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Purpose: Acute appendicitis (AA) is the leading cause of acute abdomen worldwide, with an incidence of 90–100 cases per 100,000 individuals annually and a lifetime risk of 7–12%. Despite its prevalence, historical accounts of AA are limited, particularly when compared to conditions like haemorrhoids, likely due to the appendix's internal location. This article traces the historical evolution of AA treatment from ancient times to the present, highlighting key contributions. Methods: A review of common research databases and relevant literature on AA was conducted. Results: Evidence from ancient Egypt suggests early recognition of the appendix, referring to it as the "worm of the bowel." However, detailed anatomical descriptions and treatment approaches for AA did not emerge until the Renaissance, particularly with contributions from Leonardo da Vinci and Berengario da Carpi. The article traces the progression of AA management, including the first autopsies and surgeries, the development of surgical techniques predating anaesthesia and antisepsis, and advancements achieved from the nineteenth to the twenty-first century. The shift from conservative to surgical approaches is discussed, alongside innovations such as laparoscopic appendicectomy, single-incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and endoscopic retrograde appendicitis therapy (ERAT). The impact of the COVID-19 pandemic on AA treatment, including adaptations in medical practices, is also explored. Conclusions: This review highlights the significant historical developments in AA treatment and its pivotal role in advancing abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Traditional methods for analysing surgical processes often fall short in capturing the intricate interconnectedness between clinical procedures, their execution sequences, and associated resources such as hospital infrastructure, staff, and protocols. Aim: This study addresses this gap by developing an ontology for appendicectomy, a computational model that comprehensively represents appendicectomy processes and their resource dependencies to support informed decision making and optimise appendicectomy healthcare delivery. Methods: The ontology was developed using the NeON methodology, drawing knowledge from existing ontologies, scholarly literature, and de-identified patient data from local hospitals. Results: The resulting ontology comprises 108 classes, including 11 top-level classes and 96 subclasses organised across five hierarchical levels. The 11 top-level classes include "clinical procedure", "appendicectomy-related organisational protocols", "disease", "start time", "end time", "duration", "appendicectomy outcomes", "hospital infrastructure", "hospital staff", "patient", and "patient demographics". Additionally, the ontology includes 77 object and data properties to define relationships and attributes. The ontology offers a semantic, computable framework for encoding appendicectomy-specific clinical procedures and their associated resources. Conclusion: By systematically representing this knowledge, this study establishes a foundation for enhancing clinical decision making, improving data integration, and ultimately advancing patient care. Future research can leverage this ontology to optimise healthcare workflows and outcomes in appendicectomy management. [ABSTRACT FROM AUTHOR]

Objective: This retrospective observational diagnostic accuracy study aims to demonstrate that open-access rapid-sequence non-contrast magnetic resonance imaging (MRI) is accurate for exclusion or confirmation of acute appendicitis (AA). Methods: In 2017, a locally designed 12 min MRI protocol was made available as a new open-access option (no booking needed) for any emergency department (ED) or acute surgical patient with any clinical presentation at the authors' sites. Uninterrupted single-radiologist reporting availability was provided. A 5-year consecutive report list from 1 January 2019 to 31 December 2023 was recorded in an activity log, from which 3478 eligible reports were identified as ED-based referrals assessing for possible AA. There was "appendicitis possibility" in 581/3478 (17%) reports and "no evidence of appendicitis" in 2897/3478 (83%). These were retrospectively compared with the medical record findings of 557/3478 proven cases of AA (16%). Report availability and reliability metrics have been assessed. Results: Overall, 2583/3478 reports (74%) were finalized within 2 h of MRI study completion, 3254/3478 (94%) within 4 h. The 3478 reports combined had 98% sensitivity, 98% specificity, 98% accuracy, 94% positive predictive value, and 99% negative predictive value for AA (φ = 0.95). The largest 5-year subgroup, females 15–19 years old, 66/440 with proven AA, had 98% report accuracy. Pregnant women, 21/171 with proven AA, had 99% report accuracy. Conclusions: The described MRI protocol is accurate for appendicitis assessment and is a suitable first-imaging choice for children, young adults, and pregnant women. It does not require intravenous contrast and poses no radiation risk. [ABSTRACT FROM AUTHOR]

We aimed to explore the abnormal pathology findings in appendix specimens removed based on intraoperative abnormal appearance during elective surgery for benign gynaecological conditions by a minimally invasive gynaecologist, as well as the associated complication rate. Materials and Methods: This retrospective cohort study was conducted in a tertiary referral surgical centre for benign gynaecological conditions between the years 2004– 2023. It included patients who underwent appendicectomy by a trained minimally invasive gynaecologist based on observations during surgery for benign gynaecological conditions. Data included demographic, clinical, surgical and pathological information followed by postoperative complication data obtained from electronic medical records and direct communication with surgical colleagues. The primary outcome was the evaluation of the abnormal pathological findings in the appendix. The secondary outcome was the complication rate associated with appendicectomy in these cases. Results: The study cohort included 34 women who met inclusion criteria and underwent a laparoscopic surgery for endometriosis, chronic pelvic pain or a benign ovarian mass. Indications for appendicectomy included twelve cases (38.2%) with apparent appendiceal immobility (stiffness), fourteen cases (41.2%) with an appendix adherent to ovaries or the pelvic side walls, and seven cases (20.6%) with an abnormal appearance (large, wide, long, coiled, or curved). Pathological findings revealed six cases (17.6%) of acute or chronic appendicitis, four cases (11.8%) of endometriosis, five cases (14.7%) of abnormal pathological conditions, and three cases (8.8%) of cancer (two cases of well-differentiated adenocarcinoma and one case of low-grade appendiceal mucinous cystadenoma). Postoperative complication rate was 5.8% (two cases). Conclusion: This study supports incorporating appendicectomy by trained gynaecological specialists during gynaecological elective surgery when abnormal findings are encountered. Further research and guidelines in this area can provide even greater clarity and direction for the future of gynaecological surgical practice. [ABSTRACT FROM AUTHOR]

Background: A diagnosis of appendicitis is confirmed by histomorphological examination of the specimen. This study aims to assess the incidence of common and incidental findings in the appendix on gross and microscopic examination. Materials and Methods: For each specimen assessed, we recorded a brief clinical history, placed the specimens in 10% buffered formalin for fixation, and performed a thorough gross examination. Later, the tissue bits were processed using the conventional histopathological technique, followed by hematoxylin and eosin staining. The histomorphological findings were correlated with the clinical diagnosis. Results: A total of 156 appendix specimens were studied. The sample was predominantly male (n = 112, 71.8%) with those aged between 11 and 20 years, constituting the largest age group (n = 75, 48.1%). More than half of the cases (n = 102, 65.4%) presented with right iliac fossa pain. Acute appendicitis was the most common diagnosis (n = 58, 37.2%), followed by acute gangrenous appendicitis with perforation (n = 23, 14.7%) and periappendicitis (n = 20, 12.8%). Diagnosis of chronic appendicitis, acute on chronic appendicitis, and eosinophilic appendicitis was made in 20 (12.8%), 19 (12.2%), and 7 (4.5%) cases, respectively. Two cases (1.3%) each of diverticulum, mucocele, and lymphoid hyperplasia were present. Finally, 1 case (0.6%) each of fibrous obliteration, Enterobius vermicularis, mucinous cystadenoma, and carcinoid were reported. Granulomatous appendicitis and normal appendix were seen in 3 (1.9%) cases each. Conclusions: Acute appendicitis, chronic appendicitis, and granulomatous appendicitis are the most common diagnoses following pathological examination of the resected appendix. However, rare findings such as diverticulum, parasitic infestations, and tumors of the appendix were also found. Our findings highlight the importance of histomorphological analysis of the appendix to diagnose incidental findings that may be missed clinically.

