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1.
J Med Invest ; 68(3.4): 334-341, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759155

RESUMO

Background : Appendectomy can be challenging and occasionally converted to extensive resection for complicated appendicitis. However, optimal treatment strategies can be developed using preoperative risk assessment. Thus, we aimed to investigate the preoperative predictors of extensive resection in complicated appendicitis patients undergoing surgery. Materials and methods : In total, 173 complicated appendicitis patients undergoing surgery between 2014 and 2019 were classified into the appendectomy (n = 153) or extensive resection (n = 20) groups. Clinicopathological factors and surgical outcomes were compared between groups. Results : Extensive resection was performed in 20 of 173 complicated appendicitis patients (11.5%). The rates of having defects in the wall structure at the appendix root on computed tomography images were significantly higher, and the duration from onset to surgery was significantly longer in the extensive resection group. Significant differences were found in operative duration, blood loss and postoperative hospitalization, but none in the incidence of postoperative complications between groups. Multivariate analyses showed that defects in the wall structure at the appendix root and five days or longer from onset were identified as independent predictors of extensive resection. Conclusions : Defects in the wall structure at the appendix root and five days or longer from onset predict extensive resection performance in complicated appendicitis patients. J. Med. Invest. 68 : 334-341, August, 2021.


Assuntos
Apendicite , Laparoscopia , Apendicectomia/efeitos adversos , Apendicite/complicações , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Humanos , Incidência , Complicações Pós-Operatórias , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Emerg Med Clin North Am ; 39(4): 781-794, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600637

RESUMO

Postprocedural complications encompass a wide array of conditions that vary in acuity, symptoms, index procedure, and treatment. Continued advancements in diagnostic and therapeutic procedures have led to a significant shift of procedures to the ambulatory setting. This trend is of particular interest to the emergency physician, as patients who develop complications often present to an emergency department for evaluation and treatment. Here the authors examine a high-yield collection of procedures, both ambulatory and inpatient, notable for their frequent utilization and unique complication profiles including common laparoscopic surgical procedures, bariatric surgery, endoscopic procedures, interventional radiology procedures, and hernia repairs with implantable mesh.


Assuntos
Complicações Pós-Operatórias , Apendicectomia/efeitos adversos , Cirurgia Bariátrica/efeitos adversos , Endoscopia/efeitos adversos , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Nutrição Parenteral/efeitos adversos
3.
Rozhl Chir ; 100(9): 429-434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34649451

RESUMO

INTRODUCTION: Acute appendicitis (AA) is the most common abdominal emergency. This article aims to document the impact of the ongoing COVID-19 pandemic on timely diagnosis of AA, duration of symptoms before examination in a medical institution, levels of laboratory inflammatory markers, and the length of hospital stay. Collected data were compared with current world literature. METHOD: Two datasets were created, comprising patients with the histological diagnosis of AA determined from March 1 to June 30, 2019 (before of the onset of the COVID-19 pandemic) and in the same period of the spring pandemic of COVID-19 in 2020. The following information was obtained from patient medical records: Demographic data, information on symptom duration before AA diagnosis, information on laboratory inflammatory marker levels, the used surgical method, antibiotic treatment, histopathological findings, and the length of hospital stay. These data were processed using descriptive statistics methods and the two created datasets were compared with the use of statistical methods (an unpaired t-test and Welchs t-test). RESULTS: Thirty seven patients (26 men and 11 women) with the median age of 41 years were operated on for acute appendicitis at the Department of Surgery, Military University Hospital in Prague from March 1 to June 30, 2019. Thirty four patients (19 men and 15 women) with the median age of 42 years were operated on in the same period of 2020. No significant differences were found between these two compared datasets in terms of symptom duration, laboratory inflammatory marker levels or the length of hospital stay. The distributions of histopathological findings and used antibiotic treatments were also similar. CONCLUSION: In our study, we were unable to demonstrate any statistically significant differences between the datasets of patients operated on before and after the onset of the COVID-19 pandemic.


