concomitant appendectomy have an increased risk of any complication and hospital readmission. Additional studies may be conducted to identify patients with optimal risk benefit profiles when considering performing concomitant appendectomy at time of gynecologic surgery.


Assuntos
Apendicite , Laparoscopia , Humanos , Feminino , Apendicectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Readmissão do Paciente , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Apendicite/complicações , Apendicite/cirurgia , Estudos Retrospectivos , Tempo de Internação
7.
Lancet Oncol ; 24(2): 187-194, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36640790

RESUMO

BACKGROUND: Awareness of the potential global overtreatment of patients with appendiceal neuroendocrine tumours (NETs) of 1-2 cm in size by performing oncological resections is increasing, but the rarity of this tumour has impeded clear recommendations to date. We aimed to assess the malignant potential of appendiceal NETs of 1-2 cm in size in patients with or without right-sided hemicolectomy. METHODS: In this retrospective cohort study, we pooled data from 40 hospitals in 15 European countries for patients of any age and Eastern Cooperative Oncology Group performance status with a histopathologically confirmed appendiceal NET of 1-2 cm in size who had a complete resection of the primary tumour between Jan 1, 2000, and Dec 31, 2010. Patients either had an appendectomy only or an appendectomy with oncological right-sided hemicolectomy or ileocecal resection. Predefined primary outcomes were the frequency of distant metastases and tumour-related mortality. Secondary outcomes included the frequency of regional lymph node metastases, the association between regional lymph node metastases and histopathological risk factors, and overall survival with or without right-sided hemicolectomy. Cox proportional hazards regression was used to estimate the relative all-cause mortality hazard associated with right-sided hemicolectomy compared with appendectomy alone. This study is registered with ClinicalTrials.gov, NCT03852693. FINDINGS: 282 patients with suspected appendiceal tumours were identified, of whom 278 with an appendiceal NET of 1-2 cm in size were included. 163 (59%) had an appendectomy and 115 (41%) had a right-sided hemicolectomy, 110 (40%) were men, 168 (60%) were women, and mean age at initial surgery was 36·0 years (SD 18·2). Median follow-up was 13·0 years (IQR 11·0-15·6). After centralised histopathological review, appendiceal NETs were classified as a possible or probable primary tumour in two (1%) of 278 patients with distant peritoneal metastases and in two (1%) 278 patients with distant metastases in the liver. All metastases were diagnosed synchronously with no tumour-related deaths during follow-up. Regional lymph node metastases were found in 22 (20%) of 112 patients with right-sided hemicolectomy with available data. On the basis of histopathological risk factors, we estimated that 12·8% (95% CI 6·5 -21·1) of patients undergoing appendectomy probably had residual regional lymph node metastases. Overall survival was similar between patients with appendectomy and right-sided hemicolectomy (adjusted hazard ratio 0·88 [95% CI 0·36-2·17]; p=0·71). INTERPRETATION: This study provides evidence that right-sided hemicolectomy is not indicated after complete resection of an appendiceal NET of 1-2 cm in size by appendectomy, that regional lymph node metastases of appendiceal NETs are clinically irrelevant, and that an additional postoperative exclusion of metastases and histopathological evaluation of risk factors is not supported by the presented results. These findings should inform consensus best practice guidelines for this patient cohort. FUNDING: Swiss Cancer Research foundation.


Assuntos
Neoplasias do Apêndice , Tumores Neuroendócrinos , Masculino , Humanos , Feminino , Adulto , Tumores Neuroendócrinos/cirurgia , Tumores Neuroendócrinos/patologia , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Estudos Retrospectivos , Neoplasias do Apêndice/cirurgia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/patologia , Estudos de Coortes , Metástase Linfática , Europa (Continente) , Colectomia/efeitos adversos
8.
Pediatr Surg Int ; 39(1): 90, 2023 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-36695901

