Surgical site infection (SSI) is one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. The burden of surgical site infection varies from 1.2 to 20% across the previously conducted studies. However, there are limited studies available on this problem in Ethiopia. Therefore, this study aimed to assess prevalence of post-appendectomy surgical site infection among children in Amhara region, Ethiopia. A cross-sectional study was employed. The data extraction tool was used to collect data from 423 sampled participants. Simple random sampling technique was used. Data cleaned, coded and entered into Epi Data version 4.6 and exported to STATA version 14.0. The data was presented using table and text forms. The logistic regression model was fitted after checking the required assumptions through Hosmer and lemeshow test to identify predictors of post-operative complications. The bivariable analysis was done to identify associations between dependent and each independent variable. Moreover, variables with P ≤ 0.25 levels in the bivariable analysis were entered into the multivariable analysis. Adjusted odd ratio with 95% CI was used to assess the direction, strength of association and statistical significance. Any statistical test was considered significant at P-value < 0.05. A total of 406 study participants were considered for analysis. The prevalence of surgical site infection was 9.11% (95%CI; 6.67%, 12.34%). Having fever (AOR = 2.788, 95%CI (1.10, 7.05)), being taking preoperative antibiotics (AOR = 7.3, 95%CI (2.5, 21)) and having drainage following appendectomy (AOR = 6.3, 95%CI (2.7, 14.7)) were statistically significant predictors of surgical site infection following appendectomy in children. The prevalence of surgical site infection was high as compared the national target. Taking preoperative antibiotics, having fever, and having drainage after operation were significantly associated with surgical site infection. Therefore, a prospective follow up study is important. Those children with appendicitis who presented with a clinical symptom of fever, leaving drainage after procedure and timing of preoperative antibiotics requires special attention of the surgical safety team.

Acute appendicitis is the most common cause of surgical acute abdomen, and its classification into uncomplicated, phlegmonous, and complicated forms is crucial for guiding treatment strategies. This study aims to compare the preoperative laboratory findings and postoperative outcomes of phlegmonous appendicitis with uncomplicated and complicated appendicitis. This retrospective cohort study included 1,441 patients who underwent appendectomy between January 2019 and March 2021 at Ankara Bilkent City Hospital. Patients were classified based on histopathological findings into four groups: normal appendix, uncomplicated appendicitis, phlegmonous appendicitis, and complicated appendicitis. Preoperative laboratory values, postoperative complications, and length of hospital stay were analyzed. The distribution of patients was as follows: Group A (normal appendix, 7.6%), Group B (uncomplicated appendicitis, 59.8%), Group C (phlegmonous appendicitis, 17.6%), and Group D (complicated appendicitis, 15%). Phlegmonous appendicitis exhibited significantly higher leukocyte counts and appendix diameters compared to uncomplicated appendicitis but had lower CRP values than complicated appendicitis. The median hospital stay was similar for Groups A, B, and C (1 day) but significantly longer for Group D (2.1 days, p < 0,001). Complication rates were highest in Group D (24.1%) compared to the other groups. While phlegmonous appendicitis shares some clinical and laboratory characteristics with complicated appendicitis, its postoperative outcomes align more closely with those of uncomplicated appendicitis. This suggests that phlegmonous appendicitis may be more accurately classified as a variant of uncomplicated appendicitis, emphasizing the need for consistent classification to improve treatment strategies and patient outcomes.

Tonsillectomy and appendectomy are the most frequently performed surgical procedures in pediatric and adult populations. However, comprehensive data examining their occurrence within the same hospital setting remain sparse. This study aimed to characterize the demographic and clinical profiles of patients undergoing tonsillectomy and assess the frequency and outcomes of those who additionally underwent appendectomy.

A retrospective review was performed on 337 patients who underwent tonsillectomy at a tertiary care hospital from 2015 to 2017. Data collected included age, nationality, sex, year of tonsillectomy, and details of any concurrent or subsequent appendectomy, such as complicating factors (e.g., perforation and abscess), imaging findings (appendicolith), and pathology results. Statistical analyses were performed using Minitab 18 (Minitab, Inc., State College, PA).