Assuntos
Apendicite , COVID-19 , Doença Aguda , Adulto , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Feminino , Humanos , Tempo de Internação , Masculino , Pandemias , Estudos Retrospectivos , SARS-CoV-2
6.
J Am Coll Surg ; 233(5): 593-605.e4, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34509613

RESUMO

BACKGROUND: Virtual visits (VVs) are being used increasingly to provide patient-centered care and have undergone rapid uptake during the COVID-19 pandemic. Our aim was to compare satisfaction and convenience of virtual post-discharge follow-up for surgical patients and qualitatively analyze free-text survey responses in a randomized controlled noninferiority trial. Patient satisfaction with VVs has not been evaluated previously in a randomized controlled trial and few mixed-methods analyses have been done to understand barriers and facilitators to post-discharge visits. STUDY DESIGN: Patients undergoing laparoscopic appendectomy or cholecystectomy were randomized to VV or in-person visit (2:1). Surveys with 11 multiple-choice and 2 open-ended questions evaluated patient satisfaction and convenience. Univariate analysis compared responses to the multiple-choice questions and qualitative content analysis evaluated open-ended responses. RESULTS: Of 442 enrolled patients, 289 completed their postoperative visit and were sent surveys (55% response rate). Patients were categorized as VV (n = 135), crossover (randomized to virtual but completed in-person; n = 53), and in-person visits (n = 101). Patient-reported satisfaction was similar, but convenience was higher for VV patients. Open-ended responses (72 VVs, 14 crossovers, and 41 in-person visits) were qualitatively analyzed. In all groups, patient experience was influenced by quality of care, efficiency, and convenience. Barriers were different for virtual and in-person appointments. CONCLUSIONS: We found that quality of, and access to, care-whether in person or virtual-remained critical components of patient satisfaction. VVs address many barriers associated with in-person visits and were more convenient, but can present additional technological barriers.


Assuntos
Assistência ao Convalescente/métodos , COVID-19/prevenção & controle , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Telemedicina/normas , Adulto , Assistência ao Convalescente/psicologia , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Apendicectomia/efeitos adversos , Agendamento de Consultas , COVID-19/epidemiologia , COVID-19/transmissão , Colecistectomia Laparoscópica/efeitos adversos , Controle de Doenças Transmissíveis/normas , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Inquéritos e Questionários/estatística & dados numéricos
7.
Rev Assoc Med Bras (1992) ; 67(3): 355-359, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468597

RESUMO

OBJECTIVE: The sudden COVID-19 outbreak has changed our health system. Physicians had to face the challenge of treating a large number of critically ill patients with a new disease and also maintain the essential healthcare services functioning properly. To prevent disease dissemination, authorities instructed people to stay at home and seek medical care only if they experienced respiratory distress. However, there are concerns those patients did not seek necessary health care because of these orientations. This study aims to see how the pandemic has influenced the severity of the disease, complication, and mortality of patients undergoing emergency cholecystectomy and appendectomy. METHODS: Retrospective review of medical records of patients admitted to the emergency department and undergoing to cholecystectomy and appendicectomy in the periods from March to May 2019 and 2020. RESULTS: We observed that COVID-19 did not change the severity of presentation or the outcome of patients with gallbladder disease, but caused a 24.2% increase in the prevalence of complicated appendicitis (p<0.05). However, disagreeing with what was expected, we did not identify a greater number of perioperative complications in patients undergoing an appendectomy. CONCLUSION: Therefore, it seems that in a university tertiary referral center COVID-19 did not influence the management and outcome of inflammatory diseases treated in the surgical emergency department.


Assuntos
Apendicite , COVID-19 , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , SARS-CoV-2
8.
Afr J Paediatr Surg ; 18(4): 190-194, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34341301

RESUMO

Introduction: Intra-peritoneal collection (IPC) following laparoscopic appendectomy (LA) of complicated appendicitis in children is a serious complication. This is associated with a longer duration of hospital stay, more costs, and psychological upsets of both children and their parents. The aim of this study is to evaluate different factors that may affect the development of IPC following LA of complicated appendicitis. Patients and Methods: Seventy-five children were admitted with acute complicated appendicitis. All of them had LA between January 2016 and October 2020. The following variables were studied: patients' demographics, clinical findings, laboratory and imaging studies and operative parameters. Patients were divided according to their post-operative course into two groups; Group (A): patients with IPC (n = 19), Group (B): patients without IPC (n = 56). Potential risk factors for the development of post-operative IPC were identified by univariate and multivariate logistic regression analysis. Results: Nineteen cases (25.3%), out of 75 patients, presented with post-operative collection. Forty-seven (62.7%) patients were males, the overall median age was 11 (inter-quartile range [IQR] 10-13). The most significant operative variable was the operative time, which was significantly longer in Group A, 78 min (IQR 75-88) versus 56 (50-66), P = 0.001. The following variables were associated with an elevated incidence of post-operative IPC; age, body mass index, total leucocytic count (TLC), duration of symptoms, pediatric appendicitis score, pre-operative morbidity, being on medications, operative time, suction and irrigation or suction only and drain duration. In the multivariate model, TLC (odds ratios [OR]: 1.358, P 0.006), symptoms duration (OR: 2.051, P 0.012), morbidity (OR: 2.064, P 0.041) and operative time (OR: 2.631, P 0.039) were statistically significant and confirmed as being predictors of IPC post-LA in complicated appendicitis. Conclusion: Post-operative IPC is quite common after LA for complicated appendicitis. Increased TLC, prolonged symptoms duration, associated co-morbidity and operative time could be predictors of its occurrence. Improving general condition, surgical technique and reducing operative time help to reduce its incidence.