RESUMO

PURPOSE: There is controversy about the necessity of nighttime appendectomy. The aim of this study was to determine whether timing of appendectomy performance plays a role on postoperative complications. METHODS: A retrospective single-center comparative study was performed in children who underwent surgery for acute appendicitis between 2017 and 2021. Patients were divided into groups based on the time slot in which surgery was performed: morning (8:00 h-15:00 h), afternoon (15:00 h-22:00 h) and night (22:00 h-08:00 h). Demographics, intraoperative data, length of hospital stay, and postoperative complications were analyzed and compared. RESULTS: A total of 1643 patients were included: 337 were operated in the morning, 751 in the afternoon and 555 at night. We found no demographic differences. When comparing the intraoperative data, no differences were observed in the percentage of complicated appendicitis. Night group patients presented a higher percentage of open appendectomies (64.5%) when compared to afternoon (49.6%) and morning (46.2%) groups (p < 0.001). Surgery time was also significantly shorter in the night group (45.2 min ± 18.9 min) (p < 0.001). There were no differences in length of hospital stay, postoperative complications rate or readmission rate. CONCLUSION: These results show that in our institution time slot in which the appendectomy is performed has no consequences in postoperative outcomes and complications.


Assuntos
Apendicite , Laparoscopia , Criança , Humanos , Apendicectomia/métodos , Estudos Retrospectivos , Apendicite/cirurgia , Apendicite/complicações , Resultado do Tratamento , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Tempo de Internação
9.
PLoS One ; 18(1): e0280867, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36696422

RESUMO

This study aimed to observe the impact of the COVID-19 outbreak on acute general surgery in the first German "hotspot" regions of Heinsberg and Aachen, during the first months of the pandemic. The incidence and severity of acute appendicitis, acute cholecystitis and mechanical bowel obstruction, were compared between March and May 2020 and a control period (same months of the previous three years). Pre-, intra- and postoperative data was compared between three regional hospitals of Heinsberg and the closest maximum care, university hospital. A total of 592 operated patients were included, 141 belonging to the pandemic cohort and 451 to the historic cohort. The pandemic group showed higher rates of clinical peritonitis (38% vs. 27%, p = 0.015), higher rates of mean white blood cell count (13.2±4.4 /nl vs. 12.3±4.7 /nl, p = 0.044) and mean C-reactive protein (60.3±81.1 mg/l vs. 44.4±72.6 mg/l, p = 0.015) preoperatively. Specifically in patients with acute appendicitis, there were less patients with catarrhal appendicitis (23% vs. 35%, p = 0.021) and a tendency towards more advanced histological findings in the pandemic cohort. In the university hospital, a 42% reduction in acute operated cases was observed at the onset of the pandemic (n = 30 in 2020 vs. n = 52 in 2019), whereas in the peripheral hospitals of Heinsberg there was only a 10% reduction (n = 111 in 2020 vs. n = 123 in 2019). The onset of the COVID-19 pandemic in our region was accompanied by advanced preoperative and intraoperative findings in patients undergoing emergency general surgery. A greater reduction in acute operated surgical cases was observed at the university hospital, in contrast to the smaller hospitals of Heinsberg, suggesting a possible shift of emergency patients, requiring immediate operation, from maximum care hospital to the periphery.


Assuntos
Apendicite , COVID-19 , Obstrução Intestinal , Humanos , COVID-19/epidemiologia , Estudos Retrospectivos , Apendicite/epidemiologia , Apendicite/cirurgia , Pandemias , Doença Aguda , Apendicectomia
10.
Turk Patoloji Derg ; 39(1): 42-54, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36647674

RESUMO

OBJECTIVE: Parasites and plant seeds may both be found in appendectomy specimens. Each plant seed has a different appearance and can thus exhibit wide variations under the microscope. Fragmented seeds may histologically mimic parasites. The differential diagnosis between seeds and parasites can be challenging in such cases. This study aimed to determine the incidence of parasites, seeds, and foreign bodies in appendectomy materials and highlight the most characteristic histopathological features associated with these structures. MATERIAL AND METHOD: In this study, pathology slides of 9,480 patients, who underwent appendectomy between 2010 and 2021, were reviewed, and cases that contained parasites, seeds, or foreign bodies were identified. We reviewed the literature on seeds and parasites in appendectomy specimens. RESULTS: Parasites were observed in 56 (0.6%) cases. Of these cases, 45 had Enterobius vermicularis (80%), and 11 had Taenia subspecies (20%). Plant seeds were observed in 47 cases (0.5%), and were macroscopically recognizable in 5 of them as olive, lemon, and cherry seeds. Parasites and seeds were usually observed in the lumen of appendix vermiformis, filled with abundant fecal materials. CONCLUSION: Seeds are seen in approximately 0.5% of the appendectomy specimens. Though rarely seen, the fragmented seed appearance may cause diagnostic difficulties. In this context, the key morphological features of parasites and plant seeds outlined in this study may be helpful in their differential diagnosis.


