Evidence - Appendectomy, laparoscopic - new - general and visceral surgery

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  • Literature summary

    • Drainage:
      No evidence favoring drainage, not even in perforation!
      Does not prevent any complication.
      References: Schein M. World J Surg 2008; 32: 312; Petrowsky H et al. Ann Surg 2004; 204: 1074; Wittmann DH et al. Ann Surg 1996; 224:10
    • CT study in appendicitis
      CT does not increase diagnostic accuracy.
      Same rate of perforation and negative appendectomy despite CT.
      References: Chiang DT et al. Ann R Coll Surg Engl 2008; 90:17; McDonald GP et al. Am Surg 2001; 67:1017
    • Compared with medical treatment (antibiotics, local cooling, etc.) in patients with clinical diagnosis of acute appendicitis, surgery results in:
      Lower rate of recurrent appendicitis (↑↑ [2; 7])
      Similar length of hospital stay and work disability (↑ 7)
      Higher pain intensity during the first few days (↑ 2)
    • Compared with medical treatment in patients with chronic right lower quadrant pain, surgery results in:
      Less pain in the long run (↑ 6)
      Slightly higher rates of adverse events (↑ 6)
    • Regarding incidental appendectomy in asymptomatic patients, there are:
      No results from high-quality trials.
    • Patients with suspected appendicitis may already be administered analgesics upon hospitalization because:
      This reduces pain effectively (↑↑ [4; 5])
      This does not affect the physical examination of the abdomen (↑↑ [4; 5])
  • Ongoing trials on this topic

  • References on this topic

    1. NG CS et al. BMJ. 2000; 325: 1387.
    2. Schein M. World J Surg 2008; 32: 312; Petrowsky H et al. Ann Surg 2004; 204: 1074; Wittmann DH et al. Ann Surg 1996; 224:10.
    3. Chiang DT et al. Ann R Coll Surg Engl 2008; 90:17; McDonald GP et al. Am Surg 2001; 67:1017 .
    4. Engström L, Fenyö G. Appendicectomy: assessment of stump invagination versus simple ligation: a prospective, randomized trial. Br J Surg 1985; 72: 971-2.
    5. Eriksson S, Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis Br J Surg 1995; 82: 166-9.
    6. Jacobs PP, Koeyers GF, Bruyninckx CM. [Simple ligation superior to inversion of the appendiceal stump; a prospective randomized study]. Ned Tijdschr Geneeskd 1992; 136: 1020-3.
    7. Manterola C, Astudillo P, Losada H, Pineda V, Sanhueza A, Vial M. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev 2007: CD005660.
    8. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 2006; 296: 1764-74.
    9. Roumen RMH, Groenendijk RPR, Sloots CEJ, Duthoi KES, Scheltinga MRM, Bruijninckx CMA. Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower-quadrant pain. Br J Surg 2008; 95: 169-74.
    10. Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, Rex L, Badume I, Granström L. Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg 2006; 30: 1033-7.
    11. Watters DA, Walker MA, Abernethy BC. The appendix stump: should it be invaginated? Ann R Coll Surg Engl 1984; 66: 92-3.
  • literature search

    Literature search on the pages of pubmed.