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World J Surg 2021 Jul 29. Epub 2021 Jul 29.

The Endoscope Center, The First Afilliated Hospital of Fujian Medical University, No.20, Chazhong road, Taijiang District, Fuzhou, 350005, China.

Objective: To investigate the efficacy and safety of endoscopic appendix intubation and irrigation (EAI) on acute uncomplicated appendicitis.

Methods: This prospective non-randomized study examined 169 patients with suspected acute uncomplicated appendicitis at The First Affiliated Hospital of Fujian Medical University from October 2015 to 2017. Patients were divided into three groups: endoscopic appendix intubation and irrigation (EAI, n = 18), laparoscopic appendectomy (LA, n = 87), and antibiotic alone (A, n = 64). Read More

Clin Case Rep 2021 Jul 23;9(7):e04595. Epub 2021 Jul 23.

Department of Gastrointestinal Surgery Østfold Hospital Trust Grålum Norway.

Case of rare diagnosis of lipomatosis of appendix was established based on histologic report of appendicular specimen after laparoscopic appendectomy for suspected appendicitis in 16-year-old boy. Application of imaging modality may avoid unnecessary appendectomy. Read More

J Korean Med Sci 2021 Jul 26;36(29):e192. Epub 2021 Jul 26.

Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea.

Background: Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery.

Methods: Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. Read More

J Surg Case Rep 2021 Jul 14;2021(7):rjab285. Epub 2021 Jul 14.

Department of Surgery, University Hospital of Ioannina, Ioannina, Greece.

Appendicitis after colonoscopy is rare, with an estimated incidence of 3.8 cases per 10 000 colonoscopies. Herein, we report a 56-year-old female who visited the emergency department with a history of diffuse abdominal pain and nausea 8 h after a screening colonoscopy. Read More

Visc Med 2021 Jun 5;37(3):180-188. Epub 2020 Oct 5.

Department of Anesthesiology, Bethlehem Gesundheitszentrum Stolberg (Rhld.), Stolberg, Germany.

Introduction: Since conservative antibiotic treatment in uncomplicated appendicitis might not solve the clinical problem definitively, it has to compete with the results of today's laparoscopic appendectomy.

Methods: In a county hospital, accommodating also a pediatric department, all cases of appendectomy for suspected appendicitis over 15 years were analyzed retrospectively for the following items: beginning of symptoms, time from admission to surgery, surgical technique as "open," "laparoscopic" or "converted," if perforated at operation and histological confirmation of acute inflammation. Surgical morbidity was detected in distinct categories. Read More

IEEE Trans Biomed Eng 2021 Jul 9;PP. Epub 2021 Jul 9.

Pain assessment in children continues to challenge clinicians and researchers, as subjective experiences of pain require inference through observable behaviors, both involuntary and deliberate. The presented approach supplements the subjective self-report-based method by fusing electrodermal activity (EDA) recordings with video facial expressions to develop an objective pain assessment metric. Such an approach is specifically important for assessing pain in children who are not capable of providing accurate self-pain reports, requiring nonverbal pain assessment. Read More

J Clin Transl Res 2021 Jun 27;7(3):326-332. Epub 2021 May 27.

Department of General Surgery, Tan Tock Seng Hospital, Singapore.

Background And Aim: Acute appendicitis (AA) is traditionally considered a clinical diagnosis and negative appendectomy (NA) rates vary across health-care systems. Computed tomography (CT) scans have been shown to aid in the reduction of NA rates. Our study aimed to determine the pre-operative imaging characteristics in patients undergoing appendectomy with eventual normal histology. Read More

Obstet Gynecol 2021 Aug;138(2):236-245

Division of Maternal Fetal Medicine and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Surgery, The Ohio State University, and the Department of Anesthesia, Nationwide Children's Hospital, Columbus, Ohio.

Objective: To examine whether there are racial and ethnic differences in postoperative complications after nonobstetric surgery during pregnancy in the United States.

Methods: We conducted a secondary analysis of the prospective ACS NSQIP (American College of Surgeons National Surgical Quality Improvement) program from 2005 to 2012. We assessed pregnant women 18-50 years without prior surgery in the preceding 30 days who underwent a nonobstetric surgery. Read More

Surg Laparosc Endosc Percutan Tech 2021 Jul 7. Epub 2021 Jul 7.

Department of Surgery, Dankook University College of Medicine, Cheonan, Republic of Korea.

Purpose: Elective interval appendectomy (IA) after percutaneous catheter drainage (PCD) is traditionally advocated for perforated appendicitis with an abscess. However, this is not the only way to manage these patients when we consider the cost-effectiveness of treatment. This study compared the outcomes and cost-effectiveness of patients who underwent IA and those who underwent direct surgery. Read More

Int J Surg Case Rep 2021 Jul 1;84:106156. Epub 2021 Jul 1.