Assuntos
Apendicite , Laparoscopia , Adolescente , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
9.
Cochrane Database Syst Rev ; 8: CD010168, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34402522

RESUMO

BACKGROUND: This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES: To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS: Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS: The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.


Assuntos
Abscesso/prevenção & controle , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Drenagem/métodos , Peritonite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Humanos
10.
BMJ Case Rep ; 14(7)2021 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-34312128

RESUMO

We present a case of a 41-year-old woman who visited the emergency department (ED) with acute abdomen. She was diagnosed with perforated appendicitis and abscess formation on CT. She was treated conservatively with antibiotics and discharged. On control CT 3 months later, the appendix had healed, but signs of thickening of the terminal ileum were noticed and colonoscopy was performed, which was uneventful and showed no signs of inflammation. Twelve hours later, she developed pain in the right lower quadrant, followed by fever, and visited the ED. Physical examination and blood work showed signs consistent with acute appendicitis, and appendectomy was performed laparoscopically 6 hours later. The patient recovered remarkably shortly afterwards. Whether colonoscopy resulted in de novo appendicitis or exacerbated an already existing inflammation remains unknown. However, endoscopists should be aware of this rare, yet serious complication and consider it in the workup of post-colonoscopy abdominal pain.


Assuntos
Apendicite , Apêndice , Dor Abdominal/etiologia , Adulto , Apendicectomia/efeitos adversos , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Colonoscopia , Feminino , Humanos
11.
Obstet Gynecol ; 138(2): 236-245, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34237757

RESUMO

OBJECTIVE: To examine whether there are racial and ethnic differences in postoperative complications after nonobstetric surgery during pregnancy in the United States. METHODS: We conducted a secondary analysis of the prospective ACS NSQIP (American College of Surgeons National Surgical Quality Improvement) program from 2005 to 2012. We assessed pregnant women 18-50 years without prior surgery in the preceding 30 days who underwent a nonobstetric surgery. Race and ethnicity were categorized as non-Hispanic Black, Hispanic, and non-Hispanic White (reference). The primary outcome was a composite of 30-day major postoperative complications inclusive of cardiovascular, pulmonary, and infectious complications, reoperation, unplanned readmission, blood transfusion, and death. We used modified Poisson regression to estimate the relative risk of complications. RESULTS: Among 3,093 pregnant women, 18% were non-Hispanic Black, 20% Hispanic, and 62% non-Hispanic White. The most common surgeries were appendectomy (36%) and cholecystectomy (19%). Black women (18%) were more likely to be assigned American Society of Anesthesiologists (ASA) physical status class III or higher than their White (12%) or Hispanic (9%) peers. Non-Hispanic Black pregnant women had a higher risk of 30-day major postoperative complications compared with their White peers (9% vs 6%; adjusted relative risk [aRR] 1.41, 95% CI 1.11-1.99). This difference persisted when limiting the analysis to apparently healthy women (ASA class I or II) (7% vs 4%; aRR 1.64, 95% CI 1.08-2.50), those who underwent appendectomy (10% vs 3%; aRR 2.36, 95% CI 1.13-4.96), and when appendectomy and cholecystectomy were performed by laparoscopy (7% vs 3%; aRR 2.62, 95% CI 1.22-5.58). Hispanic pregnant women were not at an increased risk of complications compared with non-Hispanic pregnant White women. CONCLUSIONS: Pregnant non-Hispanic Black women were at higher risk of major postoperative complications after nonobstetric surgery compared with their White counterparts.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/etnologia , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Afro-Americanos , Apendicectomia/efeitos adversos , Colecistectomia/efeitos adversos , Grupo com Ancestrais do Continente Europeu , Feminino , Nível de Saúde , Hispano-Americanos , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/etiologia , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
12.
BMC Musculoskelet Disord ; 22(1): 646, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330240

RESUMO

BACKGROUND: Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas' CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH. METHODS: In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas' CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups' indices were then compared. A logistic regression model was applied to assess the effects of psoas' CT measurement parameters on the occurrence of IH. RESULTS: One hundred twenty patients were included in this study. The psoas' CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients' psoas' CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas' CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH. CONCLUSIONS: When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.