Background and Aims: Despite contemporary discussion on the clinical presentation, imaging studies, indications of appendicectomy, and the best available approach, a diagnostic delay due to atypical presentations of appendicitis in preschool children is the current main cause of morbidity or mortality. Our aim is to reevaluate the present scenario of pediatric appendicitis and management strategies in our institution. MATERIALS AND METHODS: The study was conducted with hospital records of 128 patients (below the age of 12 years) with appendicitis, who were managed (surgically or conservatively) in our institute during the last five years. Basic demographic data, presenting symptoms, radiological findings, mode of intervention, records of perioperative hospital care, and outcome were cumulated and inspected. Results: Among 128 cases, 37 (28.9%) had complications at presentation. Complicated appendicitis was more consistent with younger and higher C-reactive protein (CRP) at presentation. For 48 patients (37.5%), laparoscopic surgery was used; open surgery was performed in the other cases. Both open and laparoscopic surgeries had a similar rate of postoperative complications. Compared to laparoscopy, the open approach sometimes required longer hospital stays (97 hours vs 64 hours). Patients with appendicular perforation or abscess had 1.37- and 1.33-fold higher chance of requiring to stay in the hospital for more than 72 hours, respectively. There were found to be 3.83 and 8.33 times higher odds for the same patients to be readmitted within 28 days of surgery due to complications. Conclusion: Appendicular perforation or abscess occurs in every fourth child. A raised CRP at admission highly predicted the complicated appendicitis. Complicated appendicitis consistently increases hospital stay and readmission rates. Postoperative complication rates are more or less the same with either open or laparoscopy except for the duration of the hospital stay (more in open surgery).

Background: Surgeons are sometimes reluctant to manage uncomplicated appendicitis non‐operatively. Reasons cited include the risk of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long‐term efficacy of antibiotic versus operative management of appendicitis. Method: One‐year follow‐up of patients enrolled in the multicentre, COVID:HAREM cohort study during March‐June 2020 was performed. Initial operative or non‐operative management was determined on a case‐by‐case basis by the responsible surgeon. Outcomes were appendicectomy rate at 1‐year, histology of removed appendix and predictors of unsuccessful antibiotic treatment. Results: A total of 625 patients who had non‐operative management were included. Emergency appendicectomy had been performed by 1‐year in 24% (149/625), with a median time to appendicectomy of 12 days [IQR 1–77] from presentation. Thirty‐one patients had elective appendicectomy. Normal histology was reported in 6% of emergency procedures and 58% of elective ones. There were 7 malignancies and 3 neuroendocrine tumors identified at histology. All patients with malignant histology had ≥1 risk factors for malignancy at initial presentation. Faecolithiasis (hazard ratios (HR) 2.3, 95% confidence intervals (CI) 1.51–3.49) and a high Adult Appendicitis Score (AAS >16; HR 2.44, 95% CI 1.52–3.92) were independent risk factors for unsuccessful non‐operative management. Conclusion: At 1 year, 71% of patients managed non‐operatively did not undergo an appendicectomy. Recurrence of appendicitis was associated with faecolithiasis and a high AAS. Patients at higher risk for appendiceal malignancy should have targeted follow‐up. These factors should be considered when counseling patients on non‐operative management. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Discussion Borderline ovarian tumours (BOT) are a common epithelial ovarian tumours. Typically diagnosed at an early stage with a good prognosis, many BOT are treated conservatively. Recurrence is common. This update to our last audit in 1997 represents one of the largest audits of BOT to date.All patients with BOT managed at ‘the hospital’ from 1984 to 2021 were included. Expert pathology review was available.There were 549 cases included. The recurrence rate was 5% (n = 29/549) with 1.4% (n = 8/549) undergoing malignant transformation. Three of the eight women who recurred as cancer died from their disease. Frozen section was predictive of histologic diagnosis in 92% (n = 55/60) of serous tumours (SBOT), but only 62% (n = 54/87) of mucinous tumours (MBOT). In MBOT where the appendix appeared normal intra‐operatively, it was histologically benign in all cases (n = 63). In SBOT, the recurrence rate was 5/23 (22%), 12/52 (23%), 1/29 (3%) and 3% (P = <0.01) for unilateral cystectomy, unilateral oophorectomy ± cystectomy, bilateral oophorectomy, and bilateral oophorectomy with hysterectomy, respectively, as index procedure. In MBOT this correlated to 2/20 (10%), 3/93 (3%), 0 and 1/58 (2%), respectively.This study describes important information correlating first surgical procedure and fertility‐sparing surgery to recurrence and malignant transformation. For all BOT subtypes, fertility‐preserving surgery increased the risk of recurrence and hysterectomy was not superior to removal of both ovaries. In MBOT, frozen section is of limited utility and the macroscopically normal appendix is very unlikely to be anything but benign, if MBOT is the true histologic diagnosis. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common aetiology of acute abdomen in children. Our aim is to describe the accuracy of diagnosis, and complications in a limited resources setting in children between 5 and 14 years old at the only tertiary referral hospital in the West region of Afghanistan. Methods: A retrospective study for a period of 1 year (21 March 2015–20 March 2016). Data was collected from patients' files. Data were analysed by epi info 7. Results: We identified 774 children who had appendectomies at Herat Regional Hospital during the study period with complete records available for analysis. The median age was 11 years [5–14]. The rate of positive appendectomy was 87%. 72% of appendectomies were done within 24 h of the onset of symptoms. Of 675 positive appendectomies, the most common clinical features were migratory abdominal pain (90%), nausea/vomiting (80%), RLQ tenderness (90%), and rebound tenderness (81%). Among the 99 negative appendectomies, the most common signs and symptoms were anorexia 68%, nausea/vomiting 59%, RLQ tenderness 79%, and rebound tenderness 43%. 98% of positive and 71% of negative appendectomies had elevated WBC count. Post appendectomy complications occurred in 9% of our patients mostly commonly intra‐abdominal abscesses (5%). Conclusion: Although the diagnosis of acute appendicitis is challenging in children and may involve sophisticated imaging techniques, in many settings these are unavailable. Classical manifestations such as migratory abdominal pain, abdominal tenderness, nausea, and simple lab tests play a crucial role in the diagnosis of acute appendicitis in low resource environments. [ABSTRACT FROM AUTHOR]

Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15 h (13.51–31.48), 18.47 h (10.44–29.42), and 13.04 (8.13–24.10) h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24 h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that the human vermiform appendix is not a vestigial organ but rather an immunological organ of biological relevance. It is hypothesised that the appendix acts as a bacterial 'safe house' for commensal gut bacteria and facilitates re-inoculation of the colon after disruption through the release of biofilms. To date, no studies have attempted to explore this potential mechanistic function of the appendix. We conducted a pre-post intervention study in adults (n = 59) exploring re-establishment of the gut microbiota in those with and without an appendix after colonic disruption via bowel preparation and colonoscopy. Gut microbiota composition was measured one week before and one month after bowel preparation and colonoscopy using 16S rRNA sequencing. We observed between group differences in gut microbiota composition between those with (n = 45) and without (n = 13) an appendix at baseline. These differences were no longer evident one-month post-procedure, suggesting that this procedure may have 'reset' any potential appendix-related differences between groups. Both groups experienced reductions in gut microbiota richness and shifts in beta diversity post-procedure, with greater changes in those without an appendix, and there were five bacterial genera whose re-establishment post-procedure appeared to be moderated by appendicectomy status. This small experimental study provides preliminary evidence of a potential differential re-establishment of the gut microbiota after disruption in those with and without an appendix, warranting further investigation into the potential role of the appendix as a microbial safe house. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background and Aims: Despite contemporary discussion on the clinical presentation, imaging studies, indications of appendicectomy, and the best available approach, a diagnostic delay due to atypical presentations of appendicitis in preschool children is the current main cause of morbidity or mortality. Our aim is to reevaluate the present scenario of pediatric appendicitis and management strategies in our institution. Materials and Methods: The study was conducted with hospital records of 128 patients (below the age of 12 years) with appendicitis, who were managed (surgically or conservatively) in our institute during the last five years. Basic demographic data, presenting symptoms, radiological findings, mode of intervention, records of perioperative hospital care, and outcome were cumulated and inspected. Results: Among 128 cases, 37 (28.9%) had complications at presentation. Complicated appendicitis was more consistent with younger and higher C-reactive protein (CRP) at presentation. For 48 patients (37.5%), laparoscopic surgery was used; open surgery was performed in the other cases. Both open and laparoscopic surgeries had a similar rate of postoperative complications. Compared to laparoscopy, the open approach sometimes required longer hospital stays (97 hours vs 64 hours). Patients with appendicular perforation or abscess had 1.37- and 1.33-fold higher chance of requiring to stay in the hospital for more than 72 hours, respectively. There were found to be 3.83 and 8.33 times higher odds for the same patients to be readmitted within 28 days of surgery due to complications. Conclusion: Appendicular perforation or abscess occurs in every fourth child. A raised CRP at admission highly predicted the complicated appendicitis. Complicated appendicitis consistently increases hospital stay and readmission rates. Postoperative complication rates are more or less the same with either open or laparoscopy except for the duration of the hospital stay (more in open surgery). [ABSTRACT FROM AUTHOR]

Background: Appendicectomy is a common surgical procedure for children presenting with appendicitis. Understanding the impact of appendicectomy on daily activities and social life is crucial for optimizing patient outcomes. Aims and Objectives: This study aimed to assess the impact of appendicectomy on children’s daily activities and social lives. Materials and Methods: A retrospective analysis was conducted of patients aged ≥5 years who underwent appendicectomy at our center between April 2022 and April 2023. Data on demographics, surgical approach (open or laparoscopic), post-operative outcomes, and return to daily activities were collected using a standardized questionnaire. Results: Among the 70 identified cases, there was a male predominance (63%), with most presenting with acute appendicitis (85%). Laparoscopic appendectomy was the predominant surgical approach used (80%). Post-operative symptoms included pain (n=12), vomiting (n=3), fever (n=2), and wound infection (n=6). Appendicular abscesses were found in 9% of laparoscopic surgeries and 14% of open surgeries. The average duration of hospital stay was shorter in laparoscopic cases. Return to school and normal diet varied between surgical approaches, with laparoscopic cases generally showing a quicker recovery. Conclusion: Although appendicectomy is commonly performed, it has implications for children’s daily routines and social interactions. Parental anxiety plays a crucial role in post-operative recovery. Future studies should focus on addressing these social determinants to optimize patient outcomes.

Introduction: Right hemicolectomy (RHC) remains the treatment standard for goblet cell adenocarcinoma (GCA), despite limited evidence supporting survival benefit. This study aims to explore factors influencing surgical management and survival outcomes among patients treated with RHC or appendicectomy using NCRAS (UK) and SEER (USA) data. Methods: A retrospective analysis was conducted using 998 (NCRAS) and 1703 (SEER) cases. Factors influencing procedure type were explored using logistic regression analyses. Overall survival (OS) probabilities and Kaplan–Meier (KM) plots were generated using KM analysis and the log-rank test compared survival between groups. Cox regression analyses were performed to assess hazard ratios. Results: The NCRAS analysis revealed that age and regional stage disease were determinants of undergoing RHC, with all age groups showing similar odds of receiving RHC, excluding the 75+ age group. The SEER analysis revealed tumour size > 2 cm, and receipt of chemotherapy were determinants of undergoing RHC, unlike the distant stage, which was associated with appendicectomy. Surgery type was not a significant predictor of OS in both analyses. In NCRAS, age and stage were significant predictors of OS. In SEER, age, stage, and Black race were significant predictors of worse OS. Conclusions: The study shows variations in the surgical management of GCA, with limited evidence to support a widespread recommendation for RHC.

Abstract Introduction Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. Aim To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. Methods A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Results Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were 48 h after admission. The time-of-day which surgery is performed does not impact outcomes.

Introduction: Goblet cell carcinoid (GCC) is a rare and poorly understood appendiceal neoplasm, exhibiting mixed histological and aggressive clinical features. Current guidelines recommend right hemicolectomy in all cases, although there is conflicting evidence that appendicectomy alone may be sufficient. This review aims to identify the optimal surgical management for appendiceal GCC. Methods: A systematic review was performed by searching MEDLINE, Embase, Scopus and the Cochrane Register of Controlled Trials. Randomised controlled trials, cohort studies or large case series (>5 patients) reporting clinical outcomes for patients undergoing surgical management of GCC of the appendix were included. Outcomes extracted included participant and tumour characteristics, type of surgery and survival data. Results: A total of 1341 studies were retrieved. After duplicate removal, 796 titles were screened for relevance prior to abstract and full text review. A total of six studies were included for analysis, comprising 3177 patients—1629 females and 1548 males. The median age ranged from 51 to 72 years. A total of 2329 patients underwent right hemicolectomy, while 824 were treated with appendicectomy only. Overall, the included studies report increased survival in patients undergoing right hemicolectomy compared to appendicectomy alone. A meta-analysis was not possible due to insufficient data reported in the published literature to date. Conclusions: There is no consensus regarding the optimal surgical management of appendiceal GCC, as outcomes-based data comparing surgical interventions are lacking. It is possible that some patients with favourable features are overtreated. The absence of robust evidence to support a more conservative approach means that right hemicolectomy remains the standard of care for all patients, in keeping with current international guidelines. The rarity of this condition and limited data in the published studies remain barriers to evidence-based best clinical practice. [ABSTRACT FROM AUTHOR]

