Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.204
Filtrar
1.
Khirurgiia (Mosk) ; (10): 49-59, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047586

RESUMO

OBJECTIVE: To analyze the role of mesoappendixectomy in the development of intra-abdominal surgical site infection (IAB SSI) after LAE. MATERIAL AND METHODS: A prospective randomized non-blind multiple-center registered (ClinicalTrials.gov NCT03754777) study has been performed for the period from 2016 to 2018. The study was devoted to effectiveness and safety of the modified enhanced recovery protocol in LAE. In the main group, this protocol (n=56) included routine mesoappendixectomy, restrictive strategy for abdominal drainage and postoperative antibiotic prevention. In the control group (n=71), mesoappendixectomy was performed only in case of necrotic changes. Both groups were comparable by demographic parameters and severity of comorbidities. RESULTS: In the main group, significant decrease in the incidence of IAB SSI was found (0% versus 9.8%). Moreover, the main group was characterized by reduced length of hospital-stay (1.43±1.34 d versus 2.94±2, 43 days). CONCLUSION: Mesoappendixectomy should be evaluated in further research as a potential factor in prevention of IAB SSI.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Mesocolo/cirurgia , Peritonite/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Drenagem , Recuperação Pós-Cirúrgica Melhorada , Humanos , Peritonite/etiologia , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologia
2.
Cochrane Database Syst Rev ; 10: CD008359, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33001448

RESUMO

This Cochrane review has been withdrawn. The Cochrane review is out of date and included a retracted article in the analysis. Withdrawn by Cochrane Colorectal Group. A new update is expected. The editorial group responsible for this previously published document have withdrawn it from publication.


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Doença Aguda , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Khirurgiia (Mosk) ; (9): 51-58, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030002

RESUMO

OBJECTIVE: Was to evaluate the effectiveness of anti-scar treatment with Contractubex gel in children and adults. MATERIAL AND METHODS: A group of researchers based on clinical hospitals and university medical clinics carry out the multicenter study to evaluate the effectiveness of anti-scar treatment with Contractubex gel containing cepalin, allantoin and heparin, with its early appointment in groups of children from 12 to 18 years old and adults from 21 to 35 years old. The study included data from 216 patients. Patients of both age groups were initially divided into two: the main and control ones with an equal distribution according to the type of surgical intervention (hernia repair and appendectomy), age, gender, and anamnestic data. The dynamic observation was carried out using two rating scales - filled out by a doctor (Vancouver scale) and a patient (author's rating scale in the Scar Diary mobile application). RESULTS: Based on the results of the analysis of the data obtained, a high efficiency of the use of Contractubex gel at the early stages of scar formation among patients of the main group in comparison with the control was revealed. By 90 days, the treatment result according to the Vancouver scale was 0,16±0,1 points in the main group and 0,39±0,2 points in the control group. At the same time, with a dynamic scale for assessing the cicatricial process, there was a significant (p<0.05) improvement in the main group (0,2±0,06 points) compared with the control group (0,6±0,17 points). In addition, was noticed the strong commitment to anti-scar treatment in pediatric patients. CONCLUSIONS: The work confirms the undoubted need for anti-scar treatment in the early stages of scar formation after surgical interventions, which accelerates the psychophysical rehabilitation of patients after surgery and improves the quality of life.


Assuntos
Qualidade de Vida , Adolescente , Adulto , Apendicectomia , Criança , Cicatriz , Humanos , Resultado do Tratamento , Ferimentos e Lesões , Adulto Jovem
4.
Khirurgiia (Mosk) ; (9): 89-91, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030008

RESUMO

Low-grade mucinous tumors (MT) of the appendix are rare malignancies. One of the most formidable complications of these tumors is mucin depositing in the peritoneum with development of peritoneal pseudomyxoma. Currently, there are no single clinical - pathomorphological classification and treatment approach to these tumors. This situation is complicated by the fact that tumor of the appendix cannot be preoperatively suspected in many cases and MT is detected after appendectomy for acute appendicitis or its complications. Thus, prognosis of patients is deteriorated.