Assuntos
Apendicite , Apêndice , Enterobíase , Corpos Estranhos , Parasitos , Animais , Humanos , Apêndice/parasitologia , Apêndice/patologia , Apêndice/cirurgia , Apendicite/complicações , Apendicite/epidemiologia , Apendicite/cirurgia , Enterobíase/diagnóstico , Enterobíase/epidemiologia , Enterobíase/parasitologia , Estudos Retrospectivos , Apendicectomia , Corpos Estranhos/complicações , Corpos Estranhos/patologia
11.
Langenbecks Arch Surg ; 408(1): 36, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36648548

RESUMO

PURPOSE: A diagnostic and treatment strategy for appendiceal tumors (ATs) has not been established. We aimed to evaluate our treatment strategy in ATs, including laparoscopic surgery (LS), and to identify preoperative malignancy predictors. METHODS: A total of 51 patients between 2011 and 2021 were retrospectively reviewed. Data, including tumor markers and imaging findings, were compared between carcinoma and non-carcinoma patients. Validity of planned operation was evaluated based on pathological diagnosis. RESULTS: Twenty-five patients were diagnosed with carcinoma, 13 with low-grade mucinous neoplasm, and 13 with other diseases. Symptoms were more commonly present in carcinoma patients than in non-carcinoma patients (68.0% vs. 23.1%, p = 0.001). Elevated CEA and CA19-9 were more frequently observed in carcinoma patients than in non-carcinoma patients (p < 0.01 and p = 0.04, respectively). Five carcinoma patients had malignancy on biopsy, compared with zero non-carcinoma patients. Significant differences were noted in the percentages of carcinoma and non-carcinoma patients with solid enhanced mass (41.7% vs. 0%, p < 0.001) and tumor wall irregularity (16.7% vs. 0%, p = 0.03) on imaging. Although the sensitivity was not high, the specificity and positive predictive value of these findings were 100%. Forty-two patients (82.4%) underwent LS as minimally invasive exploratory and/or radical operation, of whom 2 were converted to open surgery for invasion of adjacent organ. No patients had intraoperative complications or postoperative mortality. CONCLUSION: Clinical symptoms, elevated tumor markers, and worrisome features of solid enhanced mass and tumor wall irregularity on imaging can be malignancy predictors. For management of ATs, LS is feasible and useful for diagnosis and treatment.


Assuntos
Neoplasias do Apêndice , Carcinoma , Humanos , Neoplasias do Apêndice/cirurgia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/patologia , Estudos Retrospectivos , Apendicectomia/métodos , Biomarcadores Tumorais
12.
BMC Surg ; 23(1): 1, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36600246

RESUMO

OBJECTIVE: To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment. METHODS: The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications. RESULTS: There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05). CONCLUSION: Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.


Assuntos
Apendicite , Laparoscopia , Humanos , Adulto , Apendicite/cirurgia , Técnicas de Sutura/efeitos adversos , Estudos Retrospectivos , Apendicectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Laparoscopia/efeitos adversos , Suturas/efeitos adversos , Tempo de Internação
14.
Infect Genet Evol ; 107: 105391, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36494066

RESUMO

Human infection with Enterobius vermicularis occurs worldwide, particularly in children. The role of E. vermicularis in appendicitis is neglected. This study was designed to investigate genotypes of E. vermicularis detected from appendectomy specimens in the human population from Iran and clarify the intra-species variation of the parasite. Seventy appendectomies for acute clinical appendicitis isolates from Azerbaijan and North Khorasan of Iran were used in the present study. The genetic information of Tehran and Hamedan regions was also obtained from GenBank for comparison and analysis. The nucleotide sequence of cytochrome c oxidase subunit 1 (cox1) gene was analyzed to perform genetic differentiation, haplotype network analysis, and population structure. Phylogenetic analysis of all the isolates were included in type B haplogroup. The number of haplotypes in all geographical locations of Iran is not much. Network analysis of sequences for regions such as Thailand, Iran, Denmark, and Poland show three classified subtypes B1, B2, and B3 in the B haplogroup. It seems that the haplotypes of E. vermicularis detected from appendectomy are B type, and divided into three subtypes. Further research using another genetic marker is required to elucidate the genetic variation of the parasites in detail.