Background: Appendicectomy is a common surgical procedure for children presenting with appendicitis. Understanding the impact of appendicectomy on daily activities and social life is crucial for optimizing patient outcomes. Aims and Objectives: This study aimed to assess the impact of appendicectomy on children's daily activities and social lives. Materials and Methods: A retrospective analysis was conducted of patients aged ≥5 years who underwent appendicectomy at our center between April 2022 and April 2023. Data on demographics, surgical approach (open or laparoscopic), post-operative outcomes, and return to daily activities were collected using a standardized questionnaire. Results: Among the 70 identified cases, there was a male predominance (63%), with most presenting with acute appendicitis (85%). Laparoscopic appendectomy was the predominant surgical approach used (80%). Post-operative symptoms included pain (n=12), vomiting (n=3), fever (n=2), and wound infection (n=6). Appendicular abscesses were found in 9% of laparoscopic surgeries and 14% of open surgeries. The average duration of hospital stay was shorter in laparoscopic cases. Return to school and normal diet varied between surgical approaches, with laparoscopic cases generally showing a quicker recovery. Conclusion: Although appendicectomy is commonly performed, it has implications for children's daily routines and social interactions. Parental anxiety plays a crucial role in post-operative recovery. Future studies should focus on addressing these social determinants to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Background: A diagnosis of appendicitis is confirmed by histomorphological examination of the specimen. This study aims to assess the incidence of common and incidental findings in the appendix on gross and microscopic examination. Materials and Methods: For each specimen assessed, we recorded a brief clinical history, placed the specimens in 10% buffered formalin for fixation, and performed a thorough gross examination. Later, the tissue bits were processed using the conventional histopathological technique, followed by hematoxylin and eosin staining. The histomorphological findings were correlated with the clinical diagnosis. Results: A total of 156 appendix specimens were studied. The sample was predominantly male (n = 112, 71.8%) with those aged between 11 and 20 years, constituting the largest age group (n = 75, 48.1%). More than half of the cases (n = 102, 65.4%) presented with right iliac fossa pain. Acute appendicitis was the most common diagnosis (n = 58, 37.2%), followed by acute gangrenous appendicitis with perforation (n = 23, 14.7%) and periappendicitis (n = 20, 12.8%). Diagnosis of chronic appendicitis, acute on chronic appendicitis, and eosinophilic appendicitis was made in 20 (12.8%), 19 (12.2%), and 7 (4.5%) cases, respectively. Two cases (1.3%) each of diverticulum, mucocele, and lymphoid hyperplasia were present. Finally, 1 case (0.6%) each of fibrous obliteration, Enterobius vermicularis , mucinous cystadenoma, and carcinoid were reported. Granulomatous appendicitis and normal appendix were seen in 3 (1.9%) cases each. Conclusions: Acute appendicitis, chronic appendicitis, and granulomatous appendicitis are the most common diagnoses following pathological examination of the resected appendix. However, rare findings such as diverticulum, parasitic infestations, and tumors of the appendix were also found. Our findings highlight the importance of histomorphological analysis of the appendix to diagnose incidental findings that may be missed clinically. [ABSTRACT FROM AUTHOR]

Introduction: Right hemicolectomy (RHC) remains the treatment standard for goblet cell adenocarcinoma (GCA), despite limited evidence supporting survival benefit. This study aims to explore factors influencing surgical management and survival outcomes among patients treated with RHC or appendicectomy using NCRAS (UK) and SEER (USA) data. Methods: A retrospective analysis was conducted using 998 (NCRAS) and 1703 (SEER) cases. Factors influencing procedure type were explored using logistic regression analyses. Overall survival (OS) probabilities and Kaplan–Meier (KM) plots were generated using KM analysis and the log-rank test compared survival between groups. Cox regression analyses were performed to assess hazard ratios. Results: The NCRAS analysis revealed that age and regional stage disease were determinants of undergoing RHC, with all age groups showing similar odds of receiving RHC, excluding the 75+ age group. The SEER analysis revealed tumour size > 2 cm, and receipt of chemotherapy were determinants of undergoing RHC, unlike the distant stage, which was associated with appendicectomy. Surgery type was not a significant predictor of OS in both analyses. In NCRAS, age and stage were significant predictors of OS. In SEER, age, stage, and Black race were significant predictors of worse OS. Conclusions: The study shows variations in the surgical management of GCA, with limited evidence to support a widespread recommendation for RHC. [ABSTRACT FROM AUTHOR]

Purpose: Surgery wait times after diagnosis of appendicitis are an important factor influencing the success of a patient's treatment. The proposed study will be a quantitative multicenter retrospective cohort design with the primary aim of assessing the difference between appendicectomy wait times between rural and urban hospitals in Western Australia and the effect of this on operative outcomes. Selected outcome measures will be examined by time from initial presentation at an emergency department to the patient being diagnosed and then time of diagnosis to surgery being performed. The secondary aim is to compare rates of negative appendicectomies between hospitals. Methods: Appendicectomy patients will be identified from operating room register by medical student data collectors; then, each respective hospital's emergency room data collection will subsequently be accessed to complete case report forms based on demographics and clinical findings, pre-operative investigations, and management and follow-up. Case report forms with > 95% completeness will be accepted for pooled analysis. The expected duration of retrospective data collection will be 8 months. This study RGS6483 has received HREC approval by the Royal Perth Hospital HREC Ethics Committee, with a waiver of consent obtained and the HREC was notified of amendments to the protocol made on April 21, 2024. Dissemination of results. Data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. No patient-identifiable data will be entered into the system. Results will subsequently be shared via scientific journal publication and presentation at relevant meetings. [ABSTRACT FROM AUTHOR]