Among 337 patients, five (1.5%) underwent appendectomy in addition to tonsillectomy. Overall, 78.3% (264/337) of the tonsillectomy group were pediatric vs. 21.7% (73/337) adult, while 60% (3/5) of the appendectomy group were pediatric and 40% (2/5) adult (p = 0.33). The mean (standard deviation) age across the entire cohort was 16.17 (10.48) years, and 55.2% (186/337) were men. No cases of complicated appendicitis were identified among the appendectomy patients, although three (representing 0.9% of the total cohort and 60% of the appendectomy subgroup) exhibited an appendicolith on imaging. Pathology findings confirmed acute appendicitis in four (1.2%) of these cases and a normal appendix in one (0.3%). Statistical comparisons revealed no significant difference in median age between patients undergoing tonsillectomy alone and those who also had an appendectomy (p = 0.86), nor in distribution by gender across procedures (p = 0.78).

This review highlights the young demographic profile of patients undergoing tonsillectomy in a tertiary care hospital and underscores the relatively low incidence of appendectomy in this cohort. Despite the small subset of appendectomy cases, timely intervention may have contributed to the absence of complicated appendicitis. Notably, institutionwide data suggest that negative appendectomies remain rare overall, indicating a need for further research into this phenomenon. These findings underscore the need for continued surveillance and future multicenter studies to better elucidate potential shared risk factors and outcomes associated with these commonly performed surgical procedures.

A 17-year-old patient presented to the emergency department of the General Hospital of Trikala, Greece, reporting hypogastric pain accompanied by a fever of up to 38°C. The pain, progressively increasing in intensity, had been present for about a week, with the fever onset occurring 24 hours prior. Based on clinical examination, transvaginal ultrasound, and computed tomography findings, an incorrect diagnosis of pyosalpinx was made, and intravenous treatment with broad-spectrum antibiotics was initiated. However, the lack of improvement in the patient's clinical and laboratory findings after two days led to the decision to perform a laparotomy. Intraoperatively, a periappendiceal abscess was found, with a bilateral secondary extension of inflammation to the uterus, fallopian tubes, ovaries, and pelvic peritoneum. The inflamed appendix was resected from its retrocecal position, and the pelvic abscess was drained. The postoperative course was uneventful. This case report highlights an atypical presentation of acute appendicitis with abscess, which was preoperatively misdiagnosed as pyosalpinx. The main factors contributing to the misdiagnosis of acute appendicitis and the subsequent delay in medical care are discussed, emphasizing that early and accurate diagnosis is crucial in preventing adverse outcomes and ensuring effective treatment.

Perforated appendicitis in children is a frequently encountered and significant surgical condition. The treatment of choice is laparoscopic appendectomy, but this carries a risk of postoperative intra-abdominal abscess (IAA). The purpose of this study was to determine risk factors linked to the occurrence of IAA following laparoscopic surgery in pediatric perforated appendicitis.

This retrospective cohort study analyzed 137 children with perforated appendicitis who received laparoscopic appendectomy at four tertiary hospitals between March 2018 and December 2022. Data on patient demographics, preoperative clinical characteristics, and surgical details were collected. Independent risk factors for IAA formation were determined using logistic regression analysis.

The overall incidence of postoperative IAA was 10.9%. Prolonged symptom duration and elevated CRP levels were associated with higher IAA rates. Patients who developed IAAs experienced prolonged postoperative fevers and longer hospital stays. Significant risk factors for IAA identified through multivariable analysis included a higher severity grade of appendicitis (≥Grade IV, OR 5.9, p = 0.034) and the presence of a free appendicolith during surgery (OR 5.549, p = 0.01). Of the patients who developed IAAs, nine (60%) improved with conservative treatment, while six (40%) required invasive procedures.

A higher severity grade of appendicitis (≥Grade IV) and the presence of a free appendicolith are significant predictors of postoperative IAAs in pediatric perforated appendicitis. Recognizing these factors can help guide clinical management and postoperative care, potentially reducing the incidence of this complication.

Appendectomy and cholecystectomy are the surgical procedures to treat appendicitis and cholecystitis, respectively. However, there is a lack of investigation regarding these two similar types of abdominal complication-based disease which may primarily create confusion within patients.

To understand the variation and similarities within the preoperative symptoms of these two diseases, we included 224 participants including both appendicitis (n = 175) and cholecystitis (n = 49) patients. We obtained the preoperative symptoms through physical check-ups, thorough observation, and questionnaires.