Assuntos
Hérnia Incisional , Sarcopenia , Adulto , Apendicectomia/efeitos adversos , China/epidemiologia , Estudos Transversais , Humanos , Hérnia Incisional/patologia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/patologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Sarcopenia/etiologia , Tomografia Computadorizada por Raios X
13.
Ann R Coll Surg Engl ; 103(7): 481-486, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192486

RESUMO

INTRODUCTION: The first wave of COVID-19 was accompanied by global uncertainty. Delayed presentation of patients to hospitals ensued, with surgical pathologies no exception. This study aimed to assess whether delayed presentations resulted in more complex appendicectomies during the first wave of COVID-19. METHODS: Operation notes for all presentations of appendicitis (n=216) within a single health board (three hospitals) during two three-month periods (control period (pre-COVID) vs COVID pandemic) were analysed, and the severity of appendicitis was recorded as per the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: Presentations of appendicitis were delayed during the COVID period with a median duration of symptoms prior to hospital attendance of two days versus one day (p=0.003) with individuals presenting with higher median white cell count than during the control period (14.9 vs 13.3, p=0.031). Use of preoperative CT scanning (OR 3.013, 95% CI 1.694-5.358, p<0.001) increased significantly. More complex appendicectomies (AAST grade >1) were performed (OR 2.102, 95% CI 1.155-3.826, p=0.015) with a greater consultant presence during operations (OR 4.740, 95% CI 2.523-8.903, p<0.001). Despite the greater AAST scores recorded during the COVID period, no increase in postoperative complications was observed (OR 1.145, 95% CI 0.404-3.244, p=0.798). CONCLUSIONS: Delayed presentations during the COVID-19 pandemic were associated with more complex cases of appendicitis. Important lessons can be learnt from the changes in practice employed as a result of this global pandemic.


Assuntos
Apendicectomia/métodos , Apendicite/diagnóstico , COVID-19/epidemiologia , Índice de Gravidade de Doença , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Apendicectomia/efeitos adversos , Apendicectomia/estatística & dados numéricos , Apendicectomia/tendências , Apendicite/sangue , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , COVID-19/prevenção & controle , COVID-19/transmissão , Teste para COVID-19/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Tempo de Internação/estatística & dados numéricos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Tempo para o Tratamento/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Tomografia Computadorizada por Raios X/tendências , Adulto Jovem
14.
Dan Med J ; 68(6)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34060462

RESUMO

INTRODUCTION: Complicated appendicitis increases the risk of post-operative intra-abdominal abscess. Treatment of complicated appendicitis is usually a post-operative course of intravenous antibiotics. A study is needed to confirm the results of retrospective studies showing that a post-operative course of oral antibiotics is not inferior to intravenous antibiotics after laparoscopic surgery for complicated appendicitis. METHODS: The Per oral versus Intravenous Postoperative Antibiotics after surgery for complicated appendicitis (PIPA) trial will be a prospective, multicentre, cluster-randomised cluster-crossover non-inferiority study designed to test whether a three-day post-operative course of oral antibiotics is non-inferior to a three-day post-operative course of intravenous antibiotics as standard care after laparoscopic surgery for complicated appendicitis in regards to the risk of post-operative intra-abdominal abscess formation within 30 days. Participating hospitals will either be randomised to a six-month period with an oral antibiotic regime followed by a six-month period with an intravenous antibiotic regime for the post-operative treatment after laparoscopic surgery for complicated appendicitis, or to a six-month period with an intravenous antibiotic regime followed by a six-month period with an oral antibiotic regime for post-operative treatment after laparoscopic surgery for complicated appendicitis. CONCLUSIONS: The primary outcome will be the incidence of intra-abdominal abscess by post-operative day 30. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency and by the National/Regional Committee on Health Research Ethics.