Assuntos
Neoplasias do Apêndice , Apêndice , Apendicectomia , Apendicite , Humanos , Neoplasias Peritoneais
5.
Rozhl Chir ; 99(8): 361-363, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33032441

RESUMO

Acute appendicitis is one of the most common acute abdomen cases. Although many causes have been described in literature, it is mostly primary affection of the appendix that leads to acute appendicitis. A 57-year-old patient was admitted to our department displaying all usual signs of acute appendicitis, both clinical and laboratory. During laparoscopic appendectomy, we found the inflammation of the appendix in this case appeared secondary, originating in a structure located nearby the appendix, strongly resembling a testicle. We performed appendectomy and removed the suspected structure altogether. The patient recovered completely within a week. Subsequent histological examination confirmed that the suspected tissue was indeed a retained testicle causing se-condary inflammation of the appendix. As we found out later, this condition probably occurred in the patient secondarily in adulthood, most likely due to inguinal hernia repair undergone during childhood.


Assuntos
Apendicite , Apêndice , Hérnia Inguinal , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Testículo
7.
Mymensingh Med J ; 29(4): 887-894, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116092

RESUMO

The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of acute appendicitis and its complications. The study was conducted between January 2011 to February 2019 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and some private hospitals of Dhaka, Bangladesh. A total of 641 patients who presented with acute appendicitis and its complications were treated by laparoscopic method. Around 70% (449) patients had classical presentation, 20% (128) were atypical and 10% (64) were recurrent or chronic presentation. Maximum (527, 82%) came with acute appendicitis. Eighty eight (13.72%) patients had burst (perforated) appendicitis, 12(1.87%) patients had appendicular abscess, 11(1.71%) showed early appendicular lump, 2(0.4%) had stump appendicitis and 1(0.2%) had previous laparoscopic clip control of stump. Energy source was unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip were used for haemostosis and ligation of appendicular stump. Mean duration of surgery was 20minutes and mean hospital stay was 36 hours. Histopathological patterns were acute appendicitis (554, 86.42%), gangrenous appendicitis (58, 9.04%), catarrhal (13, 2.02%), chronic appendicitis (10, 1.56%) lymphoid hyperplasia (6, 0.93%) and carcinoid tumor (1, 0.15%), among the complications (25) were single or multiple port infections, port TB, paralytic ileus and diarrhea. Conversion was 1(0.15%) for controlling haemorrhage of burst appendicitis. The rest of the patients recovered quickly and uneventfully. In conclusion, it can be stated that laparoscopic appendicectomy is safe, convenient and achievable and can become the gold standard of management of acute appendicitis and its complications.


Assuntos
Apendicite , Laparoscopia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Bangladesh/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
8.
Acta Gastroenterol Belg ; 83(3): 441-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094592

RESUMO

Primary appendiceal cancer is rare and most commonly found incidentally on a surgical specimen after appendectomy for acute appendicitis. This small organ gives rise to different subtypes which are histological and biological distinct. Historically the classification of these tumors has been confusing because of the different nomenclature that is used. This review has broadly classified them into four subgroups : colonic-type adenocarcinoma, mucinous neoplasm, goblet cell carcinoma and neuroendocrine neoplasm. Signet ring cells is not considered as a distinct subgroup but as a histologic feature that can be present in colonic-type adeno- carcinoma and mucinous neoplasms. As staging and management of appendiceal tumors depends on these subtypes, an adequate classification of them is important. This review aimed to give an overview of the epidemiology, grading and staging, management and prognosis of these neoplasms. Despite its rarety specific staging systems and treatment guidelines exist for some subtypes. For other subtypes staging systems and management is extrapolised from colorectal cancer because of the lack of randomised, prospective trials.


Assuntos
Neoplasias do Apêndice , Apendicite , Neoplasias Colorretais , Apendicectomia , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/terapia , Neoplasias Colorretais/diagnóstico , Humanos , Estudos Prospectivos
9.
BMC Surg ; 20(1): 242, 2020 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-33069217

RESUMO

BACKGROUND: A retained surgical sponge, also known as a gossypiboma, is a rare cause of serious postoperative complications. Diverse retained surgical materials including instruments such as clamps and sutures have been reported, but surgical sponges are the most common material. We report an unusual case of a gossypiboma mimicking a complicated urachal cyst that led to perforation of the umbilicus. CASE PRESENTATION: A 38-year-old female patient presented in our facility with a palpable periumbilical mass and discharge of pus from the umbilicus for 7 months after an open appendectomy. Since the onset of symptoms, the patient had been treated conservatively in a peripheral hospital where she had been operated on. As no improvement was seen, an ultrasound scan was performed that suggested an intraperitoneal abscess adjacent to the umbilicus. Consequently, the patient was referred to our specialist outpatient department for surgical intervention. Suspecting a complicated urachal cyst, an exploratory laparotomy was performed but revealed a retained surgical sponge as the underlying cause. The gossypiboma was resected, and the postoperative period was unremarkable. CONCLUSION: This case demonstrates that gossypibomas, even though rare, continue to occur. They may clinically and radiologically mimic other pathologies, especially abscesses and tumors. Preventive measures as well as the inclusion of gossypibomas in the differential diagnosis of intraabdominal masses or fistulation detected in patients with a history of surgery are of utmost importance to minimize morbidity, mortality, and potential medicolegal implications.


