Objective: To compare Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Alvarado scores with multislice computed tomography (MSCT) for diagnosing acute appendicitis (AA). Methods: This retrospective study included patients with abdominal pain who had undergone MSCT, and whose medical notes included RIPASA and Alvarado score parameters. MSCT was compared with RIPASA and Alvarado scores for diagnosing AA. Results: Of 297 patients included, sensitivity, specificity and accuracy for diagnosing AA were 95.2%, 73.6% and 87.2% for RIPASA score (cutoff value 7.5) and 63.1%, 80.9% and 69.7% for Alvarado score (cutoff value 7). Sensitivity, specificity and accuracy of MSCT for diagnosing AA were 98.9%, 96.4% and 98.0%, respectively. In terms of accuracy, statistically significant differences were observed between RIPASA and Alvarado scores, and between MSCTand RIPASA scores. The mean RIPASA score was significantly different in the simple AA group (9.7 AE 2.2) compared with other AA groups (10.5 AE 1.7). No statistically significant difference was observed in RIPASA score between nonperforated and perforated AA. MSCT sensitivity, specificity and accuracy for diagnosing simple AA were 94.1%, 96.4% and 95.8%, respectively; for differentiating perforated and nonperforated AA, scores were 90.2%, 95.2% and 94.1%, respectively. Conclusion: MSCT is the optimum diagnostic tool for AA, followed by RIPASA score and Alvarado score, particularly in diagnosing simple and perforated AA.

No abstract

Objective Femoral hernias constantly present as incarceration or strangulation and require emergency surgery. Incarcerated and strangulated femoral hernia repair remains challenging and controversial. The aim of our study was to analyze the efficacy of preperitoneal tension-free hernioplasty via lower abdominal midline incision for incarcerated and strangulated femoral hernia. Methods Data of 47 patients who underwent emergency surgery for incarcerated or strangulated femoral hernias from January 2009 to December 2017 were retrospectively analyzed. According to the surgical incisions, they were divided into two groups: the observation group (21 cases) had a lower abdominal midline incision, and the control group (26 cases) had a traditional inguinal incision. General data of patients, intraoperative findings, operative time and postoperative complications were compared. Results Patient characteristics showed that the two groups were comparable.15 cases (31.9%) underwent intestinal resection, and 32 cases (68.1%) underwent first-stage tension-free repair in total. The rate of first-stage tension-free hernioplasty was significantly higher in the observation group (18/21, 85.7% vs 14/26 53.8%, P = 0.020). No additional incision was required in the observation group, while six cases of the control group (23.1%) had an additional incision for intestinal resection and anastomosis ( P = 0.026). Mean operative time (53.6 ± 24.7 min vs 77.9 ± 36.5 min, P = 0.012) and the length of hospital stay (6.3 ± 4.2 days vs 10.3 ± 6.9 days, P = 0.020) were significantly shorter in the observation group. The time of return to normal physical activity resulted significantly reduced compared to the control group (9.2 ± 4.1 days vs 13.3 ± 6.6 days, P = 0.017). The total incidence of postoperative complication (including chronic pain, foreign body sensation, hernia recurrence, wound infection and seroma/hematomas) in the observation group was lower (14.3% vs 42.3% P = 0.037). There were two recurrences in the control group. No mesh-related infection and no mortalities in two groups. Conclusions Midline preperitoneal approach for incarcerated and strangulated femoral hernia is a convenient and effective technique. It can improve the rate of first-stage tension-free repair of incarcerated femoral hernia and allow intestinal resection through the same incision, and with lower rate of postoperative complications.

Background：Laparoscopic treatment for incarcerated inguinal hernia has gradually increased, while more surgeons preferred open surgery. Therefore, it is necessary to analyze the safety and effectiveness of the two surgical methods.Methods: The patients with incarcerated/strangulated inguinal hernia treated in Jinshan Hospital (Shanghai, China) from January 2018 to March 2021 were retrospectively analyzed. According to different surgical approaches, the patients were divided into lower abdominal midline incision group (LAMI) and laparoscopic transabdominal preperitoneal (TAPP) group. The characteristics, surgical outcomes and postoperative complications of the two groups were compared retrospectively.Results: 104 incarcerated/strangulated inguinal hernia cases were included in total. The average age was 64.4±16.8 years, 79 of them (76.0%) were male. 44 cases (42.3%) had obvious intestinal obstruction, and a total of 27 cases (26.0%) underwent intestinal resection. There were 62 cases (59.6%) in the LAMI group and 42 cases (40.4%) in the TAPP group. The operation time in the TAPP group was about 15 minutes longer (107.0min versus 92.8min; P =0.012), but postoperative length of hospitalization and time of return to normal activity were shorter in the TAPP group (2.7days versus 6.8days P<0.001 and 8.1 days versus 13.6days; P<0.001). There were 83 cases (79.8%) of 1st stage tension-free herniorrhaphy, including 37 cases (88.1%) in the TAPP group and 46 cases (74.2%) in the LAMI group (P=0.083). The surgical complications such as incision infection (4.8% versus 0 P=0.396), seroma/hematomas (11.3% versus 9.5%, P=1.000), intra-abdominal infection (16.1% versus 2.4% P=0.056), and recurrence (1.6% versus 0 P=1.000) were similar in the two groups. There were no cases of patch infection and chronic pain in the two groups. A total of 2 cases (1.9%) died of multiple organ dysfunction in the LAMI group and no death in the TAPP group.Conclusions: Lower abdominal midline incision approach and TAPP were safe and effective in the treatment of incarcerated inguinal hernia. TAPP showed more favorable short-term results for cases that were easy to retract without intestinal resection. Midline preperitoneal repair was more suitable for strangulated hernia requiring intestinal resection.