Annals of Coloproctology

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Review

Inflammatory/benign bowel disease

Clinical outcomes and optimal indications for nonoperative management of acute appendicitis in adult patients: a comprehensive literature review: Hyun Gu Lee, In Ja Park; Ann Coloproctol. 2025;41(2):107-118. Published online April 16, 2025; DOI: https://doi.org/10.3393/ac.2023.00192.0027

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Graphical Abstract Abstract PDF: Appendectomy as the standard treatment for acute appendicitis has been challenged by accumulating evidence supporting nonoperative management with antibiotics as a potential primary treatment. This review aimed to summarize the clinical outcomes and the optimal indications for nonoperative management of acute appendicitis in adults. Current evidence suggests that uncomplicated and complicated appendicitis have different pathophysiologies and should be treated differently. Nonoperative management for uncomplicated appendicitis was not inferior to appendectomy in terms of complications and length of stay, with less than a 30% failure rate at 1 year. The risk of perforation and postoperative complications did not increase even if nonoperative management failed. Complicated appendicitis with localized abscess or phlegmon could also be treated conservatively, with a success rate of more than 80%. An interval appendectomy following successful nonoperative management is recommended only for patients over the age of 40 years to exclude appendiceal malignancy. The presence of appendicoliths increased the risk of treatment failure and complications; thus, it may be an indication for appendectomy. Nonoperative management is a safe and feasible option for both uncomplicated and complicated appendicitis. Patients should be informed that nonoperative management may be a safe alternative to surgery, with the possibility of treatment failure.

Original Articles

Benign GI diease,Benign diesease & IBD,Surgical technique

Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature: Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon; Ann Coloproctol. 2022;38(2):160-165. Published online January 18, 2022; DOI: https://doi.org/10.3393/ac.2021.00598.0085

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Abstract PDF

Purpose
This study aimed to compare the clinical outcomes of laparoscopic appendectomy (LA) according to the method of appendiceal stump closure.
Methods
Patients who underwent LA for appendicitis between 2010 and 2020 were retrospectively reviewed. Patients were classified into locking polymeric clip (LPC) and loop ligature (LL) groups. Clinical outcomes were compared between the groups.
Results
LPC and LL were used in 188 (56.6%) and 144 patients (43.4%), respectively for appendiceal stump closure. No significant differences were observed in sex, age, comorbidities, and the severity of appendicitis between the groups. The median operative time was shorter in the LPC group than in the LL group (64.5 minutes vs. 71.5 minutes, P=0.027). The median hospital stay was longer in the LL group than in the LPC group (4 days vs. 3 days, P=0.020). Postoperative incidences of intraabdominal abscess and ileus were higher in the LL group than in the LPC group (4.2% vs. 1.1%, P=0.082 and 2.8% vs. 0%, P=0.035; respectively). The readmission rate was higher in the LL group than that in the LPC group (6.3% vs. 1.1%, P=0.012).
Conclusion
Using LPC for appendiceal stump closure during LA for appendicitis was associated with lower postoperative complication rate, shorter operative time, and shorter hospital stay compared to the use of LL. Operative time above 60 minutes and the use of LL were identified as independent risk factors for postoperative complications in LA. Therefore, LPC could be considered a more favorable closure method than LL during LA for appendicitis.

Citations

Citations to this article as recorded by

Fistula formation between urinary bladder and abdominal wall caused by bladder injury from surgical clips following laparoscopic appendectomy
Wei Zhou, Yong Suo, Tian-Yan Luo, Long-Gang Wang
Asian Journal of Surgery.2025; 48(6): 3926. CrossRef
Comparison of polymeric clip and endoloop in laparoscopic appendectomy: A systematic review and meta-analysis
Aashish Kumar, Muhammad Saqlain Mustafa, Muhammad Ashir Shafique, Abdul Haseeb, Hussain Sohail Rangwala, Haimath Kumar, Burhanuddin Sohail Rangwala, Adarsh Raja, Sandesh Raja, Syed Muhammad Sinaan Ali
Surgery.2024; 176(5): 1329. CrossRef
Advantages of using a polymeric clip versus an endoloop during laparoscopic appendectomy in uncomplicated appendicitis: a randomized controlled study
Kil-yong Lee, Jaeim Lee, Youn Young Park, Seong Taek Oh
World Journal of Emergency Surgery.2023;[Epub] CrossRef

Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis: Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho; Ann Coloproctol. 2023;39(1):50-58. Published online November 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00773.0110

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Abstract PDF Supplementary Material

Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

Citations to this article as recorded by

Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Rashid, Muhammad Umar
DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 35. CrossRef
Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
Ming Liu, Ping Yang, Yunpeng Gou
Frontiers in Pediatrics.2024;[Epub] CrossRef
Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
Frontiers in Pediatrics.2024;[Epub] CrossRef

Case Report

Benign GI diease,Rare disease & stoma

Impending Rupture With a Twisted Huge Appendiceal Mucocele Treated With Totally Laparoscopic Resection: A Case Series: Hong-min Ahn, Si-Hak Lee; Ann Coloproctol. 2021;37(Suppl 1):S34-S38. Published online June 29, 2021; DOI: https://doi.org/10.3393/ac.2020.00150.0021

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Abstract PDF

Torsion of the appendix is rare, and appendiceal mucocele can be one of its causes. The first case was of a 49-year-old man who visited the emergency room (ER) for abdominal pain. Abdominal computed tomography (CT) showed appendiceal mucocele with suspected torsion and rupture. The patient underwent laparoscopic exploration and appendectomy. The second case was of a 69-year-old man who visited the ER for epigastric pain. Abdominal CT showed suspicious appendiceal mucocele with ischemic change, indicating torsion of the appendix. The twisted appendix was successfully removed by laparoscopic exploration. An appendiceal mucocele is one of the causes of twisted appendix. With torsion, the mucocele can be diagnosed as rupture by ischemia which may lead to pseudomyxoma peritonei. For this reason, open laparotomy has traditionally been preferred. However, an unruptured appendiceal mucocele or impending rupture with torsion of the appendiceal mucocele can be treated with totally laparoscopic surgery.