Introduction: Appendicectomy remains the standard treatment for appendicitis. There is a lack of clarity on the timeframe in which surgery should be performed to avoid unfavourable outcomes. Aim: To perform a systematic review and network meta-analysis to evaluate the impact the (1)time-of-day surgery is performed (2), time elapsed from symptom onset to hospital presentation (patient time) (3), time elapsed from hospital presentation to surgery (hospital time), and (4)time elapsed from symptom onset to surgery (total time) have on appendicectomy outcomes. Methods: A systematic review was performed as per PRISMA-NMA guidelines. The time-of-day which surgery was done was divided into day, evening and night. The other groups were divided into < 24 h, 24–48 h and > 48 h. The rate of complicated appendicitis, operative time, perforation, post-operative complications, surgical site infection (SSI), length of stay (LOS), readmission and mortality rates were analysed. Results: Sixteen studies were included with a total of 232,678 patients. The time of day at which surgery was performed had no impact on outcomes. The incidence of complicated appendicitis, post-operative complications and LOS were significantly better when the hospital time and total time were < 24 h. Readmission and mortality rates were significantly better when the hospital time was < 48 h. SSI, operative time, and the rate of perforation were comparable in all groups. Conclusion: Appendicectomy within 24 h of hospital admission is associated with improved outcomes compared to patients having surgery 24–48 and > 48 h after admission. The time-of-day which surgery is performed does not impact outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis remains the most common surgical emergency worldwide. There has been a low uptake of laparoscopic appendicectomy in the South African public sector. Preoperative identification of cases of uncomplicated appendicitis that are amenable to a laparoscopic approach may facilitate the implementation of laparoscopic appendicectomy programs in training hospitals. With limited access to preoperative imaging, alternative strategies for this preoperative prediction are needed. Methods: A retrospective audit of patients over the age of 12 years with a histologically confirmed diagnosis of acute appendicitis over a 5‐year period was performed. Patients were categorized as uncomplicated or complicated appendicitis and C‐reactive protein (CRP) and white cell count (WCC) reviewed. Receiver operating characteristics curves were constructed for these blood tests and acute appendicitis severity. Youden's J statistic was used to determine optimal cut off values for diagnosing complicated appendicitis. Results: 358 patients had confirmed appendicitis and complete blood results. Of these, 189 (52.79%) had complicated appendicitis with a 40.22% perforation rate. Median CRP in uncomplicated and complicated groups were 68 mg/L (IQR 19–142) and 216 mg/L (IQR 103–313) with an area under the curve (AUC) of 0.75 (95% CI: 0.70–0.80). The median WCC in the two groups were 12.6 × 109 cells/L (IQR 9.9–15.6) and 14.4 × 109 cells/L (IQR 11.5–18.28) with an AUC of 0.61 (95% CI: 0.56–0.67). The optimal cut off value for CRP was found to be 110 mg/L with a sensitivity of 74.74% and specificity of 69.23%. Conclusion: A cutoff value of 110 mg/dl CRP can distinguish patients with early appendicitis from those with complicated disease and when used in conjunction with clinical assessment may help identify patients in whom laparoscopic appendicectomy is appropriate. [ABSTRACT FROM AUTHOR]

Aim: There is currently an increased focus on competency‐based training, in which training and assessment play a crucial role. The aim of this systematic review is to create an overview of hands‐on training methods and assessment tools for appendicectomy and colon and rectal surgery procedures using either an open, laparoscopic or robot‐assisted approach. Method: A systematic review of Medline, Embase, Cochrane and Scopus databases was conducted following the PRISMA guidelines. We conducted the last search on 9 March 2023. All published papers describing hands‐on training, evaluation of performance data and development of assessment tools were eligible. The quality of studies and the validity evidence of assessment tools are reported. Results: Fifty‐one studies were identified. Laparoscopic assessment tools are abundant, but the literature still lacks good‐quality assessment tools for open appendicectomy, robotic colectomy and open rectal surgery. Overall, there is a lack of discussion regarding the establishment of pass/fail standards and the consequences of assessment. Virtual reality simulation is used more for appendicectomy than colorectal procedures. Only a few of the studies investigating training were of acceptable quality. There is a need for high‐quality studies in open and robotic‐assisted colon surgery and all approaches to rectal surgery. Conclusion: This review provides an overview of current training methods and assessment tools and identifies where more research is needed based on the quality of the studies and the current validity evidence. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common surgical emergencies. Incidental appendiceal findings without any prior clinical or radiological diagnosis are still challenging. Histopathological diagnosis can help in avoiding further complications for patient safety. Methods: A retrospective study of 504 resected appendices done in Al Emadi Hospital Doha, Qatar, during the four years from January 2016 to December 2019 and diagnosed as appendicitis underwent pathological examination that revealed confirm appendicitis in 471 (93.5%) cases while 33 (6.5%) of cases showed unusual pathological findings that did not detect either clinically or radiologically. Results: Out of 504 specimens of the appendix, appendicitis accounted for 93.5% with peak occurrence at the age group of 20 to 40 years and female predominance. Suppurative appendicitis (47.8%) was the most common findings. It was found an incidental finding in 33 (6.5%) cases, 21 (4.1%) cases were appendicitis obliterans, three (0.6%) cases were a well-differentiated neuroendocrine tumor, three (0.6%) cases were low grade appendiceal mucinous neoplasm, three (0.6%) cases were diverticulosis, two (0.4%) cases were granuloma of the appendix, and one (0.2%) case was diagnosed as eosinophilic appendicitis. Conclusions: Routine histopathoogical examination of appendectomy specimens are of value to discover unusual pathologies that require further postoperative management. Gross examination alone is not a good indicator of an unexpected finding. [ABSTRACT FROM AUTHOR]

Laparoscopic appendicectomy was performed on 15,983 patients in 2021 in Japan, of whom only 2,598 (16.2%) underwent a single-site appendicectomy. In our center, the basic strategy for patients with appendicitis is to start with a singlesite laparoscopic approach. Additional ports or ileocecal resection can be utilized depending on the intraoperative abdominal condition. In this study, we reviewed retrospectively the outcomes of the 85 consecutive patients, who underwent a single-site laparoscopic approach for appendicitis between April 2020 and March 2022 in our center. The single-site approach was completed in 94% of patients. The final surgical procedures included appendicectomy in 68 cases (80%), partial cecal resection in 7 cases (8.2%), and ileocecal resection in 10 cases (11.8%). The median operative time was 79 minutes, and the median blood loss was 0 ml. Pathological inflammation status was gangrenous appendicitis in 37 cases, phlegmonous appendicitis in 34 cases, chronic appendicitis in 6 cases, and appendiceal diverticulitis in 3 cases. Postoperative complications were observed in 13 cases without Grade IIIb or higher complications (Clavien-Dindo classification). The median post-operative hospital stay was 5 days. The single-site approach is safe and feasible to allow intraoperative modification of the extended procedure according to the inflammation condition. [ABSTRACT FROM AUTHOR]

The unexpected global overload of the health system during COVID-19 pandemic has caused changes in management of acute appendicitis worldwide. Whereas conservative treatment was widely recommended, the appendicectomy remained standard therapy in Germany. We aimed to investigate the impact of COVID-19 pandemic on treatment routine for acute appendicitis at University Hospital of Magdeburg.

