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Open Access 01-12-2022 | Appendicitis | Research

Risk factors for periappendiceal adhesions in acute appendicitis: a retrospective comparative study

Authors: Shenshuo Gao, Xiaobo Guo, Leping Li, Changqing Jing, Yan Ma

Published in: BMC Surgery | Issue 1/2022

Abstract

Purpose

Acute appendicitis usually requires immediate surgical treatment, but appendectomies were difficult for some patients with severe periappendiceal adhesions. We investigated risk factors of intraoperative adhesions to help surgeons make better treatment plans for appendicitis.

Methods

We retrospectively analyzed 186 cases diagnosed with acute appendicitis and underwent surgery in Shandong Provincial Hospital affiliated to Shandong First Medical University between January 2018 and December 2019. According to the degree of intraoperative adhesions, they were divided into mild, moderate and severe groups. Then, we analyzed a number of preoperative factors contributed to adhesions, suppuration and perforation during appendectomy in 186 patients.

Results

Contrast to the moderate group (MoG) and the mild group (MiG), the severe degree of adhesions group (SG) had a higher intraoperative perforation and suppuration rate, a greater likelihood of conversion to open and more postoperative complications. Multivariable logistic regression analysis showed that recurrent appendicitis and high neutrophil percentage were independently associated with periappendiceal adhesions. The preoperative ultrasonography (US) revealed periappendiceal fluid and high neutrophil percentage were independently associated with appendix suppuration. A high preoperative neutrophil percentage was independently associated with appendix perforation.

Conclusions

Recurrent appendicitis and preoperative high neutrophil percentage were risk factors of periappendiceal adhesions; preoperative US revealed periappendiceal fluid and high neutrophil percentage were risk factors of appendix suppuration; and a high preoperative neutrophil percentage was a risk factor of appendix perforation.

Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017;266:237–41. https://doi.org/10.1097/SLA.0000000000002188.CrossRefPubMed

Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg. 2006;30:1033–7. https://doi.org/10.1007/s00268-005-0304-6.CrossRefPubMed

Ozgüc H, Irgil C, Kaya E, Tokyay R. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis. Br J Surg. 1995;82:1284. https://doi.org/10.1002/bjs.1800820949.CrossRefPubMed

Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg. 2009;96:473–81. https://doi.org/10.1002/bjs.6482.CrossRefPubMed

Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, et al. Conservative treatment of acute appendicitis. Acta Bio-medica Atenei Parmensis. 2018;89:119–34. https://doi.org/10.23750/abm.v89i9-S.7905.CrossRefPubMed

Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11:CD001546. https://doi.org/10.1002/14651858.CD001546.pub4.CrossRefPubMed

Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World J Emerg Surg. 2016;11:44. https://doi.org/10.1186/s13017-016-0102-5.CrossRefPubMedPubMedCentral

Ukai T, Shikata S, Takeda H, Dawes L, Noguchi Y, Nakayama T, et al. Evidence of surgical outcomes fluctuates over time: results from a cumulative meta-analysis of laparoscopic versus open appendectomy for acute appendicitis. BMC Gastroenterol. 2016;16:37. https://doi.org/10.1186/s12876-016-0453-0.CrossRefPubMedPubMedCentral

Li X, Zhang J, Sang L, Zhang W, Chu Z, Li X, et al. Laparoscopic versus conventional appendectomy—a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2010;10:129. https://doi.org/10.1186/1471-230x-10-129.CrossRefPubMedPubMedCentral

10.

Finnerty BM, Wu X, Giambrone GP, Gaber-Baylis LK, Zabih R, Bhat A, et al. Conversion-to-open in laparoscopic appendectomy: a cohort analysis of risk factors and outcomes. Int J Surg (London, England). 2017;40:169–75. https://doi.org/10.1016/j.ijsu.2017.03.016.CrossRef

11.

Antonacci N, Ricci C, Taffurelli G, Monari F, Del Governatore M, Caira A, et al. Laparoscopic appendectomy: which factors are predictors of conversion? A high-volume prospective cohort study. Int J Surg (London, England). 2015;21:103–7. https://doi.org/10.1016/j.ijsu.2015.06.089.CrossRef

12.

Wagner PL, Eachempati SR, Aronova A, Hydo LJ, Pieracci FM, Bartholdi M, et al. Contemporary predictors of conversion from laparoscopic to open appendectomy. Surg Infect. 2011;12:261–6. https://doi.org/10.1089/sur.2010.079.CrossRef

13.

Sakpal SV, Bindra SS, Chamberlain RS. Laparoscopic appendectomy conversion rates two decades later: an analysis of surgeon and patient-specific factors resulting in open conversion. J Surg Res. 2012;176:42–9. https://doi.org/10.1016/j.jss.2011.07.019.CrossRefPubMed

14.