Citations

Citations to this article as recorded by

Torsion of Low-Grade Appendiceal Mucinous Neoplasm (LAMN): A Case Report
Hideo Kidogawa, Ryo Nonomura, Keizaburou Maruyama, Takashi Okimoto, Kohji Okamoto
Cureus.2024;[Epub] CrossRef
Uncommon cause of acute appendiceal torsion mucocele
Munyaradzi Gift Nyandoro, Vignesh Kumar Palanisamy, Rajesh Kumar Singh
BMJ Case Reports.2022; 15(7): e249175. CrossRef
Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef

Original Article

Benign GI diease,Benign diesease & IBD,Postoperative outcome & ERAS,Minimally invasive surgery

Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis: Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee; Ann Coloproctol. 2021;37(4):232-238. Published online September 30, 2020; DOI: https://doi.org/10.3393/ac.2020.09.15

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Abstract PDF

Purpose
The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.
Methods
Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM).
Results
After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups.
Conclusion
SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

Citations

Citations to this article as recorded by

Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children
Martin Salö, Catarina Tiselius, Anders Rosemar, Elin Öst, Sara Sohlberg, Roland E Andersson
BJS Open.2025;[Epub] CrossRef
Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
A Single Site Approach to Appendicitis: A Review of a Single Center
Yoshito Tsuji, Yujiro Nishizawa, Yuki Ozato, Akira Inoue, Yoshinori Kagawa
Nippon Daicho Komonbyo Gakkai Zasshi.2024; 77(3): 161. CrossRef
The “Hansol-roll” folding method for placement of self-gripping (ProGrip™) mesh in single-port inguinal hernia repair using ArtiSential®
Gwan Chul Lee, Dong Woo Kang, Choon Sik Chung, Chul Seung Lee
Asian Journal of Surgery.2024; 47(7): 3272. CrossRef
Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
Progress in Clinical Treatment of Uncomplicated Acute Appendicitis in Children
珊白
Advances in Clinical Medicine.2024; 14(04): 471. CrossRef
Single-incision laparoscopic total extraperitoneal inguinal-hernia repair using the new articulating instruments: A video vignette
Chul Seung Lee, Gwan Chul Lee, Choon Sik Chung, Dong Keun Lee
Asian Journal of Surgery.2024; 47(8): 3586. CrossRef
Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis
Ahmer Irfan, Ahsan Rao, Irfan Ahmed
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef
Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
Juntendo Medical Journal.2024; 70(6): 436. CrossRef
Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Annals of Coloproctology.2023; 39(1): 50. CrossRef
A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Analyzing the conversion factors associated with switching from a single-incision, one-puncture procedure to a two-site, three-port procedure in pediatric laparoscopic appendectomy
Keisuke Yano, Mitsuru Muto, Toshio Harumatsu, Taichiro Nagai, Masakazu Murakami, Chihiro Kedoin, Ayaka Nagano, Mayu Matsui, Koshiro Sugita, Shun Onishi, Koji Yamada, Waka Yamada, Makoto Matsukubo, Tatsuru Kaji, Satoshi Ieiri
Journal of Pediatric Endoscopic Surgery.2022; 4(2): 49. CrossRef
Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study
Tran Que Son, Tran Hieu Hoc, Vu Duc Long, Tran Thanh Tung, Nguyen Minh Tuan, Bui Minh Hue, Nguyen Van Minh, Nguyen Toan Thang
Cureus.2022;[Epub] CrossRef
Single-port robotic totally extraperitoneal(TEP) inguinal hernia repair using the da Vinci SP platform: A video vignette
Dongjun Kim, Chul Seung Lee
Asian Journal of Surgery.2022; 45(10): 2062. CrossRef
Single-incision compared with conventional laparoscopy for appendectomy in acute appendicitis: a systematic review and meta-analysis
Changjia Li, Yukun Liu, Yumin Jiang, Yongjing Xu, Zhiwei Wang
International Journal of Colorectal Disease.2022; 37(9): 1925. CrossRef
Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy
Abhijit Nair, Hamed Humayid Mohammed Al-Aamri, Osama Azmy Ishaq, Parwez Waseemul Haque
Journal of Acute Disease.2022; 11(5): 173. CrossRef
Robot-Assisted Colorectal Surgery
Young Il Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef

Case Report

Malignant disease,Benign diesease & IBD,Rare disease & stoma

Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach: In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek; Ann Coloproctol. 2021;37(2):125-128. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.08.10.1

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Abstract PDF

Actinomycosis is an inflammatory disease with various clinical presentations including inflammation and formation of masses. There are several reports suggesting the infiltrative mass-like nature of actinomycosis that is misunderstood as a tumor. A 39-year-old male clinically presented with a fungating mass-like lesion during colonoscopy for healthcare screening. Biopsy was performed for the lesion, and chronic inflammation was diagnosed. Abdominal computed tomography (CT) suggested severe edematous changes in the appendix with an appendicolith, suspected chronic inflammation, and wall thickening of the cecal base, but malignancy could not be definitively ruled out. The patient underwent a laparoscopic single-port cecectomy based on the possibility of cecal cancer. The final biopsy was diagnosed as actinomycosis, and the patient was prescribed antibiotics and showed no recurrence in the follow-up CT scan. We present this rare case of mass-like appendiceal actinomycosis treated with the single-port laparoscopic method.