Assuntos
Abscesso Abdominal/etiologia , Apendicectomia/efeitos adversos , Corpos Estranhos/diagnóstico por imagem , Laparotomia/métodos , Tampões de Gaze Cirúrgicos/efeitos adversos , Umbigo/diagnóstico por imagem , Abscesso Abdominal/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Corpos Estranhos/cirurgia , Humanos , Complicações Pós-Operatórias , Resultado do Tratamento , Ultrassonografia , Cisto do Úraco
10.
Niger J Clin Pract ; 23(10): 1368-1374, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047692

RESUMO

Background: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. Aims: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. Methodology: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16-87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. Conclusion: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.


Assuntos
Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Cirurgiões/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nigéria , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
12.
Scott Med J ; 65(4): 144-148, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32878574

RESUMO

BACKGROUND AND AIM: COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. METHODS: Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. RESULTS: One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. CONCLUSION: CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica , Estudos Retrospectivos , Adulto Jovem
14.
Medicine (Baltimore) ; 99(33): e21801, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872081

RESUMO

Acute appendicitis (AA) is the most common nonobstetric surgical emergency during pregnancy. According to the current guidelines and meta-analyses, traditional open appendectomy (OA) is still recommended for pregnant patients over laparoscopic appendectomy (LA), which might be associated with higher rates of fetal loss. Previous studies and experiences indicated that LA might be safe in the second trimester of pregnancy. The current study aimed to evaluate the safety and feasibility of LA in pregnant women during the second trimester.At our institution, a retrospective study was conducted with pregnant patients who underwent LA or OA during the second trimester between January 2016 and August 2018.A total of 48 patients were enrolled. Of them, 12 were managed with laparoscopy and 36 with the open approach. We found that the LA group had higher BMIs than the OA group (4.0 ±â€Š4.3 vs 21.5 ±â€Š2.9, P = .031). The financial results showed that the average daily medical costs for patients who underwent LA was higher than those who underwent OA (444 ±â€Š107 US$ vs 340 ±â€Š115 US$, P = .009), while the total cost of hospitalization was comparable between the 2 approaches. The perioperative and obstetric outcomes were comparable between LA and OA. In each group, only 1 patient had fetal loss. No "Yinao" was found in any of the patients in the LA group.In this study, with the proven advantages of the laparoscopic techniques, LA was found to be safe and feasible for pregnant women during the second trimester.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Laparoscopia/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Adulto , Apendicectomia/métodos , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Adulto Jovem
15.
Khirurgiia (Mosk) ; (8): 5-16, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869609

RESUMO

OBJECTIVE: To improve treatment outcomes in patients with acute appendicitis (AA). MATERIAL AND METHODS: An internet survey was performed. Questionnaire consisted of 15 questions concerning diagnosis and treatment of AA: application of prognostic scales, incidence and technical aspects of laparoscopic appendectomy (LA), antibiotic prophylaxis, postoperative management, compliance with international and national clinical guidelines. A total of 690 questionnaires were received and analyzed (3.67% of all surgeons in the Russian Federation). RESULTS: Eighteen percent of respondents use at least one prognostic scale. The vast majority of surgeons (92%) use antibiotic prophylaxis. Almost half of respondents place trocars in the triangulation position (44%), one third of surgeons ligate the mesentery of the appendix (35%), most respondents perform mesoappendectomy (60%) with monopolar and bipolar cautery. Forty-five percent of all respondents do not invert the appendix stump. Significant number of respondents use abdominal drainage routinely. Only 3.5% of surgeons use multimodal postoperative analgesia. Less than 22% of patients are operated under low-pressure pneumoperitoneum. Standardization of surgical technique and perioperative approaches including those specified in the guidelines is absent. We also found insufficient awareness of surgeons about international and national clinical guidelines. CONCLUSION: This study may be useful for standardizing treatment approaches, choosing the best practice, popularizing and improving of current clinical guidelines.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , Apendicite/cirurgia , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Apendicectomia/normas , Apendicite/terapia , Apêndice/cirurgia , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Humanos , Internet , Laparoscopia , Assistência Perioperatória , Guias de Prática Clínica como Assunto , Federação Russa
16.
Medicine (Baltimore) ; 99(31): e21439, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756156

