Late Abdominal Complaints after Appendectomy – Readmissions during Long-Term Follow-Up

Abstract

Background/Aims: The postoperative risk of small bowel obstruction is a recognized complication following appendectomy. Few studies have reconsidered the whole extent of abdominal complaints and problems following appendectomy. This study tries to evaluate the long-term outcome describing abdominal complaints requiring readmission following appendectomy. Methods: A retrospective study of 3,230 patients undergoing open appendectomy at a single center university hospital in Sweden between 1981 and 1996. Late (>30 days) readmissions were noted and the cause for readmission and need for surgical intervention were analyzed. Results: Overall, late readmissions occurred in 2.94% during a median follow-up of 10 years after appendectomy. Females predominated among those readmitted, as did patients with complicated appendicitis or a ‘normal’ appendix. Nonspecific abdominal pain with no sign of small bowel obstruction caused almost half of the readmissions (45%). To a large extent this group consisted of females (76%). Small bowel obstruction was seen in 1.24% and was surgically treated in 0.68% of all appendectomies. Incisional hernias were also seen (0.4% of all appendectomies). Conclusion: The magnitude of readmissions due to abdominal complaints is more pronounced than previously reported with as many patients with signs of small bowel obstruction managed nonoperatively as surgically, and frequent readmissions due to nonspecific abdominal pain.

Prior appendectomy and the phenotype and course of Crohn’s disease

“…We believe that the overrepresentation of ileal disease in appendectomized Crohn's disease patients may be at least in part a consequence of the high prevalence of smokers in this group, smoking being associated with ileal Crohn's disease and not colonic Crohn's disease [35] . Alternative explanations of the more frequent ileal involvement in appendectomized patients would be a larger use of explorative procedures such as barium follow-through or colonoscopy because patients with previous appendectomy are more prone to small bowel obstruction [36,37] and non specific abdominal pain [38] . The occurrence of abdominal pain may give the opportunity to find out a paucisymptomatic ileitis which could have been ignored otherwise.…”

“…Previous appendectomy had no effect on year-by-year disease activity while smoking was significantly deleterious. Oral or IV steroids 396 (80) 469 (86) 462 (90) 195 (89) 228 (82) 150 (87) 173 (93) 71 (90) Enteral or parenteral nutrition 53 (11) 1 94 (18) 48 (22) 23 (8) 0 35 (19) 13 (16) Azathioprine or methotrexate 163 (33) 305 (56) 290 (57) 132 (61) 100 (36) 83 (48) 101 (54) 48 (61) Infliximab 9 (2) 73 (13) 48 (9) 19 (9) 4 (1) 11 (6) 14 (8) 5 (6) Intestinal resection 283 (57) 173 (32) 176 (34) 79 (36) 165 (59) 42 (24) 73 (39) 30 (38) Numbers in parentheses are percentages.…”

Surgery versus Conservative Antibiotic Treatment in Acute Appendicitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Generally speaking, many of these experiences did not receive much attention and, consequently, early appendectomy remained the standard treatment for AA in order to avoid perforations, even though population-based evaluations have indicated significant long-term risks following surgical intervention for AA [16]. It has been shown that small bowel obstruction requiring surgery occurs in 1.3% of individuals by 30 years and that the 30-day mortality is 0.24% with an increased standard mortality ratio [17,18].…”

What Is the Role of Conservative Antibiotic Treatment in Early Appendicitis?

“…Populationbased studies have shown that there are significant long-term risks associated with surgical explorations for appendicitis (12). The risk of small bowel obstruction needing surgical intervention has been shown to be around 1.3% by 30 years.…”