Background: Appendicitis in pancreatic transplant recipients can be challenging to diagnose and manage. Incidental appendicectomy (IA) during pancreas transplantation obviates the risk of appendicitis but potentially at the cost of increased operating time or early post‐operative complications. This study reviewed the value of IA at a single center. Methods: This was a retrospective study of patients who underwent a pancreas transplant in our unit from January 1st, 2012 to December 31st, 2020, with end of follow‐up on May 21st, 2023; recipients were grouped by whether or not an IA was performed during pancreas transplantation. Donor, recipient, operative, and graft outcomes were compared between the two groups. Post‐transplant complications related to appendiceal pathology (or IA) were recorded and classified. Results: Two hundred forty‐three patients underwent a pancreas transplant; 227 (93%) patients had an appendix in situ at transplantation, and of these 53 (23%) underwent an IA and 174 (77%) did not. There were no statistically significant differences in operative time (p =.06) or hospital stay (p =.50) between the two groups. In the IA cohort, there were no Clavien‐Dindo Grade III‐V complications relating to the appendicectomy. In those that did not undergo an IA, two patients (1%) subsequently required appendicectomy due to appendicitis. Comparison of pancreatic graft survival showed no statistically significant difference between the groups (p =.44). Conclusions: This study suggests that IA is effective at reducing risks of post‐transplant appendiceal complications without significantly prolonging inpatient stay or impairing graft survival. These data support the consideration of undertaking an IA for all patients undergoing a pancreas transplant. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is expected to occur in about 6% of people during their lifetime. The most useful diagnostic techniques are still routine medical history and examination; Post surgery, after the specimen has been examined histopathologically, the final diagnosis is achievable. Systems of scoring are useful and valid for separating acute appendicitis from generalized abdominal pain and can help reduce unwanted surgery, particularly in remote areas. Aims: 1. To evaluate the efficacy of the Alvarado scoring system as a preoperative diagnostic tool in acute appendicitis, in relation to operative and histopathological findings. 2. To determine the role of the Alvarado scoring system in cutting down the rate of negative appendicectomy without increasing morbidity and mortality. 3. To know the specificity and sensitivity of the Alvarado scoring system in the diagnosis of acute appendicitis. Methods: A prospective study of 50 patients who presented with symptoms and signs of acute appendicitis and suspected enough to warrant surgery for acute appendicitis admitted in DR. PSIMS & RF under various surgical units from November 2018 to October 2020 were selected. Results: In our study, migratory pain was noted in 80% of patients in this study. In this study, anorexia was noted in 60% of cases, rebound tenderness was found in 82% of cases, 37% of cases with a fever over 99°F had appendicitis, 80% of patients had leukocytosis, and leukocyte shift to the left was observed. Sensitivity, specificity, and positive predictive value (PPV) were 77.2%, 66.6%, and 94.4% in this study. Conclusion: This study concluded that the Alvarado score is a reliable, cheap, and reproducible tool for the diagnosis of acute appendicitis in the emergency room. [ABSTRACT FROM AUTHOR]

Background: In the most severe stage of endometriosis, Stage IV, intestinal involvement is common. The true prevalence of endometriotic disease of the appendix in this population is not well described. A macroscopically normal looking appendix may harbour endometriosis. Aims: Our study aims to assess the role of routinely performing appendicectomy in Stage IV endometriosis surgery, and the histopathological prevalence of true appendiceal endometriosis in this population. Methods: This is a retrospective study of women undergoing surgery for Stage IV endometriosis between 2018 to 2022 in a tertiary public hospital in New South Wales, Australia. Patient demographics, age and post‐operative complications were retrospectively retrieved from hospital medical records. Inclusion criteria were women with Stage IV endometriosis who underwent routine appendicectomy as part of their endometriosis surgery. Exclusion criteria were women who did not have Stage IV endometriosis, those who had cancer surgery or emergency surgery for endometriosis. The primary outcome of this study was to determine the incidence of appendiceal endometriosis. Secondary outcomes included post‐operative complications and length of stay. Results: Sixty‐seven patients were included. The mean age was 36 years. All patients also underwent bowel resection for colorectal endometriosis. There were 35.8% who had confirmed appendiceal endometriosis on histopathology. Post‐operative complications included port site infections, colitis, urinary tract infection and ureteric injury. There were no complications related to appendicectomy. Mean length of stay was 4.4 days. Conclusion: Laparoscopic appendicectomy can be safely performed at time of laparoscopic surgical excision of Stage IV endometriosis and should be routinely considered in a subset of Stage IV endometriosis patients with colorectal involvement undergoing surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence of occult appendiceal neoplasm in patients aged 40 years and over who underwent appendicectomy for appendicitis. Methods: The clinical coding electronic database was used to identify patients aged 40 years and over who were diagnosed with appendicitis from September 2010 to September 2022. Patients were included if they were managed operatively. Design: Retrospective cohort study. Setting: Modified Monash category 3 (large rural town). Participants: Patients aged 40 years and over undergoing appendicectomy for appendicitis. Main Outcome Measures: Incidence of appendiceal neoplasm within appendicectomy specimen. Results: A total of 279 patients aged 40 years and over underwent appendicectomy, with a median age of 53 years (range 40–95). Nineteen patients (7%) were found to have a primary neoplastic lesion within the appendix: seven neuroendocrine neoplasms (37%), six sessile serrated lesions (32%), two colonic‐type adenocarcinoma (11%), two goblet cell adenocarcinoma (11%) and two appendiceal mucinous neoplasms (11%). Additionally, one patient had a metastatic adenocarcinoma of pancreaticobiliary aetiology. Conclusions: Occult appendiceal neoplasm was higher than reported in the literature in our cohort. This would support appendicectomy as the treatment of choice for patients aged 40 years and over with acute appendicitis and caution against nonoperative management in this demographic. [ABSTRACT FROM AUTHOR]