We found several symptoms in both patients where abdominal pain was present in all patients in both groups. However, followed by abdominal pain, vomiting (118 (67.42%)), pain RIF (right iliac fossa) (101 (57.71%)), nausea (71 (40.57%)), and sharp pain (22 (12.57%)) were prevalent in the appendicitis group whereas tenderness (49 (100%)), epigastric pain (13 (26.53%)), and hypertension (10 (20.41%)) were prevalent in the cholecystitis group. However, fever was commonly present in several patients in both groups.  Conclusion: Abdominal pain can be a major indicator of surgery in both appendicitis and cholecystitis patients. However, observation of other symptoms is crucial for initial symptomatic diagnosis and differentiating between these diseases.

Untreated periodontitis significantly increases the risk of tooth loss, often delaying treatment due to asymptomatic phases. Recent studies have increasingly associated poor dental health with conditions such as rheumatoid arthritis, diabetes, obesity, pneumonia, cardiovascular disease, and renal illness. Despite these connections, limited research has investigated the relationship between appendicitis and periodontal disease. This study aims to predict appendicitis in patients with periodontal disease using biochemical and clinical parameters through the application of a light gradient boost tree classifier.

Data from 125 patient records at Saveetha Institute of Dental College and Medical College were pre-processed and analyzed. We utilized data preprocessing techniques, feature selection methods, and model development approaches to estimate the risk of appendicitis in patients with periodontitis. Both Random Forest and Light Gradient Boosting algorithms were evaluated for accuracy using confusion matrices to assess their predictive performance.

The Random Forest model achieved an accuracy of 94%, demonstrating robust predictive capability in this context. In contrast, the Light Gradient Boost algorithms achieved a significantly higher accuracy of 98%, underscoring their superior predictive efficiency. This substantial difference highlights the importance of algorithm selection and optimization in developing reliable predictive models. The higher accuracy of Light Gradient Boost algorithms suggests effective minimization of prediction errors and improved differentiation between appendicitis with periodontitis and healthy states. Our study identifies age, white blood cell count, and symptom duration as pivotal predictors for detecting concurrent periodontitis in acute appendicitis cases.

The newly developed prediction model introduces a novel and promising approach, providing valuable insights into distinguishing between periodontitis and acute appendicitis. These findings highlight the potential to improve diagnostic accuracy and support informed clinical decision-making in patients presenting with both conditions, offering new avenues for optimizing patient care strategies.

Appendectomy is the preferred treatment for acute uncomplicated appendicitis and the most common emergency abdominal surgery. While previous studies have investigated variables affecting post-appendectomy complications, local research is limited, and data on complication rates are scarce. Therefore, this study aimed to investigate appendectomy outcomes and the factors influencing them.

This retrospective record review included all patients who underwent appendectomies at our center between 2013 and 2023, excluding those who underwent appendectomies as part of other procedures. Data were retrieved from the hospital database and recorded on predesigned Google Forms.

A total of 556 patients were included. Complications occurred in 60 patients (10.8%); the most common included intra-abdominal collections (n=19, 3.4%), postoperative fever (n=13, 2.3%), and surgical site infections (n=11, 2.0%). The most frequently documented histopathological diagnoses included acute appendicitis (n=402, 72.3%), perforated appendicitis (n=109, 19.6%), and gangrenous appendicitis (n=19, 4.4%). Surgical site infection rates were higher after open appendectomies (6.0% vs. 0.9%, P=0.006), while intra-abdominal collections were more frequent after laparoscopic appendectomies (4.1% vs. 0.0%, P=0.095). Additionally, histopathology results showing complicated or chronic appendicitis were associated with higher complication rates (P<0.001, odds ratio=3.793, 95% confidence interval=1.957-7.350).

To the best of our knowledge, this is the largest retrospective review of appendectomy cases in Saudi Arabia. However, this study was conducted in a tertiary care center, which may have caused the rates of complications to appear lower than those in primary centers. We recommend a multi-center study be conducted to establish more accurate results.

Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed. A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over 12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted with the histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.