Assuntos
Apendicite , Apêndice , Enterobíase , Parasitos , Criança , Animais , Humanos , Apendicectomia , Apendicite/genética , Apendicite/cirurgia , Apendicite/epidemiologia , Apêndice/parasitologia , Filogenia , Enterobíase/epidemiologia , Enterobíase/parasitologia , Enterobíase/cirurgia , Irã (Geográfico)/epidemiologia , Estudos Retrospectivos , Enterobius/genética , Doença Aguda
15.
J Surg Res ; 281: 112-121, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36155268

RESUMO

INTRODUCTION: There has not been a recent evaluation of the association between racial and gender and surgical outcomes in children. We aimed to evaluate improvements in race- and gender-related pediatric postoperative outcomes since a report utilizing the Kids' Inpatient Database data from 2003 to 2006. METHODS: Using Kids' Inpatient Database (2009, 2012, 2016), we identified 245,976 pediatric patients who underwent appendectomy for acute appendicitis (93.6%), pyloromyotomy for pyloric stenosis (2.7%), empyema decortication (1.6%), congenital diaphragmatic hernia repair (0.7%), small bowel resection for intussusception (0.5%), or colonic resection for Hirschsprung disease (0.2%). The primary outcome was the development of postoperative complications. Multivariable logistic regression was used to evaluate risk-adjusted associations among race, gender, income, and postoperative complications. RESULTS: Most patients were male (61.5%) and 45.7% were White. Postoperative complications were significantly associated with male gender (P < 0.0001) and race (P < 0.0001). After adjustment, Black patients were more likely to experience any complication than White patients (adjusted odds ratio 1.3, confidence interval 1.2-1.4), and males were more likely than females (adjusted odds ratio 1.3, confidence interval 1.2-1.4). CONCLUSIONS: No clear progress has been made in eliminating race- or gender-based disparities in pediatric postoperative outcomes. New strategies are needed to better understand and address these disparities.


Assuntos
Apendicectomia , Apendicite , Feminino , Criança , Humanos , Masculino , Estados Unidos/epidemiologia , Estudos Retrospectivos , Tempo de Internação , Apendicectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Apendicite/complicações
16.
J Surg Res ; 281: 282-288, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36219940

RESUMO

INTRODUCTION: Shift-based models for acute surgical care (ACS), where surgical emergencies are treated by a dedicated team of surgeons working shifts, without a concurrent elective practice, are becoming more common nationwide. We compared the outcomes for appendectomy, one of the most common emergency surgical procedures, between the traditional (TRAD) call and ACS model at the same institution during the same time frame. METHODS: A retrospective review of patients who underwent laparoscopic appendectomy for acute appendicitis during 2017-2018. ACS and TRAD-patient demographics, clinical presentation, operative details, and outcomes were compared using independent sample t-tests, Wilcoxon rank-sum tests and Fisher's exact or χ2 tests. Multiple exploratory regression models were constructed to examine the effects of confounding variables. RESULTS: Demographics, clinical presentation, and complication rates were similar between groups except for a longer duration of symptoms prior to arrival in the TRAD group (Δ = 0.5 d, P = 0.006). Time from admission to operating room (Δ = -1.85 h, P = 0.003), length of hospital stay (Δ = -2.0 d, P < 0.001), and total cost (Δ = $ -2477.02, P < 0.001) were significantly lower in the ACS group compared to the TRAD group. Furthermore, perforation rates were lower in ACS (8.3% versus 28.6%, P = 0.003). Differences for the outcomes remained significant even after controlling for duration of symptoms prior to arrival (P < 0.05). CONCLUSIONS: Acute appendicitis managed using the ACS shift-based model seems to be associated with reduced time to operation, hospital stay, and overall cost, with equivalent success rates, compared to TRAD.