Assuntos
Abscesso Abdominal , Apendicite , Abscesso Abdominal/tratamento farmacológico , Antibacterianos/uso terapêutico , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
15.
Pediatr Surg Int ; 37(8): 973-981, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33934183

RESUMO

Surgical site infections (SSIs) are the most common healthcare-associated infections in patients undergoing surgery. Various randomised control trials (RCTs) indicate that laparoscopic procedures can be associated with better outcomes compared to open procedures. However, how open versus laparoscopic approaches compare across various paediatric procedures with respect to SSI rate remains poorly defined. In this review, we examined RCTs that directly compare SSI rates after open versus laparoscopic operations for appendicitis, gastro-esophageal reflux, inguinal hernia, and pyloric stenosis. MEDLINE, Embase, and Web of Science were searched for RCTs comparing four types of open versus laparoscopic operations in children. The operations included appendectomy, fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy. 364 records were identified and screened, 54 full-text articles were assessed for eligibility, and 17 RCTs were included in the analysis. SSI rate was the primary outcome. Operative time and length of stay (LOS) were the secondary outcomes. A meta-analysis was conducted using RevMan 5.4 software. Laparoscopic appendectomy had a lower SSI rate than open appendectomy (odds ratio of 2.22 [1.19, 4.15] p = 0.01). Laparoscopic fundoplication for gastro-esophageal reflux, inguinal hernia repair, or pyloromyotomy for pyloric stenosis were not associated with lower SSI rate compared to open surgery. Operative time was shorter in open fundoplication (- 71.22 min [- 89.79, - 52.65] p < 0.00001) than laparoscopic fundoplication. There was no significant difference in operative time of any of the other procedures. There was no significant difference in LOS between open and laparoscopic procedures for all types of operations analysed. Based on the findings of this review, it is recommended to utilise the laparoscopic approach over the open approach to reduce SSI risk in paediatric appendectomy.


Assuntos
Laparoscopia/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Apendicectomia/efeitos adversos , Criança , Pré-Escolar , Feminino , Fundoplicatura/efeitos adversos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Piloromiotomia/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/prevenção & controle
16.
J Surg Res ; 264: 321-326, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33848830

RESUMO

INTRODUCTION: The optimal laparoscopic appendectomy approach is not clear, comparing single site laparoscopic appendectomy (SILA) to conventional 3-port appendectomy (CLA). We investigated outcomes in pediatric patients comparing SILA to CLA: length of operation, length of stay, time to resumption of regular diet, follow up, rehospitalization, and cost. METHODS: Data was collected from children 1 to 18 years with appendectomy at Loma Linda University from 2018 to 2020, operated by two surgeons. Analysis utilized two-sample T, chi-squared, and Fisher's exact tests. RESULTS: Of 173 patients, 77 underwent SILA and 96 had CLA. There was no gender, age, or race difference between groups. Mean WBC was 17.5 × 103/mL in SILA group, compared to 15.3 × 103/mL in CLA group (P = 0.004). Operative time was 47.0 SILA compared to 49.5 minutes CLA (P = 0.269). Of SILA cases, 55.8% were simple appendicitis, while 53.3% of the CLA cases were simple (P = 0.857). Regular diet was resumed after 1.7 days in the SILA group, 1.1 days in CLA (P = 0.018). Length of stay was 2.9 days for SILA, 2.4 days for CLA (P = 0.144). Seven children required hospital readmission, 5 SILA and 2 CLA (P = 0.244). Five of the children who returned had intra-abdominal abscesses, of whom 4 had SILA. There was no difference in cost. CONCLUSIONS: The operative techniques had similar outcomes and operative times. There was a trend toward more intra-abdominal abscesses in the SILA group. Further study and longer follow up is needed to determine if there is an advantage to one laparoscopic approach over another.


Assuntos
Abscesso Abdominal/epidemiologia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Laparoscopia/efeitos adversos , Dor Pós-Operatória/epidemiologia , Abscesso Abdominal/economia , Abscesso Abdominal/etiologia , Adolescente , Apendicectomia/economia , Apendicectomia/métodos , Apendicite/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Laparoscopia/economia , Laparoscopia/métodos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/economia , Dor Pós-Operatória/etiologia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
18.
Ann Ital Chir ; 102021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33875626

RESUMO

AIM: Laparoscopic appendectomy is currently the treatment of choice for acute appendicitis in emergency setting. When appendicitis is clinically suspected, an appendicolith can be found in 30% of the patients. Retained or dropped appendicoliths are an uncommon complication that may occur as a consequence of stone expulsion from the appendix, before or during laparoscopic appendectomies. This is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. The objective of this case report is to illustrate an intrahepatic localization of a dropped appendicolith causing liver abscess. CASE PRESENTATION: A 23-year-old female was admitted to the emergency department of our hospital for an acute appendicitis with coprolite obstructing the lumen and periappendicular effusion. Laparoscopic appendectomy was performed. Persistent liver abscess due to appendicolith was a rare complication treated by percutaneous drainage. The appendicolith was successfully removed from the liver parenchyma by Dormia basket recovery system. DISCUSSION: Treatment options include percutaneous, open, or laparoscopic drainage of the abscess and retrieval of the fecalith, as antibiotics and drainage alone are usually insufficient. CONCLUSION: Only a handful of cases of hepatic abscess formation as a result of dropped appendicoliths have been reported in literature. Our proposal of treatment was the percutaneous approach. There was no need for a surgical procedure to remove the intrahepatic appendicolith. KEY WORDS: Dormia basket, Intrahepatic abscess, Laparoscopic appendectomy, Percutaneous drainage.


Assuntos
Abscesso Abdominal , Apendicectomia/efeitos adversos , Apendicite , Abscesso Hepático Piogênico , Abscesso Abdominal/cirurgia , Antibacterianos/uso terapêutico , Apendicite/cirurgia , Apêndice/cirurgia , Drenagem , Impacção Fecal/complicações , Impacção Fecal/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Abscesso Hepático Piogênico/etiologia , Abscesso Hepático Piogênico/terapia , Reoperação , Adulto Jovem
19.
Childs Nerv Syst ; 37(6): 1825-1830, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33904935

RESUMO

OBJECTIVE: To describe the first pediatric case in the literature of neuropathic inguinal pain secondary to iatrogenic nerve injury that occurred during a laparoscopic appendectomy, detailing clinical and morphological findings before and after surgery. The literature on adult patients is reviewed and pathophysiological, therapeutic, and prognostic factors are discussed. CLINICAL PRESENTATION: A 14-year-old female patient presented with a history of a laparoscopic appendectomy 3 years previously. Three months post-operatively, she developed progressively worsening neuropathic inguinal pain refractory to neuromodulators and several nerve blocks. Given her deterioration, poor response to conservative therapy, and clearly meeting the criteria for chronic post-operative inguinal pain (CPIP), surgical management was undertaken. RESULTS: Open surgery was performed through the previous incision, during which injury to a branch of the iliohypogastric nerve (IH) was confirmed. Neurolysis of the affected branch was performed, after which the patient experienced significant pain relief, resolution of allodynia, and reversal of skin hyperpigmentation. After discharge, analgesic therapy was gradually withdrawn and, ultimately, discontinued altogether. CONCLUSIONS: Understanding the neuroanatomy of the inguinal region is an indispensable requirement for all surgeons operating in this region, to avoid complications including CPIP and optimize patient outcomes. Surgical management of CPIP can be effective for controlling severe pain in patients in whom conservative management has failed. Studies are needed in the pediatric population to identify specific characteristics of this entity in youth.


Assuntos
Hérnia Inguinal , Laparoscopia , Adolescente , Adulto , Apendicectomia/efeitos adversos , Criança , Feminino , Virilha/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos
20.
Int J Colorectal Dis ; 36(10): 2283-2286, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33852068

RESUMO

BACKGROUND: Over the last years, laparoscopic appendectomy has progressively replaced open appendectomy and become the current gold standard treatment for suspected, uncomplicated appendicitis. At the same time, though, it is an ongoing discussion that antibiotic therapy can be an equivalent treatment for patients with uncomplicated appendicitis. The aim of this systematic review was to determine the safety and efficacy of antibiotic therapy and compare it to the laparoscopic appendectomy for acute, uncomplicated appendicitis. METHODS: The PubMed database, Embase database, and Cochrane library were scanned for studies comparing laparoscopic appendectomy with antibiotic treatment. Two independent reviewers performed the study selection and data extraction. The primary endpoint was defined as successful treatment of appendicitis. Secondary endpoints were pain intensity, duration of hospitalization, absence from work, and incidence of complications. RESULTS: No studies were found that exclusively compared laparoscopic appendectomy with antibiotic treatment for acute, uncomplicated appendicitis. CONCLUSIONS: To date, there are no studies comparing antibiotic treatment to laparoscopic appendectomy for patients with acute uncomplicated appendicitis, thus emphasizing the lack of evidence and need for further investigation.


Assuntos
Apendicite , Laparoscopia , Doença Aguda , Antibacterianos/uso terapêutico , Apendicectomia/efeitos adversos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Humanos , Tempo de Internação , Resultado do Tratamento
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