Citations

Citations to this article as recorded by

Appendiceal actinomycosis mimicking malignant tumor: a rare case report
Nathan Khabyeh-Hasbani, Sivan Zino, Elena Dima, Shmuel Avital
Annals of Medicine & Surgery.2024; 86(2): 1076. CrossRef
Laparoscopic Cecectomy for Diseases of the Appendix and Cecum
Muharrem Oner, Maher A. Abbas
Journal of Coloproctology.2023; 43(04): e256. CrossRef
Appendiceal actinomycosis presenting as acute appendicitis: A diagnostic and therapeutic challenge
SP Tendulkar, PA Jain, MG Mehta, S George
Journal of Postgraduate Medicine.2023; 69(1): 63. CrossRef
Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef
Abdominal Actinomycosis Abscess Presenting as an Isolated Gastrointestinal Pseudotumor
Danisa Clarrett, Jennifer Michelle Ray, Jason R. Taylor
ACG Case Reports Journal.2021; 8(11): e00672. CrossRef

Original Articles

Benign GI diease

Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis: Tae Gyeong Lee, Soomin Nam, Hyung Soon Lee, Jin Ho Lee, Young Ki Hong, Jung Gu Kang; Ann Coloproctol. 2020;36(1):30-34. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.06.25

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Abstract PDF

Purpose
To compare the surgical outcomes of peritoneal irrigation versus suction alone during laparoscopic appendectomy and to identify the risk factors of surgical site infection in patients with uncomplicated acute appendicitis.
Methods
Data from patients with uncomplicated acute appendicitis between January 2014 and March 2016 were reviewed. We compared the irrigation and suction alone groups with regard to the following parameters: postoperative complication incidence rate, length of hospital stay, operation time, time to flatus, time to diet commencement, and duration of postoperative antibiotic.
Results
A total of 578 patients underwent laparoscopic appendectomy for uncomplicated acute appendicitis. Twenty-five patients were excluded from the analysis because of need for drain insertion, loss to follow-up, simultaneous surgery for another indication, presence of an appendix tumor, or pregnancy. A total of 207 patients (37.4%) had undergone irrigation, and 346 patients (62.6%) received suction alone during laparoscopic appendectomy. The preoperative fever rate was significantly higher in the irrigation group than in the suction alone group. Operative time was also significantly longer in the irrigation group than in the suction alone group (53.8 ± 18.5 minutes vs. 57.8 ± 21.4 minutes, P = 0.027). The postoperative complication rate was higher in the irrigation group than in the suction alone group (4.5% vs. 12.6%, P = 0.001). Multiple logistic regression analysis showed that irrigation and preoperative fever were risk factors for surgical site infection after laparoscopic appendectomy for uncomplicated acute appendicitis.
Conclusion
There is no advantage to irrigating the peritoneal cavity over suction alone during laparoscopic appendectomy for uncomplicated acute appendicitis. Irrigation may actually prolong the operative time and therefore be detrimental.

Citations

Citations to this article as recorded by

Establishment and validation of a nomogram for predicting postoperative intestinal adhesion in children with acute appendicitis
Dezhao Liu, Yuchi Wang, Liyun Sun, Lijia Pan, Junkui Wang, Ying Lu, Zhao Cui, Jingying Li, Hui Geng
BMC Pediatrics.2024;[Epub] CrossRef
Management of appendicitis: appendicectomy, antibiotic therapy, or both?
Elroy P. Weledji, Anutebeh V. Zisuh, Eleanore Ngounou
Annals of Medicine & Surgery.2023; 85(4): 897. CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef
To Reduce the Incidence of Postoperative Intraabdominal Abscess, the Application of Nonoperative Management Should be Circumspect Considering Patient Factors and the Nature of Acute Appendicitis
You Jin Lee, Kwang Hyun Yoon
Journal of Acute Care Surgery.2022; 12(3): 111. CrossRef
Effect and safety of peritoneal lavage for appendectomy: A meta-analysis
Yi-Ting Yen, El-Wui Loh, Ka-Wai Tam
The Surgeon.2021; 19(6): e430. CrossRef
A Novel Suction-and-Irrigation Laparoscopic Surgical Instrument: Internal Design and Preclinical Performance Evaluation
Sang Wook Yi
Journal of Medical Devices.2021;[Epub] CrossRef
Aspiration versus peritoneal lavage in appendicitis: a meta-analysis
Gloria Burini, Maria Chiara Cianci, Marco Coccetta, Alessandro Spizzirri, Salomone Di Saverio, Riccardo Coletta, Paolo Sapienza, Andrea Mingoli, Roberto Cirocchi, Antonino Morabito
World Journal of Emergency Surgery.2021;[Epub] CrossRef

Benign GI diease

Resident Learning Curve for Laparoscopic Appendectomy According to Seniority: Chang Woo Kim, Sook Young Jeon, Bomina Paik, Jun Woo Bong, Sang Hyun Kim, Suk-Hwan Lee; Ann Coloproctol. 2020;36(3):163-171. Published online February 14, 2020; DOI: https://doi.org/10.3393/ac.2019.07.20

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Abstract PDF

Purpose
To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training.
Methods
Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.
Results
Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.
Conclusion
The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.

Citations

Citations to this article as recorded by

Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon
Theophilus TK. Anyomih, Thomas Jennings, Alok Mehta, J Robert O'Neill, Ioanna Panagiotopoulou, Stavros Gourgiotis, Elizabeth Tweedle, John Bennett, R Justin Davies, Constantinos Simillis
The American Journal of Surgery.2023; 225(1): 168. CrossRef
Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study
Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon
European Journal of Trauma and Emergency Surgery.2023; 49(1): 33. CrossRef
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper
Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri
World Journal of Emergency Surgery.2023;[Epub] CrossRef
How does the number of training years in pediatric surgery affect appendectomy outcomes?
Carlos Delgado-Miguel, Miriam Miguel-Ferrero, María San Basilio, Carla Ramírez, Juan Camps, Francisco Hernández Oliveros
Pediatric Surgery International.2023;[Epub] CrossRef
Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature
Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon
Annals of Coloproctology.2022; 38(2): 160. CrossRef
Laparoscopic appendicectomy without the use of disposable materials - a low-cost alternative - 1,552 cases operated in 20 years
CARLOS EDUARDO DOMENE, PAULA VOLPE, ANDRÉ VALENTE SANTANA
Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery
Hyung Ook Kim
Annals of Coloproctology.2022; 38(3): 276. CrossRef
Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial
Stefano Cioffi, Andrea Spota, Michele Altomare, Stefano Granieri, Roberto Bini, Francesco Virdis, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi
Journal of Personalized Medicine.2022; 12(11): 1904. CrossRef
Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea
Chang Woo Kim, Suk-Hwan Lee
Annals of Surgical Treatment and Research.2021; 101(4): 240. CrossRef

Malignant disease

Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy: Jungtak Son, Yong Jun Park, Sung Ryol Lee, Hyung Ook Kim, Kyung Uk Jung; Ann Coloproctol. 2020;36(5):311-315. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.15.1

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Abstract PDF

Purpose
The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy.
Methods
This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed.
Results
All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). Conclusion: The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy. These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.

