scholarly journals Nonoperative Antibiotic Treatment of Appendicitis in Adults: A Survey among Clinically Active Surgeons

2020 ◽  
Vol 36 (6) ◽  
pp. 494-500
Author(s):  
Alexander Reinisch ◽  
Martin Reichert ◽  
Andreas Hecker ◽  
Winfried Padberg ◽  
Frank Ulrich ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Therapeutic Option ◽  
Clinical Care ◽  
Long Term Results ◽  
University Hospitals ◽  
Online Questionnaire ◽  
Nonoperative Therapy ◽  
Uncomplicated Acute Appendicitis

<b><i>Background:</i></b> As a result of well-publicized studies, the nonsurgical antibiotic therapy of uncomplicated acute appendicitis has been propagated since 2006. A final assessment regarding efficiency and long-term results is not possible; however, nonoperative therapy of acute appendicitis is actually being discussed more diversely and receives a lot of attention. It is still unknown how far this therapy has found its way into everyday clinical care. <b><i>Methods:</i></b> An online questionnaire was sent to 1,400 randomly selected specialists for general/visceral surgery in Germany. Representativeness was achieved by a preselection according to the geographical origin and the care level of the hospitals. <b><i>Results:</i></b> 14% of surgeons stated that they methodically treat appendicitis conservatively. 38.1% do so in exceptional cases, while 48.8% reject this therapy. For methodically use, sonography or computed tomography is demanded beforehand. Nonoperative therapy is performed more often in metropolitan areas and maximum-care/university hospitals. Patients’ request for antibiotic therapy is an important factor for conservative treatment. The main argument against this therapy is “medical doubts.” 26% of the surgeons would treat their own appendicitis conservatively. There are distinct associations between the application of conservative therapy, satisfaction with it, and expectations about future development. The response rate was 19.9%. <b><i>Conclusion:</i></b> The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.

scholarly journals A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023623 ◽  
Author(s):  
Suvi Sippola ◽  
Juha Grönroos ◽  
Ville Sallinen ◽  
Tero Rautio ◽  
Pia Nordström ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Ct Scan ◽  
Symptomatic Treatment ◽  
Spontaneous Resolution ◽  
University Hospital ◽  
Controlled Study ◽  
Double Blind ◽  
Uncomplicated Acute Appendicitis

IntroductionRecent studies show that antibiotic therapy is safe and feasible for CT-confirmed uncomplicated acute appendicitis. Spontaneous resolution of acute appendicitis has already been observed over a hundred years ago. In CT-confirmed uncomplicated acute diverticulitis (left-sided appendicitis), studies have shown no benefit from antibiotics compared with symptomatic treatment, but this shift from antibiotics to symptomatic treatment has not yet been widely implemented in clinical practice. Recently, symptomatic treatment of uncomplicated acute appendicitis has been demonstrated in a Korean open-label study. However, a double-blinded placebo-controlled study to illustrate the role of antibiotics and spontaneous resolution of uncomplicated acute appendicitis is still lacking.Methods and analysisThe APPAC III (APPendicitis ACuta III) trial is a multicentre, double-blind, placebo-controlled, superiority randomised study comparing antibiotic therapy with placebo in the treatment CT scan-confirmed uncomplicated acute appendicitis aiming to evaluate the role of antibiotics in the resolution of uncomplicated acute appendicitis. Adult patients (18–60 years) with CT scan-confirmed uncomplicated acute appendicitis (the absence of appendicolith, abscess, perforation and tumour) will be enrolled in five Finnish university hospitals.Primary endpoint is success of the randomised treatment, defined as resolution of acute appendicitis resulting in discharge from the hospital without surgical intervention within 10 days after initiating randomised treatment (treatment efficacy). Secondary endpoints include postintervention complications, recurrent symptoms after treatment up to 1 year, late recurrence of acute appendicitis after 1 year, duration of hospital stay, sick leave, treatment costs and quality of life. A decrease of 15 percentage points in success rate is considered clinically important difference. The superiority of antibiotic treatment compared with placebo will be analysed using Fisher’s one-sided test and CI will be calculated for proportion difference.Ethics and disseminationThis protocol has been approved by the Ethics Committee of Turku University Hospital and the Finnish Medicines Agency (FIMEA). The findings will be disseminated in peer-reviewed academic journals.Trial registration numberNCT03234296; Pre-results.

scholarly journals Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis

JAMA Surgery ◽  
2020 ◽  
Vol 155 (4) ◽  
pp. 283 ◽  
Author(s):  
Suvi Sippola ◽  
Jussi Haijanen ◽  
Lauri Viinikainen ◽  
Juha Grönroos ◽  
Hannu Paajanen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Uncomplicated Acute Appendicitis

Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis

2015 ◽  
Vol 70 (10) ◽  
pp. 619-620
Author(s):  
Paulina Salminen ◽  
Hannu Paajanen ◽  
Tero Rautio ◽  
Pia Nordström ◽  
Markku Aarnio ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Uncomplicated Acute Appendicitis

scholarly journals Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial

JAMA ◽  
2018 ◽  
Vol 320 (12) ◽  
pp. 1259 ◽  
Author(s):  
Paulina Salminen ◽  
Risto Tuominen ◽  
Hannu Paajanen ◽  
Tero Rautio ◽  
Pia Nordström ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Randomized Clinical Trial ◽  
Uncomplicated Acute Appendicitis

scholarly journals Fourteen-Year Long-Term Results after Gastric Banding

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Christine Stroh ◽  
Ulrich Hohmann ◽  
Harald Schramm ◽  
Frank Meyer ◽  
Thomas Manger
Keyword(s):  
Weight Loss ◽  
Gastric Banding ◽  
Therapeutic Option ◽  
Reoperation Rate ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Short And Long Term

Background. Gastric banding (GB) is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up.Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome.Results. The mean postoperative follow up time was 94.4 months (range 2–144). The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up.Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

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