Chen Y, Pei W, Wang Q, Wang W, Xu T, Jing C, et al. One-stitch versus traditional method of protective loop ileostomy in laparoscopic low anterior rectal resection: a retrospective comparative study. Int J Surg (London, England). 2020;80:117–23. https://doi.org/10.1016/j.ijsu.2020.06.035.CrossRef

15.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64. https://doi.org/10.1016/s0196-0644(86)80993-3.CrossRefPubMed

16.

Sammalkorpi HE, Mentula P, Leppäniemi A. A new adult appendicitis score improves diagnostic accuracy of acute appendicitis—a prospective study. BMC Gastroenterol. 2014;14:114. https://doi.org/10.1186/1471-230x-14-114.CrossRefPubMedPubMedCentral

17.

Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15:27. https://doi.org/10.1186/s13017-020-00306-3.CrossRefPubMedPubMedCentral

18.

Andersson M, Kolodziej B, Andersson RE, Group SS. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis. Br J Surg. 2017;104:1451–61. https://doi.org/10.1002/bjs.10637.CrossRefPubMed

19.

Andersson M, Andersson RE. The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score. World J Surg. 2008;32:1843–9. https://doi.org/10.1007/s00268-008-9649-y.CrossRefPubMed

20.

Vons C, Barry C, Maitre S, Pautrat K, Leconte M, Costaglioli B, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. The Lancet. 2011;377:1573–9. https://doi.org/10.1016/s0140-6736(11)60410-8.CrossRef

21.

Wilms IM, Suykerbuyk-de Hoog DE, de Visser DC, Janzing HM. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev. 2020;10:CD008359. https://doi.org/10.1002/14651858.CD008359.pub3.CrossRefPubMed

22.

Martínez Carrilero J. Safety an efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. Rev Clin Esp. 2012;212:460. https://doi.org/10.1016/j.rce.2012.05.005.CrossRefPubMed

23.

Flum DR. Clinical practice. Acute appendicitis–appendectomy or the “antibiotics first” strategy. N Engl J Med. 2015;372:1937–43. https://doi.org/10.1056/NEJMcp1215006.CrossRefPubMed

24.

Canal C, Lempert M, Birrer DL, Neuhaus V, Turina M. 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. Int J Surg (London, England). 2020;76:16–24. https://doi.org/10.1016/j.ijsu.2020.02.001.CrossRef

25.

Saida F, Matsumoto S, Kitano M. Preoperative predictor of extensive resection for acute appendicitis. Am J Surg. 2018;215:599–602. https://doi.org/10.1016/j.amjsurg.2017.06.033.CrossRefPubMed

26.

Busch M, Gutzwiller FS, Aellig S, Kuettel R, Metzger U, Zingg U. In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg. 2011;35:1626–33. https://doi.org/10.1007/s00268-011-1101-z.CrossRefPubMed

27.

Teixeira PG, Sivrikoz E, Inaba K, Talving P, Lam L, Demetriades D. Appendectomy timing: waiting until the next morning increases the risk of surgical site infections. Ann Surg. 2012;256:538–43. https://doi.org/10.1097/SLA.0b013e318265ea13.CrossRefPubMed

28.

Kim JW, Shin DW, Kim DJ, Kim JY, Park SG, Park JH. Effects of timing of appendectomy on the risks of perforation and postoperative complications of acute appendicitis. World J Surg. 2018;42:1295–303. https://doi.org/10.1007/s00268-017-4280-4.CrossRefPubMed

29.

Bhangu A. Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg. 2014;259:894–903. https://doi.org/10.1097/sla.0000000000000492.CrossRefPubMed

30.

Chang ST, Jeffrey RB, Olcott EW. Three-step sequential positioning algorithm during sonographic evaluation for appendicitis increases appendiceal visualization rate and reduces CT use. AJR Am J Roentgenol. 2014;203:1006–12. https://doi.org/10.2214/ajr.13.12334.CrossRefPubMed

31.

Gaskill CE, Simianu VV, Carnell J, Hippe DS, Bhargava P, Flum DR, et al. Use of computed tomography to determine perforation in patients with acute appendicitis. Curr Probl Diagn Radiol. 2018;47:6–9. https://doi.org/10.1067/j.cpradiol.2016.12.002.CrossRefPubMed

Title: Risk factors for periappendiceal adhesions in acute appendicitis: a retrospective comparative study
Authors: Shenshuo Gao
Xiaobo Guo
Leping Li
Changqing Jing
Yan Ma
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Appendicitis
Appendicitis
Appendectomy
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01579-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for periappendiceal adhesions in acute appendicitis: a retrospective comparative study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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