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Related Concept Videos

Appendicitis-II: Diagnostic Studies and Management01:29

Appendicitis-II: Diagnostic Studies and Management

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Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
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Appendicitis-I: Introduction01:22

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The appendix, a small, narrow, blind tube extending from the inferior part of the cecum, is widely regarded as a vestigial organ, having lost much of its original function through evolution. Despite its diminished role, the appendix can become inflamed, a condition known as appendicitis.
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
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Inflammatory Bowel Disease V: Surgical Management01:21

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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.

Joseph V Sakran1, Konstantinos S Mylonas, Alexandros Gryparis

  • 1From the Department of Surgery (J.V.S.), Johns Hopkins University, Baltimore, Maryland; Surgery Working Group (K.S.M., K.P.E.), Society of Junior Doctors, Athens, Greece; Division of Pediatric Surgery, Department of Surgery (K.S.M.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Institute of Preventive Medicine, Environmental & Occupational Health (A.G.), Prolepsis, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics (A.G.), Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Research & Innovation (S.P.S.), St Luke's University Health Network, Bethlehem, Pennsylvania; Department of Surgery (C.J.B.), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery (M.M.M.), Medical University of South Carolina, Charleston, South Carolina; and Department of Surgery (K.P.E.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

The Journal of Trauma and Acute Care Surgery
|March 25, 2017
PubMed
Summary

Nonoperative management with antibiotics for uncomplicated appendicitis shows lower efficacy (63.8%) compared to surgery (93%) but results in fewer complications. Shared decision-making is key for optimizing nonoperative outcomes.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Evidence-Based Medicine

Background:

  • Acute appendicitis presents ongoing diagnostic and therapeutic challenges.
  • This study synthesizes evidence comparing nonoperative versus surgical management for uncomplicated acute appendicitis in adults.

Purpose of the Study:

  • To compare the efficacy and complication rates of nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients.
  • To provide evidence-based insights for clinical decision-making.

Main Methods:

  • Systematic literature search of PubMed, Cochrane, and Scopus databases following PRISMA guidelines.
  • Inclusion of five randomized controlled trials (RCTs) involving 1,430 adult patients.
  • Data extraction and quality assessment using the modified Jadad scale, with meta-analysis using random-effects or fixed-effects models.

Main Results:

  • Surgical management demonstrated significantly higher treatment efficacy (93%) compared to nonoperative management (63.8%) at 1-year follow-up.
  • Nonoperative management led to significantly fewer overall complications (7.7%) versus surgical management (23.6%).
  • No significant differences were observed in perforation rates, hospital stay, pain duration, or sick leave between the groups.

Conclusions:

  • Conservative (nonoperative) management of uncomplicated appendicitis in adults requires further investigation.
  • Shared decision-making, incorporating patient expectations, is vital for enhancing outcomes in nonoperative treatment strategies.