The Unacceptable Morbidity of Negative Laparoscopic Appendicectomy

Allaway, Matthew G R; Eslick, Guy D.; Cox, Michael R.

doi:10.1007/s00268-018-4784-6

Cited by 29 publications

(33 citation statements)

References 100 publications

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“…The authors reported an overall negative appendectomy rate of 36.0% among 1413 patients who met inclusion criteria (904 in the positive group and 509 in the negative group). Morbidity rates (6.3% vs 6.9%; P = 0.48) and types of morbidity were the same for negative appendicectomy and uncomplicated AA, and there was no significant difference in complication severity or length of stay (2.3 vs 2.6 days; P = 0.06) between negative appendicectomy and uncomplicated AA groups [200].…”

Section: Q47: Does Aspiration Alone Confer Clinical Advantages Overmentioning

confidence: 85%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q47: Does Aspiration Alone Confer Clinical Advantages Overmentioning

confidence: 85%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…Detailed analysis of the indications, findings and outcomes have been previously published. 8 There were 42 (0.9%) patients with post-appendicectomy IAA that comprised this cases series. Sixteen (38.1%) had large (> 4 cm) IAAs that were managed with a percutaneous drainage.…”

Section: Resultsmentioning

confidence: 97%

“…1,[4][5][6]35,36 One explanation is the high negative appendicectomy rate (36%) during the study period. 8 As IAA is more commonly associated with complicated appendicitis compared with uncomplicated appendicitis [4][5][6] but has a similar incidence for uncomplicated appendicitis and a normal appendix, 8 this is less likely to be the sole explanation. Another explanation is the use of laparoscopic washout in 41 (0.8%) patients with persistent evidence of sepsis following appendicectomy during the study period 37 that may have resulted in the prevention of the subsequent development of an IAA.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with post-appendicectomy IAA were identified as part of a large cases series study on the outcomes of appendicectomy. 8,30,31 Prior to commencement of the study, ethics approval was obtained from the Nepean Blue Mountains Local Health District Human Research Ethics Committee (study numbers 14/29 and 14/67). Only patients with suspected acute appendicitis were included; appendicectomies performed for other indications were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Post-operative intra-abdominal abscess (IAA) is a serious complication of appendicectomy with an incidence ranging from 1.4% to 4.4%. [1][2][3][4][5][6][7] The incidence is significantly higher in complicated (gangrenous or perforated) appendicitis compared with uncomplicated appendicitis [3][4][5]8,9 and when there is more extensive peritoneal contamination. 10,11 Early in the laparoscopic era, there was an increased incidence of IAA following laparoscopic appendicectomy (LA) for complicated appendicitis compared to open surgery.…”

Section: Introductionmentioning

confidence: 99%

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Non‐operative management of small post‐appendicectomy intra‐abdominal abscess is safe and effective

Collins

Allaway

Eslick

et al. 2020

ANZ Journal of Surgery

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Background: Intra-abdominal abscess (IAA) post-appendicectomy occurs in 1.4-4.4% of cases. Non-operative management of small (<4 cm) post-appendicectomy IAA in children is well established, but minimal evidence exists in adults. Percutaneous catheter drainage is considered standard treatment for IAA, yet outcome data for post-appendicectomy IAA are sparse. The aims of this study were to assess the effectiveness of non-operative management of small (<4 cm diameter) IAA and the outcomes of percutaneous drainage for larger (>4 cm) IAA post-appendicectomy. Methods: A retrospective case note review of a series of patients with a postappendicectomy IAA between 2006 and 2017 was conducted. IAAs were treated selectively; small (<4 cm) IAAs were managed non-operatively and larger IAAs were managed with percutaneous drainage. Results: A total of 4901 patients had an appendicectomy. Forty-two (0.9%) developed a post-operative IAA. Sixteen (38%) had a percutaneous drainage and 26 (62%) had non-operative management. The percutaneous drainage group had a higher proportion of complicated appendicitis (75%) compared to the non-operative group (42%, P = 0.04). The percutaneous drainage group had a significantly higher leucocytosis (P = 0.01) and C-reactive protein (P = 0.02). All patients managed non-operatively resolved without the need for invasive procedures. In the percutaneous drainage group, six had aspiration alone, nine had a percutaneous drain and one was abandoned. Three required repeat percutaneous drainage and four (25%) required operative drainage. Seven patients (34%) of the percutaneous drainage group had grade II or III complications. Conclusion: This case series study provides support that small (<4 cm) IAA postappendicectomy can be safely and effectively managed non-operatively.

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