Intra-abdominal infections (IAIs) is the most common type of surgical infection, with high associated morbidity and mortality rates. In recent years, due to the use of antibiotics, various drug-resistant bacteria have emerged, making the treatment of abdominal infections more challenging. Early surgical exploration can reduce the mortality of patients with abdominal infection and the occurrence of complications. However, available evidence regarding the optimal timing of IAI surgery is still weak. In study, we compared the effects of operation time on patients with abdominal cavity infection and tried to confirm the best timing of surgery.

To assess the efficacy of early vs delayed surgical exploration in the treatment of IAI, in terms of overall mortality.

A systematic literature search was performed using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and ScienceDirect. The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Based on the timing of the surgical operation, we divided the literature into two groups: Early surgery and delayed surgery. For the early and delayed surgery groups, the intervention was performed with and after 12 h of the initial surgical intervention, respectively. The main outcome measure was the mortality rate. The literature search was performed from May 5 to 20, 2021. We also searched the World Health Organization International Clinical Trials Registry Platform search portal and ClinicalTrials.gov on May 20, 2021, for ongoing trials. This study was registered with the International Prospective Register of Systematic Reviews.

We identified nine eligible trial comparisons. Early surgical exploration of patients with IAIs (performed within 12 h) has significantly reduced the mortality and complications of patients, improved the survival rate, and shortened the hospital stay.

Early surgical exploration within 12 h may be more effective for the treatment of IAIs relative to a delayed operation.

Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method.

The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions.

The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. The recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method.

There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The second part of the guidelines covers sections 6 to12 and the following challenges for surgical practice: acute appendicitis, acute mesenteric ischemia, abdominal injuries, bowel obstruction, diverticulitis, laparoscopy in pregnancy and postoperative complications requiring a reoperation.

Background The coronavirus disease 2019 (COVID-19) pandemic caused changes in surgical practice. For acute appendicitis (AA), measures to control the pandemic might hinder patients from seeking medical care timely, resulting in increasing severity, postoperative complications, and mortality. This study aimed to investigate whether the COVID-19 pandemic had a negative impact on the severity and postoperative outcomes of patients with AA. Methodology We retrospectively reviewed medical records of AA patients treated operatively at Nhan Dan Gia Dinh Hospital hospital from June 1st to September 30th in three consecutive years: pre-pandemic (2019)/Group 1, minor waves (2020)/Group 2, and major wave (2021)/Group 3 (2021). Data were collected focusing on the duration of symptoms, severity of AA, time from admission to operation, postoperative complications, and mortality. Results There were 1,055 patients, including 452 patients in Group 1, 409 in Group 2, and 194 in Group 3. The overall number of patients decreased mainly in non-complicated AA. The percentages of hospital admission after 24 hours gradually increased (20.8%, 27.9%, and 43.8%, p < 0.05). The percentages of complicated AA in Group 2 and Group 3 were statistically higher than in Group 1 (39% and 55% vs. 31%, p < 0.05). Waiting time for operation increased to five hours during the major wave. Laparoscopic appendectomy was performed in 98-99% of AA patients during the pandemic, with an early postoperative complication rate of 5-9% and a mortality rate of 0.2-1%. Conclusions Although the percentages of hospital admission after 24 hours and complicated AA increased, laparoscopic appendectomy was still feasible and effective and should be maintained as the standard management for AA during the COVID-19 pandemic.

The COVID-19 pandemic has had an influence on the number of patients presenting to the emergency department (ED) with surgical conditions.

To evaluate the number of patients presenting with acute appendicitis (AA) and the percentage of complicated appendicitis before and after the COVID-19 disease outbreak.

This is a retrospective study based on the data of all patients presenting with AA to the ED of a tertiary COVID referral university hospital in Greece. We analysed the number of patients treated with AA, patient characteristics, and the proportion of patients with complicated appendicitis, and we compared the 2 groups of patients treated 12 months before and 12 months after COVID-19 onset in Greece.

A total of 152 patients were included in this study. There was a significant decrease in the number of patients presenting with AA after COVID-19 onset in Greece. Respectively, 91 and 61 patients were subjected to appendectomy 12 months before and after COVID-19 onset. Comparing the 2 groups of patients, there was a statistically significant increase in the operation time (p = 0.01) after COVID-19 onset, whereas the percentage of complicated appendicitis, the duration of symptoms before presenting to the ED (< 24 h, > 24 h), and the type of operation (laparoscopic, open, converted) did not differ significantly between the 2 groups of patients.