Assuntos
Apendicite , Laparoscopia , Humanos , Apendicectomia/efeitos adversos , Apendicectomia/métodos , Apendicite/cirurgia , Apendicite/complicações , Resultado do Tratamento , Tempo de Internação , Doença Aguda , Estudos Retrospectivos , Laparoscopia/efeitos adversos
17.
J Surg Res ; 281: 299-306, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36228340

RESUMO

INTRODUCTION: The delivery of pediatric surgical care for acute appendicitis involves general surgeons (GS) and pediatric surgeons (PS), but the differences in clinical practice are primarily undescribed. We examined charge differences between GS and PS for the treatment of pediatric acute appendicitis. METHODS: We performed a retrospective review of the North Carolina hospital discharge database (2013-2017) in pediatric patients (≤18 y) who had surgery for appendiceal pathology (acute or chronic appendicitis and other appendiceal pathology). We performed a bivariate analysis of surgical charges over the type of surgical providers (GS, PS, other specialty, and unassigned surgeons). RESULTS: Over the study period, 21,049 patients had appendicitis or other diseases of the appendix, and 15,230 (72.4%) underwent appendectomy. Patients who were operated on by PS were younger (10 y, interquartile range (IQR): 6-13 versus 13 y, IQR: 9-16, P < 0.001). Acute appendicitis was diagnosed in 2860 (44.3%) and 3173 (49.2%) of the PS and GS cohorts, respectively, P = 0.008. PS compared to GS performed a higher percentage of laparoscopic (n = 2,697, 89.4% versus n = 2,178, 65.5%) than open appendectomies (n = 280, 9.3% versus n = 1,118, 33.6%), P < 0.001. The overall hospital charges were $28,081 (IQR: $21,706-$37,431) and $24,322 (IQR: $17,906-$32,226) for PS and GS, respectively, P < 0.001. Surgical charges where higher for PS than GS, $12,566 (IQR: $9802-$17,462) and $8051 (IQR: $5872-$2331), respectively. When controlling for diagnosis, surgical approach, emergent status, age, and surgical cost of appendiceal surgery, and hospital charges following appendiceal surgery were $4280 higher for PS than GS (95% CI: 3874-4687). CONCLUSIONS: The total charge for operations for appendiceal disease is significantly higher for PS compared to GS. Pediatric surgeons had increased surgical charges compared to GS but decreased radiology charges. The specific reasons for these differences are not clearly delineated in this data set and persist after controlling for relevant covariates. However, these data demonstrate that increasing value in pediatric appendicitis may require specialty-based targets.


Assuntos
Apendicite , Apêndice , Laparoscopia , Cirurgiões , Humanos , Criança , Apendicectomia , Apendicite/cirurgia , Apendicite/diagnóstico , North Carolina/epidemiologia , Estudos Retrospectivos , Doença Aguda
18.
J Surg Res ; 281: 328-334, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36240719

RESUMO

INTRODUCTION: Surgical resident operative autonomy has decreased markedly over time, reducing resident readiness for independent practice. We sought to examine operative resident autonomy for emergency acute care surgery (ACS) compared to elective cases and associated patient outcomes at veterans affairs hospitals. METHODS: The Veterans Affairs Surgical Quality Improvement Program database was queried for ACS cases (emergency general, vascular, and thoracic) at veterans affairs hospitals from 2004 to 2019. Cases are coded prospectively for the level of supervision: attending primary surgeon (AP); attending scrubbed with resident surgeon (AR); resident primary (RP), attending not scrubbed. Baseline demographics, operative variables, and outcomes were compared. RESULTS: A total of 61,275 ACS cases and 605,146 elective cases were performed during the study period. The ACS had a higher proportion of RP cases (7.2% versus 5.7%, P < 0.001). The proportion of ACS RP cases decreased from 9.9% to 4.1% (58.6%); elective RP cases decreased from 8.9% to 2.9% (67.4%). The most common ACS RP surgeries were appendectomy, amputations, and cholecystectomy. RP cases had lower American Society of Anesthesia class and lower median work relative value units than AP and AR. There was no difference between mortality rates of RP compared to AP (adjusted odds ratio [OR] 0.94 [0.80-1.09] or AR 0.94 [0.81-1.08]). While there was no difference in complications between the RP and AP (OR 1.01 [0.92-1.12]), there were significantly more complications in AR compared to RP (OR 1.20 [1.10-1.31]). CONCLUSIONS: More autonomy is granted for ACS cases compared to elective cases. While both decreased over time, the decrease is less for ACS cases. Resident autonomy does not negatively impact outcomes, even in emergent cases.