Citations

Citations to this article as recorded by

Appendiceal Tumor Prevalence in Patients With Periappendicular Abscess
Roosa Salminen, Jenny Alajääski, Tero Rautio, Saija Hurme, Pia Nordström, Elisa Mäkäräinen, Elina Lietzén, Tarja Pinta, Marie Grönroos-Korhonen, Tuomo Rantanen, Jan Andersén, Anne Mattila, Jyrki Kössi, Antti Riikola, Hannu Paajanen, Markku Matikainen, Ves
JAMA Surgery.2025; 160(5): 526. CrossRef
Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?
Şevki Pedük
European Journal of Therapeutics.2024; 30(2): 145. CrossRef
Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy
Pietro Fransvea, Caterina Puccioni, Gaia Altieri, Luca D’Agostino, Gianluca Costa, Giuseppe Tropeano, Antonio La Greca, Giuseppe Brisinda, Gabriele Sganga
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Exploring the mysterious mucinous appendiceal neoplasm
Erika Hissong
Seminars in Diagnostic Pathology.2024; 41(5): 222. CrossRef
High Incidence of Appendiceal Neoplasms in the Elderly: A Critical Concern for Non-Surgical Treatment
Gizem Issin, Fatih Demir, Irem Guvendir Bakkaloglu, Diren Vuslat Cagatay, Hasan Aktug Simsek, Ismail Yilmaz, Ebru Zemheri
Medical Principles and Practice.2023; 32(6): 358. CrossRef
Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef
Risk of appendiceal neoplasm after interval appendectomy for complicated appendicitis: A systematic review and meta-analysis
Roberto Peltrini, Valeria Cantoni, Roberta Green, Ruggero Lionetti, Michele D'Ambra, Carolina Bartolini, Marcello De Luca, Umberto Bracale, Alberto Cuocolo, Francesco Corcione
The Surgeon.2021; 19(6): e549. CrossRef
Interval appendicectomy for complicated appendicitis: do not let your guard down!
R Peltrini, M Podda, S Di Saverio, U Bracale, F Corcione
British Journal of Surgery.2021; 108(9): e288. CrossRef
Modern Management of the Appendix
CPT Samuel Grasso, LTC Avery Walker
Surgical Clinics of North America.2021; 101(6): 1023. CrossRef

Benign GI diease, Functional outcomes

The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy: Ji Won Seo, Moon Jin Kim, Sung-Hoon Yoon, Kwang Yeol Paik, Sun Min Park, Won Kyung Kang, Dosang Lee, Chul Seung Lee; Ann Coloproctol. 2020;36(6):398-402. Published online January 24, 2020; DOI: https://doi.org/10.3393/ac.2020.01.16

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Abstract PDF Supplementary Material

Purpose
Few studies have analyzed the effects of preoperative pain education on the postoperative decision to discharge. The purpose of this study was to determine the effects of pain education and management on the decision to discharge patients after single-incision laparoscopic appendectomy (SILA).
Methods
We analyzed 135 patients who had undergone SILA for acute appendicitis between March 2017 and April 2018 in a single medical center. Of these, 72 patients (53.3%) had received preoperative pain education (group 1), and 63 (46.7%) had not (group 2). We compared perioperative outcomes and complications between the groups.
Results
Baseline characteristics of sex, age, body mass index, American Society of Anesthesiologist score, and systemic inflammation factors (neutrophil-lymphocyte ratio, C-reactive protein level) did not differ significantly between the groups. There were no postoperative complications for patients in either group. Perioperative consequences and pathologic findings were not significantly different between the groups; however, length of hospital was significantly shorter in group 1.
Conclusion
Preoperative pain education in relation to postoperative pain management influenced the decision to shorten the postoperative hospital length of stay after SILA.

Citations

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Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017
Ki Bum Park, Jinwook Hong, Jong Youn Moon, Jaehun Jung, Ho Seok Seo
Journal of Korean Medical Science.2022;[Epub] CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef
Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study
Won Jong Kim, Ji Yeon Mun, Hee Ju Kim, Sung-Hoon Yoon, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee, Do Sang Lee, Chul Seung Lee
International Journal of Colorectal Disease.2021; 36(1): 75. CrossRef
Clinical effect of multimodal perioperative pain management protocol for minimally invasive colorectal cancer surgery: Propensity score matching study
Chul Seung Lee, Soo Ji Park, Sang Hyun Hong, Jung-Woo Shim, Min Suk Chae, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Dosang Lee, Yoon Suk Lee, Seong Taek Oh
Asian Journal of Surgery.2021; 44(2): 471. CrossRef
Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
Annals of Coloproctology.2021; 37(4): 232. CrossRef

Patient-Controlled Nutrition After Abdominal Surgery: Novel Concept Contrary to Surgical Dogma: Hyung Ook Kim, Mingoo Kang, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2018;34(5):253-258. Published online October 31, 2018; DOI: https://doi.org/10.3393/ac.2018.05.29

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Abstract PDF

Purpose
According to surgical dogma, patients who are recovering from general anesthesia after abdominal surgery should begin with a clear liquid diet, progress to a full liquid diet and then to a soft diet before taking regular meals. We propose patient-controlled nutrition (PCN), which is a novel concept in postoperative nutrition after abdominal surgery.
Methods
A retrospective pilot study was conducted to evaluate the feasibility and effects of PCN. This study was carried out with a total of 179 consecutive patients who underwent a laparoscopic appendectomy between August 2014 and July 2016. In the PCN group, diet was advanced depending on the choice of the patients themselves; in the traditional group, diet was progressively advanced to a full liquid or soft diet and then a regular diet as tolerated. The primary endpoints were time to tolerance of regular diet and postoperative hospital stay.
Results
Time to tolerance of a regular diet (P < 0.001) and postoperative hospital stay (P < 0.001) showed statistically significant differences between the groups. Multivariate analysis using linear regression showed that the traditional nutrition pattern was the only factor associated with postoperative hospital stay (P < 0.001). Multivariate analysis using logistic regression showed that traditional nutrition was the only risk factor associated with prolonged postoperative hospital stay (≥3 days).
Conclusion
After abdominal surgery, PCN may be a feasible and effective concept in postoperative nutrition. In our Early Recovery after Surgery program, our PCN concept may reduce the time to tolerance of a regular diet and shorten the postoperative hospital stay.