The number of patients presenting to the ED with AA decreased after COVID-19 onset, most likely because patients hesitated to seek help in a COVID-19 referral hospital.

The inflammatory response after laparoscopy and laparotomy has been compared in studies in adults, but only a few studies have compared the immune response between laparoscopy and laparotomy in children.

To compare open and laparoscopic appendectomies regarding a new biomarker, suPAR, to evaluate the inflammatory response.

Patients between 3 and 17 years of age who were admitted to the pediatric surgery department and scheduled for appendectomy due to appendicitis were enrolled in the investigation. The patients were randomized to receive either laparoscopic (n = 20) or conventional open appendectomy (n = 20). The primary outcome was a change in preoperative and postoperative suPAR levels. The secondary outcomes were the white blood cell count, lymphocytes, neutrophils, platelets, C-reactive protein level, appendix diameter, symptoms, symptom duration, surgical complications, operative time, rescue analgesics, hospital stay, and family satisfaction.

The mean age of the patients undergoing laparoscopic appendectomy was 10.55 ±2.743 (3-17) years. The mean age of the patients undergoing open appendectomy was 11.40 ±3.515 (3-17) years. A statistically significant difference was found when the postoperative suPAR values between the two groups were compared (p = 0.048). The operative time and hospital stay in the laparoscopic group were significantly shorter than those in the open group (p = 0.001, p = 0.047).

Laparoscopic appendectomy is associated with a shorter operative time, a shorter hospital stay, and a smaller inflammatory response caused by surgical stress than open appendectomy. suPAR is an effective marker for comparing postoperative inflammatory stress between open and closed appendectomies.

To investigate the effect of laparoscopic purse-string sutures in adult complicated appendicitis treatment.

The data of 568 adult cases of complicated appendicitis treated by laparoscopic appendectomy at the Hefei Second People's Hospital, Anhui Province, China, from September 2018 to September 2021 were analysed retrospectively. The patients were divided into two groups: 295 cases in the laparoscopic purse-string suture treatment group (observation group) and 273 cases in the simple Hem-o-lok^® clamp treatment group (control group). The baseline data collected included age, gender, preoperative body temperature, leukocyte count and percentage of neutrophils and the surgery time. The postoperative data collected included antibiotic treatment duration, drainage tube placement time and the incidence of complications.

There were no significant differences in the baseline data of the two groups, including age, gender, preoperative body temperature, leukocyte count and neutrophil percentage (all P > 0.05). Compared with the control group, the postoperative hospital length of stay, duration of antibiotic treatment, the recovery time of peripheral white blood cell and neutrophil counts and the incidence of postoperative complications in the observation group were significantly decreased (P < 0.05).

Purse-string sutures can effectively reduce the incidence of postoperative complications after a laparoscopic appendectomy for adult acute complicated appendicitis. There was faster postoperative recovery when patients' appendiceal stumps were treated with laparoscopic purse-string sutures.

Introduction There are a variety of conflicting recommendations in the literature for pre-operative imaging in acute appendicitis. There is debate over what the ideal imaging protocol is to lower the negative appendicectomy rate (NAR) without increasing missed appendicitis. The aim of this study is to compare the audited NAR between two groups with different imaging approaches: (i) mandatory pre-operative computed tomography (CT) imaging and (ii) selective imaging with CT, ultrasound (US), or no imaging prior to appendicectomy. Materials and methods A retrospective chart audit was conducted of 400 patients who underwent an appendicectomy at two hospitals with different approaches to pre-operative imaging (hospital A and hospital B). The primary outcome measure was histologically confirmed appendicitis. It was also documented whether there was radiological (CT or US) evidence of appendicitis.  Results At hospital A, all 200 patients underwent CT imaging prior to appendicectomy. The total histologically confirmed NAR for this group was 9.5% (19/200). At hospital B, 97 (48.5%) patients underwent CT, 41 (25.5%) underwent US, 10 (5%) had both US and CT, and 52 (26%) had no imaging. The total NAR was 11.5% (23/200). Conclusion There was no statistically significant difference (p=0.62) in audited NARs when comparing clinician-guided selective imaging versus routine CT imaging for all patients undergoing appendicectomy.