Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgery Today

10-04-2024 | Appendicitis | Original Article

The benefits of interval appendectomy and risk factors for nonoperative management failure in the therapeutic strategy for complicated appendicitis

Authors: Kohki Takeda, Takeshi Yamada, Kay Uehara, Akihisa Matsuda, Seiichi Shinji, Yasuyuki Yokoyama, Goro Takahashi, Takuma Iwai, Sho Kuriyama, Toshimitsu Miyasaka, Shintaro Kanaka, Hiroshi Yoshida

Published in: Surgery Today

Login to get access

Abstract

Purpose

Emergency surgery (ES) for complicated appendicitis (CA) is associated with high morbidity. Interval appendectomy (IA) decreases this rate; however, nonoperative management (NOM) is not always successful. Some patients require unplanned ES due to NOM failure (IA failure: IA-F). This study aimed to verify the benefits of IA and to evaluate the risk factors for NOM failure.

Methods

Patients diagnosed with CA who underwent surgery between January 2012 and December 2021 were included in this study. We compared the surgical outcomes of the ES group with those of the IA success (IA-S) and IA-F groups. We also analyzed 14 factors that predicted NOM failure.

Results

Among 302 patients, the rate of severe complications (Clavien–Dindo grade ≥ III) was significantly higher in the ES group (N = 165) than in the IA-S group (N = 102). The rates were equal between the ES (N = 165) and IA-F (N = 35) groups. NOM was successful in 110 patients and failed in 27. Lack of abscesses, comorbidities, high WBC count, and free air were independent risk factors for NOM failure.

