Evidence - Appendectomy, open - general and visceral surgery
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Literature summary
Compared with medical treatment (antibiotics, local cooling, etc.) in patients with clinical diagnosis of acute appendicitis, surgery results in:
- Lower rate of recurrent appendicitis
- Similar length of hospital stay and work disability
- Higher pain intensity during the first few days
Compared with medical treatment in patients with chronic right lower quadrant pain, surgery results in:
- Less pain in the long run
- Slightly higher rates of adverse events
Regarding incidental appendectomy in asymptomatic patients, there are:
- No results from high-quality trials.
In open appendectomy simple ligation of the appendiceal stump versus stump inversion (= purse string suture) resulted in:
- Comparable or even lower rates of local complications
- Shorter operating times
Patients with suspected appendicitis may already be administered analgesics upon hospitalization because:
- This reduces pain effectively
- Without affecting the physical examination of the abdomen
Ongoing trials on this topic
References on this topic
- Engström L, Fenyö G. Appendicectomy: assessment of stump invagination versus simple ligation: a prospective, randomized trial. Br J Surg 1985; 72: 971-2.
- Eriksson S, Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis Br J Surg 1995; 82: 166-9.
- 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.
- 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.
- 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.
- 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.
- 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.
- Watters DA, Walker MA, Abernethy BC. The appendix stump: should it be invaginated? Ann R Coll Surg Engl 1984; 66: 92-3.
Reviews
Wu Z, Zhao L, Liu Y, Qian S, Wu L, Liu X. Fibrinogen as a Marker of Overall and Complicated Acute Appendicitis: A Systematic Review and Meta-Analysis. J Surg Res. 2022 Aug 6;280:19-26.
Li C, Liu Y, Jiang Y, Xu Y, Wang Z. Single-incision compared with conventional laparoscopy for appendectomy in acute appendicitis: a systematic review and meta-analysis. Int J Colorectal Dis. 2022 Sep;37(9):1925-1935.
Skjold-Ødegaard B, Søreide K. The Diagnostic Differentiation Challenge in Acute Appendicitis: How to Distinguish between Uncomplicated and Complicated Appendicitis in Adults. Diagnostics (Basel). 2022 Jul 15;12(7).
de Almeida Leite RM, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, de Souza AV, Bay CP, Zilberstein B, Marchi E, Machado RB, Barchi LC, Ricciardi R. Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-analysis. JAMA Surg. 2022 Sep 1;157(9):828-834.
Zagales I, Sauder M, Selvakumar S, Spardy J, Santos RG, Cruz J, Bilski T, Elkbuli A. Comparing Outcomes of Appendectomy Versus Non-operative Antibiotic Therapy for Acute Appendicitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Am Surg. 2022 Jul 12:31348221114045.
Wang X, Liu Y, Yan M, Gao M. Evaluating quality of guidelines for appendicitis in children: A systematic review. Asian J Surg. 2022 Jun 9.
Zhou J, Xu W, Wang J, Fan Z. Related Markers for the Precision Diagnosis of Complex Appendicitis in Children. Front Pharmacol. 2022 Mar 31;13:865303.
Shi W, Wu Y, Zhong L, Huang Z, Zhong M, Wang J, Huang W, Yi X, Lu X, Yuan J, Huang W, Zhou X. Diagnostic Accuracy of Serum Amyloid A in Acute Appendicitis: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt). 2022 May;23(4):380-387.
Park JH, Salminen P, Tannaphai P, Lee KH. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence. Korean J Radiol. 2022 May;23(5):517-528.
Rossi E, Imdahl A. [Appendicitis in the elderly - a challenge]. MMW Fortschr Med. 2022 Feb;164(2):44-45. doi: 10.1007/s15006-021-0572-6.
Teng TZJ, Thong XR, Lau KY, Balasubramaniam S, Shelat VG. Acute appendicitis-advances and controversies. World J Gastrointest Surg. 2021 Nov 27;13(11):1293-1314.
Wang Y, Sun CY, Liu J, Chen Y, Bhan C, Tuason JPW, Misra S, Huang YT, Ma SD, Cheng XY, Zhou Q, Gu WC, Wu DD, Chen X. Is endoscopic retrograde appendicitis therapy a better modality for acute uncomplicated appendicitis? A systematic review and meta-analysis. World J Clin Cases. 2021 Nov 26;9(33):10208-10221.
Grasso CS, Walker LA. Modern Management of the Appendix: So Many Options. Surg Clin North Am. 2021 Dec;101(6):1023-1031.
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