RESUMO

RATIONALE: Duodenal atresia in association with situs inversus abdominus is extremely rare. Care should be taken when selecting appropriate surgical methods, and caution should be exercised during the surgery to avoid misdiagnosis and mistreatment. With prompt recognition of the condition, the surgical procedure should be performed in a timely manner to achieve positive results. PATIENT CONCERNS: A newborn affected by situs inversus abdominus associated with duodenal atresia, midgut malrotation, and volvulus. DIAGNOSIS: Congenital duodenal atresia with situs inversus abdominis. INTERVENTIONS: Diamond-shaped duodenoduodenostomy with appendectomy was performed, with the release of Ladd band and correction of the malrotation. OUTCOMES: The baby boy is thriving well with no abdominal complaints at 4 years of surgical follow-up. LESSONS: Although several theories are put forward to clarify this matter, the proper cause of duodenal atresia is not well defined. Clinical symptoms and examinations can assist diagnosis, the definitive cause should be ascertained by surgical approach. And the operating surgeon must be aware of the "mirror anatomy" to prevent unnecessary injuries. Additionally, long-term prognosis for duodenal atresia are very good, therefore, careful attention in postoperative management are important in such a case.


Assuntos
Obstrução Duodenal/congênito , Obstrução Duodenal/complicações , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Atresia Intestinal/complicações , Atresia Intestinal/cirurgia , Situs Inversus/complicações , Assistência ao Convalescente , Anastomose Cirúrgica/métodos , Apendicectomia/métodos , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico , Obstrução Duodenal/diagnóstico , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Masculino , Situs Inversus/diagnóstico , Resultado do Tratamento
17.
Ther Umsch ; 77(4): 147-156, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32772694

RESUMO

Acute appendicitis - recent controversies in diagnostic and therapy Abstract. Acute appendicitis is one of the most frequent surgically treated gastrointestinal diseases. For most of the patients it is supposed to be easily diagnosed and treated, but there are cases with complex diagnosis and indistinct treatment. For correct diagnosis an elaborated patients' history and clinical examination by an experienced surgeon is necessary. In many countries, patients undergo additional extensive radiological diagnostics beside of ultrasound. This fact leads to an unjustified risk of x-ray exposure and increased costs in the health care system. In contrast, delay during diagnosis and treatment and consecutive complications are often the trigger for legal dispute and the accusation of malpractice of the responsible surgeon. In addition, the treatment of acute appendicitis has undergone changes towards a non-surgical therapy, so that the routinely performed urgent appendectomy has been displaced by conservative therapy using antibiotics, percutaneous drainage, and interval surgery after a certain time in a non-inflammatory state. So far, no distinct guideline is available, as profound prospective and randomized results and subgroup analysis are still missing. In this article these problems and controversies are enlightened. Particularly, legal aspects and potential conflicts between family doctors, surgeons, relatives, and patients are discussed. Finally, nothing is easy to diagnose or treat, even potentially simple diseases as acute appendicitis is considered to be.


Assuntos
Apendicite , Doença Aguda , Antibacterianos/uso terapêutico , Apendicectomia , Drenagem , Humanos , Estudos Prospectivos
18.
Wiad Lek ; 73(7): 1489-1491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32759443