One of the most performed emergency abdominal surgeries is appendicectomy. Studies show that serum bilirubin is raised in acute appendicitis and appendicular perforation, the significance of which has not been stressed. The purpose of the study is to find the relation between them. To study the relationship between hyperbilirubinemia and acute appendicitis; and to evaluate its credibility as a diagnostic marker for acute appendicitis and perforation. Case series analysis. This study was conducted in a tertiary hospital S.C.B. Medical College, Cuttack from October 2019 to October 2021. One hundred-fifty patients with clinical diagnosis acute appendicitis or appendicular perforation were randomly sampled. Serum bilirubin and liver function tests were carried out in the patients opting for the study. The mean total serum bilirubin was 1.771 SD0.92mg/dl which was above >1.0 mg/dl representing hyperbilirubinemia. Amongst the 117 patients diagnosed with acute appendicitis, 74 patients (63.24%) were found to have elevated bilirubin (mean 1.49 SD0.63 mg/dl) whereas in patients diagnosed with appendicular perforation (n = 33), 28 patients (84.8%) had bilirubin elevated (mean 2.77 SD1.08 mg/dl). The cut-off value of serum bilirubin was found to be 2.15 mg/dl above which complications occur. The sensitivity and specificity of bilirubin in diagnosing acute appendicitis and appendicular perforation were 71.96% and 38.88% respectively. The p-value is 0.001 suggesting a positive correlation. Serum bilirubin can be a useful investigation as it can be done easily and is less expensive. Patients with raised bilirubin of three or more times the normal bilirubin value and clinical signs of appendicitis and appendicular perforation have a higher probability of having complicated appendicitis on histopathological report. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common surgical emergency in children. Eighty percent of paediatric appendicectomies are performed by adult general surgeons on an annual basis. The remaining 20% are performed at Children's Health Ireland (CHI) centres. Occasionally patients are transferred from Non-Specialist Paediatric Surgical Centres (NSPSC) for specialised pre-operative or post-operative care. Aim: To assess the rates of and characterise appendicitis-related referrals to CHI at Crumlin from NSPSC. Methods: A retrospective review of all appendicitis-related transfers to CHI at Crumlin between January 2020 and December 2021 was performed. Data relating to indications for transfer, referring hospital level, patient demographics, management, type of surgery, length of stay (LOS), and radiological studies were collected and analysed. Results: Seventy-two patients were transferred to CHI at Crumlin over the 2-year period. A total of 60.9% were male, mean age 9 ± 4.3 years, mean LOS 6.0 ± 2.2 days (range 1–30 days). Nineteen percent were under 5 years of age. Seventy-three percent were transferred from level 4 centres. Ninety-seven percent were transferred pre-operatively, 25% of those transferred pre-operatively had imaging in CHI confirming appendicitis. Fifty-five percent (40/72) of patients had pre-operative imaging performed. A total of 37.5% (15/40) confirmed complicated appendicitis. Twenty percent (8/40) underwent both ultrasound and computerised tomography (CT) at the referring centre. A total of 2.7% (2/72) were transferred with known co-morbidities. Ninety-two percent (66/72) underwent appendicectomy. Eight percent (6/72) were managed non-operatively (NOM) — 2 failed NOM, 2 underwent interval appendicectomy. Of those managed operatively, 76% (50/66) underwent laparoscopic appendicectomy, and 24% (16/66) were performed open. Conclusion: The majority of paediatric appendicectomies are performed at Non-Specialist Paediatric Surgical Centres. It is vital to maintain this working relationship so that specialist paediatric centres are available to provide care to complex paediatric patients. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis a surgical emergencies is still a difficult diagnosis to make, especially in young persons, the elderly, and in reproductive-age women. Different scoring systems have been created to increase diagnostic accuracy based on clinical history and intial lab parameters. Objectives: This study was done to prospectively evaluate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score for the diagnosis of acute appendicitis in patients presenting to the Accident and Emergency department or the Surgical wards with right iliac fossa pain. Methods: A prospective study was conducted in MVJ MC & RH on symptomatic patients presented with complaints of right iliac fossa pain. Clinical history and examination, radiological record and histopathologic reports were noted. We studied accuracy modified RIPASA score with Ultrasound and Histopathological reports in evaluation the diagnosis of acute appendicitis. Results: In our study we noted Sensitivity, specificity and diagnostic accuracy of modified RIPASA score was 89.5%, 66.7% and 88.3% respectively. Sensitivity, specificity and diagnostic accuracy of USG was 70.2%, 67% and 70%respectively. On combining modified RIPASA score with USG, Sensitivity, specificity and diagnostic accuracy were 98.2%, 66.7% and 96.7% respectively. Conclusion: On adding USG with modified RIPASA score there is increase in sensitivity and diagnostic accuracy. So modified RIPASA score with USG can be used in patient with RIF pain for making diagnosis of acute appendicitis.

Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare malignant neoplasm seen in less than 0.3% of appendectomy specimens. Patients with LAMN can present with abdominal pain, mimicking appendicitis clinically. In later stages, it can rupture, leading to Pseudomyxoma peritonei (PMP). Therefore, a high clinical suspicion is needed for correct diagnosis and management. The prognosis of LAMN depends on the presence or absence of mucin/neoplastic epithelium outside the appendix. For LAMN confined to the appendix, appendectomy alone is sufficient for management, with conservative follow-up. For LAMN with extruded acellular mucin localised to the appendiceal serosa, management involves appendectomy and PMP surveillance. For all mucinous lesions of the appendix, it is essential to submit the entire appendix for histopathologic examination, thoroughly evaluating the presence of mucin/neoplastic epithelium involving the serosa/extra appendiceal tissue for accurate staging and to predict the risk of recurrence and determine further management. Here four cases of LAMN due to their rarity and clinical importance is presented. This study of four cases emphasises that the clinical diagnosis of this rare malignancy is difficult, and radiological investigations were not available as these patients presented with clinical features mimicking appendicitis. Emergency appendectomy was performed in all cases. LAMN should be considered as a differential diagnosis because if not diagnosed and treated in the early stages, it can lead to dreaded complications like PMP. The histopathological examination of all four cases of LAMN showed dissecting acellular mucin in various stages of progression in the appendicular wall, but none involving the serosa. This highlights the importance of timely surgical intervention and histopathological examination for an exact diagnosis and staging of LAMN for further follow-up or treatment.

Emerging evidence suggests that the human vermiform appendix is not a vestigial organ but rather an immunological organ of biological relevance. It is hypothesised that the appendix acts as a bacterial ‘safe house’ for commensal gut bacteria and facilitates re-inoculation of the colon after disruption through the release of biofilms. To date, no studies have attempted to explore this potential mechanistic function of the appendix. We conducted a pre-post intervention study in adults (n = 59) exploring re-establishment of the gut microbiota in those with and without an appendix after colonic disruption via bowel preparation and colonoscopy. Gut microbiota composition was measured one week before and one month after bowel preparation and colonoscopy using 16S rRNA sequencing. We observed between group differences in gut microbiota composition between those with (n = 45) and without (n = 13) an appendix at baseline. These differences were no longer evident one-month post-procedure, suggesting that this procedure may have ‘reset’ any potential appendix-related differences between groups. Both groups experienced reductions in gut microbiota richness and shifts in beta diversity post-procedure, with greater changes in those without an appendix, and there were five bacterial genera whose re-establishment post-procedure appeared to be moderated by appendicectomy status. This small experimental study provides preliminary evidence of a potential differential re-establishment of the gut microbiota after disruption in those with and without an appendix, warranting further investigation into the potential role of the appendix as a microbial safe house.

