Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2015  |  Volume : 8  |  Issue : 6  |  Page : 749--750

Recent concepts in management of acute appendicitis


Subhash Chawla 
 Department of Surgery, Command Hospital (WC), Chandimandir, Panchkula, Haryana, India

Correspondence Address:
Subhash Chawla
Department of Surgery, Command Hospital, Chandimandir
India




How to cite this article:
Chawla S. Recent concepts in management of acute appendicitis.Med J DY Patil Univ 2015;8:749-750


How to cite this URL:
Chawla S. Recent concepts in management of acute appendicitis. Med J DY Patil Univ [serial online] 2015 [cited 2020 Nov 27 ];8:749-750
Available from: https://www.mjdrdypu.org/text.asp?2015/8/6/749/169915


Full Text

Acute appendicitis is one of the most common surgical emergency reporting to a general surgeon. Diagnosis of appendicitis is generally straightforward, made on clinical history, examination, supported by routine blood investigations and urine test. However in infants, elderly, pregnant women and young children, the diagnosis is difficult because 33-50% will have an atypical presentation. [1] The performance of complementary tests is often unnecessary and results in a delay in diagnosis and management. Several scoring systems have been devised to aid decision making in doubtful acute appendicitis cases, including the Ohmann, Alvarado, Eskelinen, Raja Isteri Pengiran Anak Saleha Appendicitis, and several others. [2] These scores utilize routine clinical and laboratory assessments and are simple to use in a variety of clinical settings. However, differences in sensitivities and specificities were observed in different clinical settings. They can reliably categorize three zones of diagnostic probability: probable, doubtful, or improbable. Only the intermediate category requires complementary imaging. Accurate diagnosis is especially difficult in women, where the sensitivity of available diagnostic methods leads to an unacceptably high negative appendectomy rate due to gynecological disorders that frequently mimic appendicitis. [3] The ability of a score to fulfill standardized criteria: An initial negative appendicectomy rate of 15% or less, a potential perforation rate of 35% or less, an initial missed perforation rate of 15% or less, and a missed appendicitis rate of 5% or less. Alvarado first developed a scoring system based on operative findings, and this has been modified and improved by others. [4] The criteria for diagnostic quality have been postulated as a 15% rate of negative appendectomies, a 10% rate of negative laparotomies, a 35% rate of potential perforations, a 15% rate of overlooked perforations, and a 5% rate of overlooked acute appendicitis. [5],[6] Although the negative appendectomy rate reported by surgeons advocating early surgical intervention in suspected cases to prevent perforation varies between 20% and 40%, the generally accepted negative appendectomy rate is approximately 15-20%. [7]

The first appendectomy was performed in 1735 by Amyan, a surgeon of the English army to remove a perforated appendix. Minimal invasive surgeons have made great efforts to improve perioperative outcomes in patients undergoing an appendectomy. The establishment of three ports via the umbilicus, the suprapubic region and the left iliac fossa is currently considered the best approach to achieve proper triangulation. Laparoscopic appendectomy has some advantages, including decreased postoperative pain, better esthetic result, a shorter time to return to daily routine activities and lower incidence of wound infections or dehiscence. Single incision laparoscopic appendicectomy (SILA) is a new technique developed for performing operations without a visible scar and is becoming popular amongst surgeons. Patients have a quicker recovery time and less postoperative pain scores and reduced postoperative complications such as infection, port-site hernias, and hematomas. SILA procedure is associated with significantly less bleeding while providing an improved cosmetic outcome despite a modest increase the ratio of conversion. In conclusion, the Ohmann and RIPASA scoring systems have the highest specificity for the diagnosis of acute appendicitis. Single incision laparoscopic surgery for an appendectomy is widely accepted and is gradually becoming a viable option for treatment of appendicitis. [8] SILA is a technically feasible and reliable approach in experienced hands with short-term results similar to those obtained with CLA. [9],[10]

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