Hospital Angeles Lomas, Department of Surgery, Edo. Mex 52763, Mexico. Electronic address:

Introduction: Appendectomy is one of the most common surgical procedures performed worldwide There are different etiologies for acute appendicitis such as obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, or neoplasm. Laparoscopic appendectomy has become the treatment of choice for both complicated and uncomplicated appendicitis; common postoperative complications include wound infection, bleeding, intraabdominal abscess. Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy. Read More

Am J Trop Med Hyg 2021 Jul 6. Epub 2021 Jul 6.

Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.

Hantaviruses are Bunyaviridae viruses that cause hemorrhagic fever with renal syndrome (HFRS). Appendicitis caused by Hantaan virus has not been reported previously. An 81-year-old man who underwent laparoscopic appendectomy for suspected appendicitis based on abdominal pain, fever, hypotension, and computed tomography findings. Read More

Updates Surg 2021 Jul 4. Epub 2021 Jul 4.

Department of Surgical Sciences, University of Torino, corso AM Dogliotti 14, 10126, Torino, Italy.

Major surgical societies advised using non-operative management of appendicitis and suggested against laparoscopy during the COVID-19 pandemic. The hypothesis is that a significant reduction in the number of emergent appendectomies was observed during the pandemic, restricted to complex cases. The study aimed to analyse emergent surgical appendectomies during pandemic on a national basis and compare it to the same period of the previous year. Read More

Int J Surg Case Rep 2021 Jul 11;84:106060. Epub 2021 Jun 11.

Hernia Center, Gastrointestinal Surgery Service, Oswaldo Cruz German Hospital, São Paulo, SP, Brazil.

Introduction: There has been a great advance in the treatment of inguinal hernias with a significant reduction in recurrences with the use of polypropylene mesh. Local complications such as infections, rejection, and chronic pain are widely studied and reported in the literature. The Autoimmune [Auto-inflammatory] Syndrome Induced by Adjuvants (ASIA) is little known and can be triggered by using polypropylene mesh. Read More

BMJ Paediatr Open 2021 31;5(1):e001066. Epub 2021 Mar 31.

Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh.

Objective: The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country.

Design: A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' () and controls during a similar period in 2019 (). Read More

Ann Coloproctol 2021 Jun 29. Epub 2021 Jun 29.

Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

Torsion of the appendix is rare, and appendiceal mucocele can be one of its causes. The first case was of a 49-year-old man who visited the emergency room (ER) for abdominal pain. Abdominal computed tomography (CT) showed appendiceal mucocele with suspected torsion and rupture. Read More

Ann Coloproctol 2020 09 30. Epub 2020 Sep 30.

Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Purpose: The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol.

Methods: Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution's ERAS protocol. Read More

Int J Surg Case Rep 2021 Jul 9;84:106077. Epub 2021 Jun 9.

Tripler Army Medical Center, Department of Surgery, 1 Jarrett White Rd, Honolulu, HI 96859, United States of America.

Introduction And Importance: Appendicitis is an extremely common surgical problem, especially in the pediatric population. However, leukemic infiltration of the appendix is rare and even more so is having acute appendicitis as the initial manifestation.

Case Presentation: The patient is a 2-year-old female with multiple febrile illnesses since birth, who presented to the emergency department with a 3-day history of abdominal pain, fever, and decreased appetite. Read More

Surg Case Rep 2021 Jun 23;7(1):147. Epub 2021 Jun 23.

Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.

Background: The prevalence of acute lower gastrointestinal bleeding has been increased including colonic diverticulitis and angioplasty. However, appendiceal bleeding is extremely rare.

Case Presentation: We present a case of lower gastrointestinal bleeding from the appendix in an elderly male who presented with melena. Read More

Br J Surg 2021 06;108(6):717-726

Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione LombardiaVarese, Italy.

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Read More

J Laparoendosc Adv Surg Tech A 2021 Jun 21. Epub 2021 Jun 21.

Surgical Outcomes Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Laparoscopic surgery has become the standard of care for many surgical treatments. The diffusion of laparoscopy has been investigated for adult patient populations but is still unknown for pediatric populations. This study sought to describe national trends in diffusion of laparoscopic surgery for common pediatric conditions and identify disparities in use of laparoscopic surgery. Read More

VideoGIE 2021 Jun 19;6(6):269-271. Epub 2021 Mar 19.

Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

Video 1Endoscopic transcecal appendectomy under laparoscopic single-port assistance. Read More

J Surg Res 2021 Jun 8;267:1-8. Epub 2021 Jun 8.

Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address:

Background: Fast Track Pathways (FTP) directed at reducing length of stay (LOS) and overall costs are being increasingly implemented for emergency surgeries. The purpose of this study is to evaluate implementation of a FTP for Emergency General Surgery (EGS) at an academic medical center (AMC).