Conclusions

Considering the benefits of IA and the non-inferior surgical outcomes of IA-F compared to ES, IA is a good therapeutic strategy for CA. However, in patients exhibiting four independent risk factors for NOM failure, careful monitoring of unplanned ES is necessary.
Appendix
Available only for authorised users
Literature
1.
Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101:e9–22.CrossRefPubMed
2.
Cameron DB, Anandalwar SP, Graham DA, Melvin P, Serres SK, Dunlap JL, et al. Development and implications of an evidence-based and public health-relevant definition of complicated appendicitis in children. Ann Surg. 2020;271:962–8.CrossRefPubMed
3.
Yeh DD, Eid AI, Young KA, Wild J, Kaafarani HMA, Ray-Zack M, et al. Multicenter study of the treatment of appendicitis in America: acute, perforated, and gangrenous (Mustang), an EAST multicenter study. Ann Surg. 2021;273:548–56.CrossRefPubMed
4.
Yamada T, Endo H, Hasegawa H, Kimura T, Kakeji Y, Koda K, et al. Risk of emergency surgery for complicated appendicitis: Japanese nationwide study. Ann Gastroenterol Surg. 2021;5:236–42.CrossRefPubMed
5.
Oba T, Yamada T, Matsuda A, Otani M, Matsuda S, Ohta R, et al. Patient backgrounds and short-term outcomes of complicated appendicitis differ from those of uncomplicated appendicitis. Ann Gastroenterol Surg. 2022;6:273–81.CrossRefPubMed
6.
Mosegaard A, Nielsen OS. Interval appendectomy. A retrospective study. Acta Chir Scand. 1979;145:109–11.PubMed
7.
8.
Lai HW, Loong CC, Chiu JH, Chau GY, Wu CW, Lui WY. Interval appendectomy after conservative treatment of an appendiceal mass. World J Surg. 2006;30:352–7.CrossRefPubMed
9.
Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Ann Surg. 2007;246:741–8.CrossRefPubMed
10.
Lane JS, Schmit PJ, Chandler CF, Bennion RS, Thompson JE Jr. Ileocecectomy is definitive treatment for advanced appendicitis. Am Surg. 2001;67:1117–22.CrossRefPubMed
11.
Gillick J, Velayudham M, Puri P. Conservative management of appendix mass in children. Br J Surg. 2001;88:1539–42.CrossRefPubMed
12.
Cheng Y, Xiong X, Lu J, Wu S, Zhou R, Cheng N. Early versus delayed appendicectomy for appendiceal phlegmon or abscess. Cochrane Database Syst Rev. 2017;6: CD011670.PubMed
13.
Jaschinski T, Mosch C, Eikermann M, Neugebauer EA. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol. 2015;15:48.CrossRefPubMedPubMedCentral
14.
Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11: CD001546.PubMed
15.
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.CrossRefPubMedPubMedCentral
16.
Maruyama H, Kusachi S, Makino H, Kanno H, Yoshida H, Niitsuma T. Postoperative infection after colorectal surgery: subanalysis of data from the 2015 Japan postoperative infectious complications survey. J Nippon Med Sch. 2020;87:204–10.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
18.
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. Lancet. 2011;377:1573–9.CrossRefPubMed
19.
Park HC, Kim MJ, Lee BH. Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis. Br J Surg. 2017;104:1785–90.CrossRefPubMed
20.
Fujishiro J, Fujiogi M, Hirahara N, Terui K, Okamoto T, Watanabe E, et al. Abdominal drainage at appendectomy for complicated appendicitis in children: a propensity-matched comparative study. Ann Surg. 2021;274:e599–604.CrossRefPubMed
21.
Maxfield MW, Schuster KM, Bokhari J, McGillicuddy EA, Davis KA. Predictive factors for failure of nonoperative management in perforated appendicitis. J Trauma Acute Care Surg. 2014;76:976–81.CrossRefPubMed
22.
Sadakari Y, Date S, Murakami S, Ichimiya S, Nishimura S, Kawaji H, et al. Prediction of negative outcomes in non-surgical treatment for appendiceal abscess in adults. J Anus Rectum Colon. 2018;2:59–65.CrossRefPubMedPubMedCentral
23.
Walker C, Moosavi A, Young K, Fluck M, Torres D, Widom K, et al. Factors associated with failure of nonoperative management for complicated appendicitis. Am Surg. 2019;85:865–70.CrossRefPubMed
24.
Kohga A, Kawabe A, Yajima K, Okumura T, Yamashita K, Isogaki J, et al. Does the presence of an appendicolith or abscess predict failure of nonoperative management of patients with acute appendicitis? Emerg Radiol. 2021;28:977–83.CrossRefPubMed
25.
Aprahamian CJ, Barnhart DC, Bledsoe SE, Vaid Y, Harmon CM. Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences. J Pediatr Surg. 2007; 42:934–8; discussion 8.
26.
Mahida JB, Lodwick DL, Nacion KM, Sulkowski JP, Leonhart KL, Cooper JN, et al. High failure rate of nonoperative management of acute appendicitis with an appendicolith in children. J Pediatr Surg. 2016;51:908–11.CrossRefPubMed
27.
Fuhrer AE, Sukhotnik I, Ben-Shahar Y, Weinberg M, Koppelmann T. Predictive value of Alvarado score and pediatric appendicitis score in the success of nonoperative management for simple acute appendicitis in children. Eur J Pediatr Surg. 2021;31:95–101.CrossRefPubMed
28.
Talishinskiy T, Limberg J, Ginsburg H, Kuenzler K, Fisher J, Tomita S. Factors associated with failure of nonoperative treatment of complicated appendicitis in children. J Pediatr Surg. 2016;51:1174–6.CrossRefPubMed
29.
St Peter SD, Aguayo P, Fraser JD, Keckler SJ, Sharp SW, Leys CM, et al. Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial. J Pediatr Surg. 2010;45:236–40.CrossRefPubMed
30.
Darwazeh G, Cunningham SC, Kowdley GC. A systematic review of perforated appendicitis and phlegmon: interval appendectomy or wait-and-see? Am Surg. 2016;82:11–5.CrossRefPubMed
31.
Hall NJ, Eaton S, Stanton MP, Pierro A, Burge DM, CHINA Study Collaborators and the Paediatric Surgery Trainees Research Network. Active observation versus interval appendicectomy after successful non-operative treatment of an appendix mass in children (CHINA study): an open-label, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:253–60.CrossRefPubMed
Metadata
Title
The benefits of interval appendectomy and risk factors for nonoperative management failure in the therapeutic strategy for complicated appendicitis
Authors
Kohki Takeda
Takeshi Yamada
Kay Uehara
Akihisa Matsuda
Seiichi Shinji
Yasuyuki Yokoyama
Goro Takahashi
Takuma Iwai
Sho Kuriyama
Toshimitsu Miyasaka
Shintaro Kanaka
Hiroshi Yoshida
Publication date
10-04-2024
Publisher
Springer Nature Singapore
Published in
Surgery Today
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-024-02842-w