Citations

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Bilateral Exchange: Enteral Nutrition Clinical Decision Making in Pediatric Surgery Patients
Manisha B. Bhatia, Cassandra M. Anderson, Abdiwahab N. Hussein, Brian Opondo, Nereah Aruwa, Otieno Okumu, Sarah G. Fisher, Tasha Sparks Joplin, JoAnna L. Hunter-Squires, Brian W. Gray, Peter W. Saula
Journal of Surgical Research.2024; 295: 139. CrossRef
Clinical pharmacist intervention in Appendectomy - Dexmedetomidine as an adjunct therapy ‎
Bushra Abdel-Hadi, Sami Raid Abdel-Fattah
Journal Of Advanced Pharmacy Education And Research.2022; 12(2): 1. CrossRef
外科患者の栄養管理における給食の意義

The Japanese Journal of SURGICAL METABOLISM and NUTRITION.2021; 55(2): 57. CrossRef

Is a One Night Delay of Surgery Safe in Patients With Acute Appendicitis?: Jae Min Lee, Beom Seok Kwak, Young Jin Park; Ann Coloproctol. 2018;34(1):11-15. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.11

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19 Citations

Abstract PDF

Purpose

With varied reports on the impact of time to appendectomy on clinical outcomes, the purpose of this study was to determine the effect of preoperative in-hospital delay on the outcome for patients with acute appendicitis.

Methods

A retrospective review of 1,076 patients who had undergone an appendectomy between January 2010 and December 2013 was conducted.

Results

The outcomes of surgery and the pathologic findings were analyzed according to elapsed time. The overall elapsed time from onset of symptoms to surgery was positively associated with advanced pathology, increased number of complications, and prolonged hospital stay. In-hospital elapsed time was not associated with any advanced pathology (P = 0.52), increased number of postoperative complications (P = 0.14), or prolonged hospital stay (P = 0.24). However, the complication rate was increased when the in-hospital elapsed time exceeded 18 hours.

Conclusion

Advanced pathology and postoperative complication rate were associated with overall elapsed time from symptom onset to surgery rather than in-hospital elapse time. Therefore, a short-term delay of an appendectomy should be acceptable.

Citations

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Nigam’s scoring system: a reliable and accurate scoring system to diagnose acute appendicitis
Vinod Kumar Nigam, Siddharth Nigam
International Surgery Journal.2025; 12(3): 326. CrossRef
Influence of the timing of antibiotic administration and control of infectious foci on the prognosis of adult patients with critical surgical sepsis
Pedro M. Garrido Benedicto, Pitter F. Cueto Quintana, Juan Antonio Brito Piris, Elisabet Garcia Mañosa, Karla Malpica Basurto, Raquel Enriquez Sanchez, Immaculada Vallverdú Perapoch, Jordi Camps Andreu
The Journal of Emergency Medicine.2025;[Epub] CrossRef
Is the performance of acute appendectomy at different times of day equal, in terms of postoperative complications, readmission, death, and length of hospital stay? A Swedish retrospective cohort study of 4950 patients
Petter Nyström, Martin Nordberg, Lennart Boström
European Journal of Trauma and Emergency Surgery.2024; 50(3): 791. CrossRef
Does the timing of appendectomy affect outcomes and postoperative complications?
María San Basilio, Carlos Delgado-Miguel, Carla Ramírez-Amorós, María Sarmiento, Lucas Moratilla-Lapeña, Arturo Almeyda, Ricardo Mejía, Leopoldo Martínez
Pediatric Surgery International.2023;[Epub] CrossRef
Timing of surgical operation for patients with intra-abdominal infection: A systematic review and meta-analysis
Shu-Rui Song, Yang-Yang Liu, Yu-Ting Guan, Ruo-Jing Li, Lei Song, Jing Dong, Pei-Ge Wang
World Journal of Gastrointestinal Surgery.2023; 15(10): 2320. CrossRef
Patient Outcomes Related to In-Hospital Delays in Appendicectomy for Appendicitis: A Retrospective Study
Oliver Claydon, Billy Down, Sidharth Kumar
Cureus.2022;[Epub] CrossRef
Possibility for avoidance of urgent nighttime operations for acute appendicitis in a regional core university hospital
Tomoya Tago, Mitsugi Shimoda, Ryosuke Imazato, Ryutaro Udou, Kenji Katsumata, Akihiko Tsuchida, Shuji Suzuki
Asian Journal of Endoscopic Surgery.2022; 15(1): 22. CrossRef
Daytime versus nighttime laparoscopic appendectomy in term of complications and clinical outcomes: A retrospective study of 1001 appendectomies
Amjad A. Shah, Raed M. Al-Zoubi, Ahmad R. Al-Qudimat, Mohamed Amine Rejeb, Laxmi Kumari Ojha, Sharif Abdulzem, Khadija Qadir, Sara Sameer, Ahmad Zarour, Mohamed Said Ghali
Heliyon.2022; 8(12): e11911. CrossRef
Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies
T. Mönttinen, H. Kangaspunta, J. Laukkarinen, M. Ukkonen
Scandinavian Journal of Surgery.2021; 110(2): 227. CrossRef
Revisiting delayed appendectomy in patients with acute appendicitis
Jian Li
World Journal of Clinical Cases.2021; 9(20): 5372. CrossRef
Laparoscopic Appendectomy in the Days of COVID-19
Roi Abramov, Mariya Neymark, Asaf Harbi, Hayim Gilshtein
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2021; 31(5): 599. CrossRef
Did the COVID-19 Pandemic Prolong the Time Till Diagnosis and Worsen Outcomes for Children with Acute Appendicitis?
Idilė Vansevičienė, Danielė Bučinskaitė, Dalius Malcius, Aušra Lukošiūtė-Urbonienė, Mindaugas Beržanskis, Emilis Čekanauskas, Vidmantas Barauskas
Medicina.2021; 57(11): 1234. CrossRef
Factors influencing surgical management of acute appendicitis in a large university hospital without a dedicated emergency theatre
Megan Power Foley, Michael MacLean, Ciaran Doyle, Timothy Nugent, Michael E. Kelly, Fady Narouz, Brian Mehigan, Paul McCormick, John Larkin
Irish Journal of Medical Science (1971 -).2020; 189(2): 649. CrossRef
Invited commentary on “Short-term outcome after appendectomy is related to preoperative delay but not to the time of day of the procedure: A nationwide retrospective cohort study of 9224 patients”
Xuan Liang, Yanxia Sun
International Journal of Surgery.2020; 79: 140. CrossRef
Quality Outcomes in Appendicitis Care: Identifying Opportunities to Improve Care
Syed Mohammad Umar Kabir, Magda Bucholc, Carol-Ann Walker, Opeyemi O. Sogaolu, Saqib Zeeshan, Michael Sugrue
Life.2020; 10(12): 358. CrossRef
Effect of Delay to Operation on Outcomes in Patients with Acute Appendicitis: a Systematic Review and Meta-analysis
Jian Li, Run Xu, Deng-Min Hu, Yao Zhang, Tu-Ping Gong, Xue-Lian Wu
Journal of Gastrointestinal Surgery.2019; 23(1): 210. CrossRef
Is postponed laparoscopic appendectomy justified for patients with acute appendicitis?
Atsushi Kohga, Kiyoshige Yajima, Takuya Okumura, Kimihiro Yamashita, Jun Isogaki, Kenji Suzuki, Katsuaki Muramatsu, Akira Komiyama, Akihiro Kawabe
Asian Journal of Endoscopic Surgery.2019; 12(4): 423. CrossRef
Is early appendectomy in adults diagnosed with acute appendicitis mandatory? A prospective study
Salma Abu Foul, Ella Egozi, Ahmad Assalia, Yoram Kluger, Ahmad Mahajna
World Journal of Emergency Surgery.2019;[Epub] CrossRef
Preoperative Clinical Factors Associated with Short‐Stay Laparoscopic Appendectomy
Aurélie Vuagniaux, Olivier Gié, Fabio Butti, Pedro Manuel Marques‐Vidal, Nicolas Demartines, Styliani Mantziari
World Journal of Surgery.2019; 43(11): 2771. CrossRef