RESUMO

OBJECTIVE: The aim: Determine the frequency of surgery-appendectomy of patients with chronic non-atrophic gastritis and the impact of this transaction on the pathogenesis of chronic gastritis. PATIENTS AND METHODS: Materials and methods: Data of disease history and life were analyses, as well as the results of a comprehensive survey of 245 patients with chronic non-atrophic gastritis. Comprehensive examination included: step-by-step рН-metry, esophagogastroduodenoscopy, helicobacter infection test (НР) (helicobacter urease test and microscopic examination of stained smears), histological investigations of the gastric stump mucous. RESULTS: Results: Helicobacter infection was detected in 100% of cases. It was found that 56 (22.9%) of patients were subjected to appendectomy. Age of patients, who had an appendectomy ranged from 4 to 40 years and averaged 18.34 ± 1.05 years, and the first pathological manifestations of the gastro-intestinal tract appeared in an average of 28.27± 1.75 year, i.e. in 10 years. As for the age qualification pupil were the earliest pathological manifestations appeared in a group of patients from 11 to 15 years (13 people (23.2%) and amounted to about 6 years after the operation, and 6 (46.2%) patients, manifestations appeared in 2-6 months after surgery; the most recent is in group from 16 to 20 years (19 people (33.9%) and amounted to about 14 years (p < 0.05). CONCLUSION: Conclusions: Surgery on the body of immune system - appendix provokes activation of latent form of chronic non-atrophic gastritis, especially during puberty.


Assuntos
Gastrite Atrófica , Helicobacter pylori , Adolescente , Adulto , Apendicectomia , Criança , Pré-Escolar , Infecções por Helicobacter , Humanos , Adulto Jovem
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 786-790, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810951

RESUMO

Objective: To analyze clinical characteristics of recurrent appendicitis. Methods: A retrospective cohort study was carried out. Clinical data of patients who underwent appendectomy due to acute appendicitis confirmed by pathology in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were analyzed retrospectively. Exclusion criteria: (1) age of less than 18 years;(2) chronic appendicitis; (3) periappendiceal abscess; (4) appendiceal mucocele or mucinous neoplasms; (5) appendiceal neuroendocrine tumors or cancers; (6) appendicitis during pregnancy; (7) concurrent AIDS, hematological disease, autoimmune disease, inflammatory bowel disease or advanced cancer; (8) other simultaneous surgery. A total of 373 patients were enrolled the study. These patients were divided into the recurrent group (133 cases) and the first episode group (240 cases) according to the previous history of antibiotic therapy for acute appendicitis. The prevalence of recurrent appendicitis was calculated, and the clinical characteristics were analyzed, including gender, age, comorbidities and preoperative CT images. Results: Of 373 patients, 209 were male and 164 were female, with a median age of 42 (18 to 88) years. Median recurrent time of the recurrent group was 4 (1 to 60) months. Compared to the first episode group, the recurrent group had higher proportion of age <50 years [71.4% (95/133) vs. 57.5% (138/240), χ(2)=7.081, P=0.008], higher proportion of concurrent diabetes [13.5% (18/133) vs. 5.4% (13/240), χ(2)=7.399, P=0.007], shorter onset time [(41.7±13.6) hours vs. (59.4±56.2) hours, t=-3.286, P=0.001], lower proportion of abdominal tension and rebound pain [57.9% (77/133) vs. 66.7% (160/240), χ(2)=5.065, P=0.024], lower score of modified Alvarado score [(5.6±1.9) point vs. (6.1±1.9) point, t=-2.417, P=0.016], lower WBC count [(10.5±4.6) ×10(9)/L vs. (11.5±4.5)×10(9)/L, t=-1.190, P=0.047], higher percentage of lymphocyte [(19.4±14.7)% vs. (16.1±13.3)%, t=2.069, P=0.039]. In the recurrent group, ratio of length of removed appendix ≥7 cm was higher as compared with the first episode group [44.4% (59/133) vs. 32.9% (79/240), χ(2)=4.808, P=0.028], while the ratio of complicated appendicitis was significantly lower [8.3% (11/133) vs. 22.9% (55/240), χ(2)=10.823, P=0.001]. CT images were available in 129 patients, intraluminal appendicoliths was found in 19 of 50 patients (38%) in the recurrent group, while in 16 of 79 patients (20.3%) in the first episode group, and there was statistically significant difference between the two groups (χ(2)=4.880, P=0.027). Conclusions: Clinical characteristics of recurrent acute appendicitis include age less than 50 years, concurrent diabetes, short onset time, less abdominal tension or rebound pain, low modified Alvarado score, low WBC count, high percentage of lymphocyte, appendix length longer than 7 cm, non-complicated appendicitis and intraluminal appendicoliths.


Assuntos
Apendicite , Apêndice , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Recidiva , Estudos Retrospectivos , Adulto Jovem
20.
Chirurg ; 91(9): 700-711, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32747976

RESUMO

The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis.


Assuntos
Apendicite , Laparoscopia , Doença Aguda , Apendicectomia , Alemanha , Humanos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA