scholarly journals P066: Outcomes of non-operative versus operative management in pediatric acute uncomplicated appendicitis

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S100
Author(s):  
W. Janjua ◽  
A. Janjua ◽  
E. Loubani ◽  
N. Merritt ◽  
K. Van Aarsen
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Operative Management ◽  
Final Diagnosis ◽  
Uncomplicated Appendicitis ◽  
Long Term Follow Up ◽  
Ed Visits ◽  
Non Operative Management

Introduction: The purpose of this study was to look at outcomes of pediatric patients with early, acute appendicitis who were treated with non-operative management (NOM) with antibiotics. Primary outcomes were subsequent appendectomy or Emergency Department (ED) visits. Methods: The method used for this study was a retrospective chart review of children under the age of 18, looking at outcomes of those who received non-operative management (NOM) for early acute appendicitis between April 2014-April 2015. The inclusion criteria included: (a) Age 0-17, (b) US or CT suggested acute uncomplicated appendicitis (c) Final diagnosis of appendicitis during April 2014-2015. Outcomes that were investigated were repeat ED visits and need for subsequent appendectomy. Results: Data extracted from the EMR found 209 charts with an ED diagnosis of appendicitis. Two charts (.9%) were excluded as they were duplicates. Sixty-seven patients (32%) were excluded after appendicitis was ruled out. One hundred and forty patients (67%) had a final diagnosis of appendicitis, 124 patients (88.6%) were taken directly to the operating room for appendectomy, 16 patients (11.4%) were treated with antibiotics instead of operative management. Three patients who received non-operative management had complex appendicitis, 13 had acute uncomplicated appendicitis. Six patients out of 13 (46%) were successfully treated with antibiotics with no repeat visits to the ED or Pediatric Surgery for appendectomy, 7 patients (54%) required appendectomy after initial treatment with antibiotics. Two patients who underwent appendectomy after initial NOM had no evidence of clinical appendicitis, one patient was taken to the OR based on parent preference and one patient had an episode of abdominal pain that prompted an interval appendectomy four weeks post the episode of abdominal pain. Conclusion: Treatment of acute uncomplicated appendicitis with NOM remains a management option in the pediatric population. Further studies and long term follow up are required to better identify appropriate patients for non-operative management versus operative management.

scholarly journals Management of acute appendicitis during the COVID-19 pandemic: Views of two Brazilian surgical societies

2021 ◽  
Vol 48 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
LOUISIE GALANTINI LANA DE-GODOY ◽  
TERCIO DE-CAMPOS ◽  
PEDRO DE SOUZA LUCARELLI-ANTUNES ◽  
LUIZ GUSTAVO DE-OLIVEIRA-E-SILVA ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Open Appendectomy ◽  
Operative Management ◽  
Chest Ct ◽  
Therapeutic Options ◽  
Non Operative Management

ABSTRACT Acute appendicitis (AA) is a frequent cause of abdominal pain requiring surgical treatment. During the COVID-19 pandemic, surgical societies considered other therapeutic options due to uncertainties in the evolution of the disease. The purpose of this study is to assess the treatment of AA by members of two Brazilian surgical societies in this period. A common questionnaire was sent in 2020. There were 382 responses. Most surgeons had more than 15 years of profession (68.3%) and treated more than five cases per month (44.8%). About 72.5% would indicate chest CT to investigate COVID-19 in patients with AA. For those patients sustaining uncomplicated AA, without COVID-19, 60.2% would indicate laparoscopic appendectomy (VLA), followed by open appendectomy (OA) (31.7%) and non-operative management (NOM) (1.3%). For those with mild COVID-19, OA was suggested by 51.0%, followed by VLA (29.6%) and NOM (6.0%). For those with severe COVID-19, OA was proposed by 35.3%, followed by NOM (19.9%) and VLA (18.6%). For patients with periappendiceal abscesses, without COVID-19, VLA was suggested by 54.2%, followed by OA (33.2%) and NOM (4.4%). For those with mild COVID-19, OA was proposed in 49.5%, followed by VLA (29.3%) and NOM (8.9%). In those with severe COVID-19, OA was proposed in 36.6%, followed by NOM (25.1%) and VLA (17.3%). This information, based on two recognized Brazilian surgical societies, can help the surgeon to select the best approach individually.

Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

2017 ◽  
Vol 42 (5) ◽  
pp. 1358-1363 ◽  
Author(s):  
Peter Moreno ◽  
Matthias Von Allmen ◽  
Tobias Haltmeier ◽  
Daniel Candinas ◽  
Beat Schnüriger
Keyword(s):  
Operative Management ◽  
Liver Injuries ◽  
Long Term Follow Up ◽  
Non Operative Management

scholarly journals Appendectomy During the COVID-19 Pandemic in Italy. A Multicenter Ambispective Cohort Study by the Italian Society of Endoscopic Surgery and new technologies (the CRAC study).

2021 ◽  
Author(s):  
Alberto Sartori ◽  
Mauro Podda ◽  
Emanuele Botteri ◽  
Roberto Passera ◽  
Alberto Arezzo ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Open Surgery ◽  
Primary Outcome ◽  
New Technologies ◽  
Operative Management ◽  
Complication Rates ◽  
Multicenter Observational Study ◽  
Non Operative Management ◽  
Pandemic Wave ◽  
Study Inclusion

Abstract Background To determine on a national basis the surgical activity regarding appendectomies during the first Italian wave of the COVID-19 pandemic. Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. Methods Multicenter, observational study investigating the outcomes of patients undergoing appendectomy in the two months of March-April 2019 vs. March-April 2020. The primary outcome was the number of appendectomies performed during each of the two months, classified according to the American Association for the Surgery of Trauma (AAST) score. Secondary outcomes were the type of surgical technique employed (laparoscopic vs. open), and the complication rates. Results 1541 patients with acute appendicitis underwent surgery during the two study periods. 1337 (86.8%) patients met the study inclusion criteria. 546 (40.8%) patients underwent surgery for acute appendicitis in 2020 and 791 (59.8%) in 2019. Patients with complicated appendicitis operated in 2019 were 76 (9.6%) vs. 87 (15.9%) in 2020 (p = 0.001). An increase in the number of post-operative complications was found in 2020 (15.9%) compared to 2019 (9.6%) (p < 0.001). The following determinants increased the likelihood of complication occurrence: undergoing surgery during 2020 (+ 67%), having a unit AAST (+ 26%) increase, having waited for surgery > 24 h (+ 58%), being the surgeon aged > 40 years (+ 47%), undergoing open surgery (+ 112%) and being converted to open surgery (+ 166%). Conclusions In Italian hospitals, in March and April 2020, the number of appendectomies has drastically dropped. Patients undergoing surgery during the first pandemic wave were more frequently affected by more severe appendicitis than the previous year's timeframe and a higher complication rate was reported. Trial registration: ResearchRegistry ID 5789.

scholarly journals Conservative management of early uncomplicated appendicitis in children

2017 ◽  
Vol 4 (3) ◽  
pp. 1024 ◽  
Author(s):  
Sunil Kumar Maini ◽  
Neeraj Kumar Jain ◽  
Manjari Goel Jain ◽  
Vicky Khobragade
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Medical Management ◽  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Primary Treatment ◽  
Research Centre ◽  
Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

scholarly journals Multi-institutional trial of non-operative management and surgery for uncomplicated appendicitis in children: Design and rationale

2019 ◽  
Vol 83 ◽  
pp. 10-17 ◽  
Author(s):  
Peter C. Minneci ◽  
Erinn M. Hade ◽  
Amy E. Lawrence ◽  
Jacqueline M. Saito ◽  
Grace Z. Mak ◽  
...  
Keyword(s):  
Operative Management ◽  
Uncomplicated Appendicitis ◽  
Non Operative Management

Non-operative management of acute appendicitis: a review

2020 ◽  
pp. 1709-1711
Author(s):  
Bashaier Albalawi ◽  
Kholood Alolayan ◽  
Maryam Ansari ◽  
Omar Alamoudi ◽  
Ahdab Alsabhi ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Operative Management ◽  
Non Operative Management
Sign in / Sign up

Export Citation Format

Share Document