Unexpected Appendiceal Pathologies and Their Changes With the Expanding Use of Preoperative Imaging Studies: Hong Yeol Yoo, Jaewoo Choi, Jongjin Kim, Young Jun Chai, Rumi Shin, Hye Seong Ahn, Chang-Sup Lim, Hae Won Lee, Ki-Tae Hwang, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2017;33(3):99-105. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.99

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6 Citations

Abstract PDF

Purpose

The preoperative diagnosis of acute appendicitis is often challenging. Sometimes, pathologic results of the appendix embarrass or confuse surgeons. Therefore, more and more imaging studies are being performed to increase the accuracy of appendicitis diagnoses preoperatively. However, data on the effect of this increase in preoperative imaging studies on diagnostic accuracy are limited. We performed this study to explore unexpected appendiceal pathologies and to delineate the role of preoperative imaging studies in the diagnosis of acute appendicitis.

Methods

The medical records of 4,673 patients who underwent an appendectomy for assumed appendicitis between 1997 and 2012 were reviewed retrospectively. Pathological results and preoperative imaging studies were surveyed, and the frequencies of pathological results and preoperative imaging studies were investigated.

Results

The overall rate of pathology compatible with acute appendicitis was 84.4%. Unexpected pathological findings, such as normal histology, specific inflammations other than acute appendicitis, neoplastic lesions, and other pathologies, comprised 9.6%, 3.3%, 1.2%, and 1.5%, respectively. The rate of unexpected pathological results was significantly reduced because of the increase in preoperative imaging studies. The decrease in normal appendices contributed the most to the reduction while other unexpected pathologies did not change significantly despite the increased use of imaging studies. This decrease in normal appendices was significant in both male and female patients under the age of 60 years, but the differences in females were more prominent.

Conclusion

Unexpected appendiceal pathologies comprised 15.6% of the cases. Preoperative imaging studies reduced them by decreasing the negative appendectomy rate of patients with normal appendices.

Citations

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The appendix: An unexpected band obstruction
Rowan Klein Nulend, Rakesh Quinn, Kar Yin Fok, Nimalan Pathmanathan
Journal of Case Reports and Images in Surgery.2024; 10(1): 1. CrossRef
The Vermiform Appendix and Its Pathologies
Marian Constantin, Livia Petrescu, Cristina Mătanie, Corneliu Ovidiu Vrancianu, Adelina-Gabriela Niculescu, Octavian Andronic, Alexandra Bolocan
Cancers.2023; 15(15): 3872. CrossRef
Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role?
Hisham F. Bahmad, Abed Alhalim Aljamal, Juan Carlos Alvarez Moreno, Ali Salami, Philip Bao, Sarah Alghamdi, Robert J. Poppiti
Annals of Diagnostic Pathology.2021; 52: 151724. CrossRef
The Impact of Pathological Criteria on Pediatric Negative Appendectomy Rate
Caroline Maloney, Morris C. Edelman, Alexandra C. Bolognese, Aaron M. Lipskar, Barrie S. Rich
Journal of Pediatric Surgery.2019; 54(9): 1794. CrossRef
Communication and management of incidental pathology in 1,214 consecutive appendicectomies; a cohort study
Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazzetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore
International Journal of Surgery.2019; 72: 185. CrossRef
Unexpected Appendiceal Pathologies and Preoperative Imaging Studies on Patients With Acute Appendicitis
Byung Chun Kim
Annals of Coloproctology.2017; 33(3): 82. CrossRef

Single-Port Laparoscopic Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess: Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek; Ann Coloproctol. 2016;32(3):105-110. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.105

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8 Citations

Abstract PDF

Purpose

Nonoperative management followed by an interval appendectomy is a commonly used approach for treating patients with perforated appendicitis with abscess formation. As minimally-invasive surgery has developed, single-port laparoscopic surgery (SPLS) is increasingly being used to treat many conditions. We report our initial experience with this procedure using a multichannel single-port.

Methods

The study included 25 adults who underwent a single-port laparoscopic interval appendectomy for perforated appendicitis with periappendiceal abscess by using a single-port with or without needlescopic grasper between June 2014 and January 2016.

Results

Of the 25 patients, 9 (36%) required percutaneous drainage for a median of 7 days (5–14 days) after insertion, and 3 (12%) required conversion to reduced-port laparoscopic surgery with a 5-mm port insertion because of severe adhesions to adjacent organs. Of 22 patients undergoing SPLS, 13 underwent pure SPLS (52.0%) whereas 9 patients underwent SPLS with a 2-mm needle instrument (36.0%). Median operation time was 70 minutes (30–155 minutes), and a drainage tube was placed in 9 patients (36.0%). Median total length of incision was 2.5 cm (2.0–3.0 cm), and median time to soft diet initiation and length of stay in the hospital were 2 days (0–5 days) and 3 days (1–7 days), respectively. Two patients (8.0%) developed postoperative complications: 1 wound site bleeding and 1 surgical site infection.

Conclusion

Conservative management followed by a single-port laparoscopic interval appendectomy using a multichannel single-port appears feasible and safe for treating patients with acute perforated appendicitis with periappendiceal abscess.

Citations

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Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef
Single-port laparoscopic appendectomy for perforated appendicitis using ArtiSential® wristed articulated instrument
Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimal Access Surgery.2023; 19(1): 168. CrossRef
Single incision laparoscopic appendectomy with surgical-glove port is cost-effective and reliable in complicated acute appendicitis: A casecontrol multicenter study in Colombia
Andrés Felipe Carrillo Montenegro, Sofía Aristizabal Rojas, Jean André Pulido Segura, Mauricio Pedraza, Laura Padilla, Ivan David Lozada-Martinez, Alexis Rafael Narvaez-Rojas, Luis Felipe Cabrera-Vargas
Heliyon.2023; 9(1): e12972. CrossRef
A prospective randomized controlled study comparing patient-reported scar evaluation of single-port versus multiport laparoscopic appendectomy for acute appendicitis
Kyeong Eui Kim, In Soo Cho, Sung Uk Bae, Woon Kyung Jeong, Hyung Jin Kim, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2023; 26(2): 55. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Single-incision Laparoscopy-assisted Appendectomy in the Pediatric Age Group: Our Experience
Hemanshi Shah, Charu Tiwari, Suraj Gandhi, Gursev Sandlas, Neha Sisodiya Shenoy
World Journal of Laparoscopic Surgery with DVD.2020; 13(2): 77. CrossRef
Clinical outcomes of single‐site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy
Masaaki Miyo, Shoichiro Urabe, Satoshi Hyuga, Tomo Nakagawa, Toshiya Michiura, Nobuyasu Hayashi, Kazuo Yamabe
Annals of Gastroenterological Surgery.2019; 3(5): 561. CrossRef
Minimally Invasive Interval Appendectomy for Perforated Appendicitis With a Periappendiceal Abscess
Ik Yong Kim
Annals of Coloproctology.2016; 32(3): 88. CrossRef

Predictive Factors to Distinguish Between Patients With Noncomplicated Appendicitis and Those With Complicated Appendicitis: Tae Hyung Kim, Byung Sun Cho, Jae Hag Jung, Moon Soo Lee, Je Ho Jang, Chang Nam Kim; Ann Coloproctol. 2015;31(5):192-197. Published online October 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.5.192

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28 Citations

Abstract PDF

Purpose

Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

Methods

A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis.

Results

The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant.

Conclusion

Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.

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Utilizing non-invasive biomarkers for early and accurate differentiation of uncomplicated and complicated acute appendicitis: a retrospective cohort analysis
Mehmet Torun, İsmail Ege Subaşı, Deniz Kol Özbay, Mehmet Ali Özbay, Hakan Özdemir
Scientific Reports.2025;[Epub] CrossRef
High Diagnostic Accuracy but Persistent Risk of Complicated Appendicitis: A Retrospective Analysis from Hail Province, Saudi Arabia
Alfatih Mohamed Ahmed Aljanib, Faisal Fawaz Alshammari, Fahad Maiyah Alshammari, Ali Ahmed Alqahtani, Bandar Alsaif, Jerold C. Alcantara, Abdulaziz Bin Ali Alshammari, Talal Alharazi
International Journal of Applied & Basic Medical Research.2025; 15(2): 85. CrossRef
Development and Validation of the Scoring System of Appendicitis Severity 2.0
Jochem C. G. Scheijmans, Wouter J. Bom, Umme Habiba Ghori, Anna A. W. van Geloven, Gerjon Hannink, Charles C. van Rossem, Lieke van de Wouw, Peter M. Huisman, Annemiek van Hemert, Rutger J. Franken, Steven J. Oosterling, Camiel Rosman, Lianne Koens, Jaap
JAMA Surgery.2024; 159(6): 642. CrossRef
Oxidative Stress Enzyme NOX1 Is a New and Important Biomarker for Childhood Appendicitis?
Veli Avci, Kemal Ayengin, Zubeyir Huyut, Mehmet Tahir Huyut, Lokman Soysal, Salim Bilici
Indian Journal of Surgery.2023; 85(5): 1139. CrossRef
Individual biomarkers in the blood are not yet applicable in diagnosing complicated appendicitis: A scoping review
Binyamin Sikander, Jacob Rosenberg, Siv Fonnes
The American Journal of Emergency Medicine.2023; 67: 100. CrossRef
Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis
Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho
Annals of Coloproctology.2023; 39(1): 50. CrossRef
Application of Artificial Neural Network Models to Differentiate Between Complicated and Uncomplicated Acute Appendicitis
Hui-An Lin, Li-Tsung Lin, Sheng-Feng Lin
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Serdar SAHİN
Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi.2023; 56(2): 52. CrossRef
Predicting complicated appendicitis is possible without the use of sectional imaging—presenting the NoCtApp score
Jens Strohäker, Martin Brüschke, You-Shan Feng, Christian Beltzer, Alfred Königsrainer, Ruth Ladurner
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Validation of scoring systems for the prediction of complicated appendicitis in adults using clinical and computed tomographic findings
Rathachai Kaewlai, Sasima Tongsai, Wanwarang Teerasamit, Dhanawin Wongsaengchan, Napakadol Noppakunsomboon, Pramuk Khamman, Anchisa Chatkaewpaisal, Piyaporn Apisarnthanarak
Insights into Imaging.2023;[Epub] CrossRef
Predictive scoring systems to differentiate between simple and complex appendicitis in children (PRE-APP study)
Paul van Amstel, Sarah-May M.L. The, Roel Bakx, Taco S. Bijlsma, Sophie M. Noordzij, Oumaima Aajoud, Ralph de Vries, Joep P.M. Derikx, L.W. Ernest van Heurn, Ramon R. Gorter
Surgery.2022; 171(5): 1150. CrossRef
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Khaled Noureldin, Ali Asgar Hatim Ali, Mohamed Issa, Heer Shah, Bolu Ayantunde, Abraham Ayantunde
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Evaluation of radiological and temporal characteristics of acute appendicitis on the non-enhanced computed tomography images
Xuan Gao, Wei-Yong Sheng, Biao Chen, Wei-Yi Cheng, Bing-Qing Ma, Peng Xu, Mellisa Evelyn, Jin-Xiang Zhang
Abdominal Radiology.2022; 47(7): 2279. CrossRef
Meta-analysis of the clinical efficacy of laparoscopic appendectomy in the treatment of acute appendicitis
Guangzhe Zhang, Bo Wu
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Predictors and management outcomes of perforated appendicitis in sub-Saharan African countries: A retrospective cohort study
Dereje Zewdu, Mekete Wondwosen, Temesgen Tantu, Tamiru Tilahun, Tewodros Teshome, Ahmed Hamu
Annals of Medicine & Surgery.2022;[Epub] CrossRef
Periappendiceal fat-stranding models for discriminating between complicated and uncomplicated acute appendicitis: a diagnostic and validation study
Hui-An Lin, Hung-Wei Tsai, Chun-Chieh Chao, Sheng-Feng Lin
World Journal of Emergency Surgery.2021;[Epub] CrossRef
Comparison of Outer Diameter of Appendix, C-reactive Protein, and Serum Bilirubin Levels in Complicated Versus Uncomplicated Appendicitis
Dhanish Parekh, Dinesh Jain, Saurabh Mohite, Deepak Phalgune
Indian Journal of Surgery.2020; 82(3): 314. CrossRef
A simple classification of peritoneal contamination in perforated appendicitis predicts surgery‐related complications
Jia J Wee, Chang J Park, York T Lee, Yee L Cheong, Rambha Rai, Shireen A Nah
Journal of Paediatrics and Child Health.2020; 56(2): 272. CrossRef
Irrigation Versus Suction Alone During Laparoscopic Appendectomy for Uncomplicated Acute Appendicitis
Tae Gyeong Lee, Soomin Nam, Hyung Soon Lee, Jin Ho Lee, Young Ki Hong, Jung Gu Kang
Annals of Coloproctology.2020; 36(1): 30. CrossRef
An observational study of innate immune responses in patients with acute appendicitis
Toon Peeters, Sandrina Martens, Valentino D’Onofrio, Mark H. T. Stappers, Jeroen C. H. van der Hilst, Bert Houben, Ruth Achten, Leo A. B. Joosten, Inge C. Gyssens
Scientific Reports.2020;[Epub] CrossRef
The value of ischemia-modified albumin and oxidative stress markers in the diagnosis of acute appendicitis in adults
Hakan Hakkoymaz, Selçuk Nazik, Muhammed Seyithanoğlu, Özlem Güler, Ahmet Rıza Şahin, Emrah Cengiz, Fatih Mehmet Yazar
The American Journal of Emergency Medicine.2019; 37(11): 2097. CrossRef
Systematic Review and Meta-Analysis of CT Features for Differentiating Complicated and Uncomplicated Appendicitis
Hae Young Kim, Ji Hoon Park, Yoon Jin Lee, Sung Soo Lee, Jong-June Jeon, Kyoung Ho Lee
Radiology.2018; 287(1): 104. CrossRef
Ischemia-modified albumin as a predictor of the severity of acute appendicitis
Murat Özgür Kılıç, Cem Emir Güldoğan, İlhan Balamir, Mesut Tez
The American Journal of Emergency Medicine.2017; 35(1): 92. CrossRef
Increased anatomic severity predicts outcomes
Matthew C. Hernandez, Johnathon M. Aho, Elizabeth B. Habermann, Asad J. Choudhry, David S. Morris, Martin D. Zielinski
Journal of Trauma and Acute Care Surgery.2017; 82(1): 73. CrossRef
Role of hematological parameters in prediction of complicated appendicitis
Hakan Ataş, Murat Ö. Kılıç, Serdar G. Terzioğlu, Bariş Saylam
Wiener klinische Wochenschrift.2017; 129(9-10): 369. CrossRef
International normalized ratio and serum C-reactive protein are feasible markers to predict complicated appendicitis
Maru Kim, Sung-Jeep Kim, Hang Joo Cho
World Journal of Emergency Surgery.2016;[Epub] CrossRef
Prolonged operative time in laparoscopic appendectomy: Predictive factors and outcomes
Byeong Geon Jeon, Hyuk Jung Kim, Kuk Hyun Jung, Sang Wook Kim, Jin Soo Park, Ki Ho Kim, Il Dong Kim, Sang-Jeon Lee
International Journal of Surgery.2016; 36: 225. CrossRef
Change in the Diagnosis of Appendicitis by Using a Computed Tomography Scan and the Necessity for a New Scoring System to Determine the Severity of the Appendicitis
Byung Wook Min
Annals of Coloproctology.2015; 31(5): 174. CrossRef

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