Assuntos
Cirurgia Geral , Internato e Residência , Cirurgiões , Humanos , Estados Unidos/epidemiologia , Cuidados Críticos , Melhoria de Qualidade , Apendicectomia , Competência Clínica , Cirurgia Geral/educação , Duração da Cirurgia
19.
J Paediatr Child Health ; 59(2): 360-364, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36546400

RESUMO

AIM: This study examined if the classification systems for acute appendicitis could be applied in the emergency department as an indicator for surgical consultation, in order to reduce unnecessary paediatric surgery admission. METHODS: The Alvarado Score (ALS) and the Pediatric Appendicitis Score (PAS) were applied. The decisions for hospitalisation and treatment were made independent of the scores. RESULTS: In total, 307 children with abdominal pain suggestive of acute appendicitis were included. We used a cut-off point of 7 and divided the patients into groups; the group with score ≥ 7 points was considered the positive ALS and/or PAS group, and the group with score < 7 points was the negative ALS and/or PAS group. The same process for cut-values set at 6 points was followed. The joint probabilities for the 7-point-thresholds were: ALS-sensitivity 84%, PAS-sensitivity 85%, ALS-specificity 92%, PAS-specificity 92%, ALS-positive predictive value (PPV) 83%, PAS-PPV 84% and 93% negative predictive value (NPV) for both scores. Considering the 6-point-thresholds, we estimated: 94% sensitivity for both scores, 74% ALS-specificity, 84% PAS-specificity, 66% ALS-PPV, 73% PAS-PPV, 91% ALS-NPV and 97% PAS-NPV. CONCLUSION: The scoring systems provided acceptable prediction of patients with and without appendicitis. They may be of use in the emergency department, as assistive diagnostic-tools, in order to reduce paediatric surgery consultations, admissions and treatment costs.


Assuntos
Apendicite , Criança , Humanos , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Sensibilidade e Especificidade
20.
Surg Laparosc Endosc Percutan Tech ; 32(6): 720-723, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36468896

RESUMO

BACKGROUND: Laparoscopic appendectomy is among the most common general surgical procedures performed in developed countries. Among the most critical steps in laparoscopic appendectomy is transection of the appendix meso. This study evaluates the postoperative and economic outcomes between total mesoicular excision and isolated (traditional) appendectomy technique during appendix transsection, in line with the patients' clinicopathologic data. MATERIALS AND METHODS: Patients who were operated on with the diagnosis of acute appendicits in our clinic between October 2021 and January 2022 were evaluated retrospectively. Patients were divided into 2 groups. In the first group, there is the isolated appendectomy technique in which the appendix meso is dissection from the tip of the appendix to the base of the cecum, while in the second group there is the technique in which the appendix meso is dissected from the base of the cecum. In addition, demographic data (age, sex), body mass index, presence of comorbid disease, operation time, postoperative hospital stay, health care costs, appendix size of the patients included in the study were recorded. RESULT: During the study, 157 patients were included in the study. Seventy-one (45.2%) of the patients were in group 1, and 86 (54.8%) were in group 2. There was no difference between the groups regarding age, sex, body mass index, presence of comorbid disease, appendix size, and postoperative hospital stay ( P >0.05). However, operation time and health care costs were statistically higher in group 2 than in group 1 ( P =0.01). CONCLUSION: Although there was no difference in postoperative complications between the isolated appendectomy technique and the mesoicular technique, the operation time was shorter, and the operation cost was lower in the isolated appendectomy technique.


Assuntos
Apendicite , Apêndice , Laparoscopia , Humanos , Apendicectomia/métodos , Apêndice/cirurgia , Apendicite/cirurgia , Estudos Retrospectivos , Laparoscopia/métodos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
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