Methods: The study included 165 patients at an AMC between 2016 and 2018 who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI). Read More

Dtsch Arztebl Int 2021 Apr;118(14):244-249

Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of MunichMünchner Studienzentrum, Klinikum rechts der Isar, School of Medicine,Technical University ofMunichDepartment of Health Care Management, Institute of Technology and Management, TechnischeUniversität Berlin.

Background: Appendectomy is the gold standard for treatment of acute appendicitis. However, recent studies favor primary antibiotic therapy. The aim of this observational study was to explore changes in the numbers of operations for acute appendicitis in the period 2010-2017, paying special attention to disease severity. Read More

Cost Eff Resour Alloc 2021 Jun 10;19(1):34. Epub 2021 Jun 10.

Faculty of Health Sciences, Universidad Icesi, Calle 18 No. 122-135 Pance, 70000, Cali, Colombia.

Background: Traditionally, uncomplicated acute appendicitis (AA) has been treated with appendectomy. However, the surgical alternatives might carry out significant complications, impaired quality of life, and higher costs than nonoperative treatment. Consequently, it is necessary to evaluate the different therapeutic alternatives' cost-effectiveness in patients diagnosed with uncomplicated appendicitis. Read More

Updates Surg 2021 Jun 7. Epub 2021 Jun 7.

Department of Surgery, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, Italy.

Appendectomy is the most frequently performed emergent procedure in paediatric patients. However, there is a wide heterogeneity in outcome definitions and, conversely, a lack of information about complications' severity. This study aims to analyse the outcome of children operated for acute appendicitis, with reference to complications' severity grading. Read More

Cir Esp (Engl Ed) 2021 Jun-Jul;99(6):450-456. Epub 2021 May 28.

Servicio de Cirugía General, Hospital Regional Universitario Carlos Haya, Málaga, Sección de Trauma y Cirugía de Urgencias de la AEC, Spain.

Introduction: The COVID-19 pandemic has had a significant impact on Spanish hospitals, which have had to allocate all available resources to treat these patients, reducing the ability to attend other common pathologies. The aim of this study is to analyze how the treatment of acute appendicitis has been affected.

Method: A national descriptive study was carried out by an online voluntary specific questionnaire with Google Drive™ distributed by email by the Spanish Association of Surgeons (AEC) to all affiliated surgeons currently working in Spain (5203), opened from April 14th to April 24th. Read More

Curr Opin Gastroenterol 2021 Jun 4. Epub 2021 Jun 4.

Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou, China.

Purpose Of Review: This review is an update on the recent advancements and clinical applications of flexible endoscopy in the context of natural orifice translumenal endoscopic surgery (NOTES). We focus on recent developments in gastrointestinal luminal and transluminal NOTES.

Recent Findings: NOTES has evolved from a hybrid approach utilizing a laparoscopic assistant to pure NOTES without laparoscopic assistance. Read More

Eur J Trauma Emerg Surg 2021 Jun 3. Epub 2021 Jun 3.

Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.

Purpose: Stump appendicitis (SA) is a rare long-term complication after laparoscopic appendectomy (LA) that can be associated with high morbidity due to delayed diagnosis. We aimed to determine the incidence, risk factors, diagnosis, and management of SA by reviewing our large cohort of LA and performing a systematic review of the literature.

Methods: We retrospectively reviewed data of all patients who developed SA after LA between 2006 and 2020. Read More

Ann Coloproctol 2021 Jun 4. Epub 2021 Jun 4.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: This study aimed to evaluate the safety and feasibility of single-port laparoscopic surgery (SLS) for appendiceal mucinous neoplasm (AMN) when compared with conventional laparoscopic surgery (CLS).

Methods: This retrospective study enrolled patients who underwent surgery for AMN between July 2014 and June 2020 at Seoul National University Bundang Hospital. Patient demographics, surgical data, pathology, hospital stay, postoperative morbidity, and follow-up data were extracted from electronic records for analysis. Read More

BMC Pediatr 2021 06 1;21(1):258. Epub 2021 Jun 1.

Department of Pediatrics, Medical College of Wisconsin, Children's Corporate Center Suite 560, 999 North 92nd Street, Wisconsin, 53226, Milwaukee, USA.

Background: Abdominal pain and other gastrointestinal symptoms are common presenting features of multisystem inflammatory syndrome in children (MIS-C) and can overlap with infectious or inflammatory abdominal conditions, making accurate diagnosis challenging.

Case Presentation: We describe the case of a 16-year-old female who presented with clinical symptoms suggestive of appendicitis and an abdominal computed tomography (CT) that revealed features concerning for appendicitis. After laparoscopic appendectomy, histopathology of the appendix demonstrated only mild serosal inflammation and was not consistent with acute appendicitis. Read More