Purpose: Appendicectomy is the primary treatment for acute appendicitis. However, extended resection (ER) may be required in difficult cases. Preoperative prediction of ER may identify challenging cases but remains difficult. We aimed to establish a preoperative scoring system for ER prediction during emergency surgery for acute appendicitis. Methods: This was a single-center retrospective study. Patients who underwent emergency surgery for acute appendicitis between January 2014 and December 2022 were included and divided into ER and appendicectomy groups. Independent variables associated with ER were identified using multivariate logistic regression analysis. A new scoring system was established based on these independent variables. The discrimination of the new scoring system was assessed using the area under the receiver operating characteristic curve (AUC). The risk categorization of the scoring system was also analyzed. Results: Of the 179 patients in this study, 12 (6.7%) underwent ER. The time interval from symptom onset to surgery ≥ 4 days, a retrocecal or retrocolic appendix, and the presence of an abscess were identified as independent preoperative predictive factors for ER. The new scoring system was established based on these three variables, and the scores ranged from 0 to 6. The AUC of the scoring system was 0.877, and the rates of ER among patients in the low- (score, 0–2), medium- (score, 4), and high- (score, 6) risk groups were estimated to be 2.5%, 28.6%, and 80%, respectively. Conclusion: Our scoring system may help surgeons identify patients with acute appendicitis requiring ER and facilitate decision-making regarding treatment options. [ABSTRACT FROM AUTHOR]

Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing news of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery's major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended. [ABSTRACT FROM AUTHOR]

Background Appendicectomy is the standard surgery to remove an inflamed appendix and prevent peritonitis and other serious complication of a perforated appendix. Relieving postappendicectomy pain can help in early mobility and rehabilitation. The study compares the efficacy of using ketamine versus bupivacaine for surgical site infiltration for postoperative analgesia following appendicectomy. Methods We enrolled 60 patients aged between 14 and 50 with ASA status class I and II undergoing uncomplicated appendicectomy under general anesthesia. Patients were randomly divided into two equal groups where group 1 received surgical site infiltration using plain bupivacaine at the end of the operation while group 2 received surgical site infiltration using ketamine. The visual analog scale (VAS) was estimated at zero, 1, 2, 6, 12, and 24 h after surgery. The time until the first need for analgesia and the overall analgesic consumption were recorded in both groups. Any adverse effects in the recovery room were recorded. Postoperative hemodynamics were also recorded every 2 h for up to 24 h. Results The VAS score at 1, 2, 6, and 12 h was significantly lower in the ketamine group than in the bupivacaine group (P < 0.001). The time until the first need for analgesia was significantly prolonged in the ketamine group than in the bupivacaine group (P value < 0.001). The total ketorolac and morphine consumption in the first 24 h postoperatively was significantly lower in the ketamine group than in the bupivacaine group (P value < 0.001). Postoperative nausea and vomiting (PONV) occurred in five (16.667%) patients in the bupivacaine group and in six (20%) patients in the ketamine group. Conclusions Surgical site infiltration using either ketamine or bupivacaine can be used safely and efficiently to control acute postoperative pain and decrease the total consumption of systemic analgesics; however, ketamine infiltration seems superior in this field. [ABSTRACT FROM AUTHOR]

Introduction: The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis. Methods: Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink and hospital episode statistics data. Length of stay, re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. Results: A total of 40,353 patients underwent appendicectomy and of these 75 (0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p < 0.0001) and have comorbidities (p < 0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90 days (20% vs 11%, p = 0.019). Most importantly, their odds of death at 90 days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49). Conclusion: Patients with cirrhosis have a threefold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis. [ABSTRACT FROM AUTHOR]

Abstract Introduction Recent evidence confirms that the treatment of acute appendicitis is not necessarily surgical, and selected patients with uncomplicated appendicitis can benefit from a non-operative management. Unfortunately, no cost-effective test has been proven to be able to effectively predict the degree of appendicular inflammation as yet, therefore, patient selection is too often left to the personal choice of the emergency surgeon. Our paper aims to clarify if basic and readily available blood tests can give reliable prognostic information to build up predictive models to help the decision-making process. Methods Clinical notes of 2275 patients who underwent an appendicectomy with a presumptive diagnosis of acute appendicitis were reviewed, taking into consideration basic preoperative blood tests and histology reports on the surgical specimens. Variables were compared with univariate and multivariate analysis, and predictive models were created. Results 18.2% of patients had a negative appendicectomy, 9.6% had mucosal only inflammation, 53% had transmural inflammation and 19.2% had gangrenous appendicitis. A strong correlation was found between degree of inflammation and lymphocytes count and CRP/Albumin ratio, both at univariate and multivariate analysis. A predictive model to identify cases of gangrenous appendicitis was developed. Conclusion Low lymphocyte count and high CRP/Albumin ratio combined into a predictive model may have a role in the selection of patients who deserve appendicectomy instead of non-operative management of acute appendicitis.

The persistent vitellointestinal duct (PVID) is the rarest of all the vitelline duct anomalies. The enteric end of the vitelline duct mostly connects to the terminal ileum. The appendico-umbilical fistula (appendiceal-umbilical fistula) in which the proximal end of the vitelline duct connects to the appendix is a rare clinical entity. This systematic literature review was carried out to review the demographics, clinical characteristics and operative procedures executed for the appendico-umbilical fistula. Literature/cases with incomplete desired details for the above-mentioned anomaly were excluded. The guidelines of the preferred reporting items for systematic reviews and meta-analyses are followed for presenting this manuscript. An online search was made for the retrieval of the published manuscripts. The search was performed for the previous 100 years from 1921 to December 2021. A total of n = 21 (n = 12 female and n = 9 males) cases of the appendico-umbilical fistula were included in the systematic review. All the cases, except one, were infants and n = 10 of the cases were neonates/newborn babies. Their ages ranged from 1 day to 5 years. Three-fourths (n = 16) of the children presented with the chief complaint of discharge of mucus/stool through the umbilicus. An appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa was executed as the standard operative procedure for the entire case. A peri-umbilical incision was preferred and frequently employed for surgical therapy. This review revealed only one (4.76%) post-operative death that was unrelated to the surgical procedure. PVID connected to the appendix, presented clinically as appendico-umbilical fistula is a rare entity. The standard surgical procedure performed for the appendico-umbilical fistula was an appendicectomy with resection of the PVID/fistulous duct/prolapsed mucosa.

Background: In acute appendicitis, decision‐making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross‐sectional imaging. In regional settings, non‐paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres. Methods: A retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length‐of‐stay and post‐operative complication rates. Results: Four hundred and twenty‐one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109, neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re‐admission or complications compared with appendicectomy for appendicitis. Conclusions: Our centre's NA rate is higher than that observed in the literature at both non‐paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic review on the use of magnetic resonance imaging (MRI) of the abdomen to evaluate clinically suspected appendicitis in the general adult population. We examined the diagnostic accuracy, the reported trends of MRI use, and the factors that affect the utility of MRI abdomen, including study duration and cost-benefits. Methods: We conducted a systematic literature search on PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library databases. We enrolled primary studies investigating the use of MRI in diagnosing appendicitis in the general adult population, excluding studies that predominantly reported on populations not representative of typical adult appendicitis presentations, such as those focusing on paediatric or pregnant populations. Results: Twenty-seven eligible primary studies and 6 secondary studies were included, totaling 2,044 patients from eight countries. The sensitivity and specificity of MRI for diagnosing appendicitis were 96% (95% CI: 93–97%) and 93% (95% CI: 80–98%), respectively. MRI can identify complicated appendicitis and accurately propose alternative diagnoses. The duration of MRI protocols in each primary study ranged between 2.26 and 30 minutes, and only one study used intravenous contrast agents in addition to the non-contrast sequences. Decision analysis suggests significant benefits for replacing computed tomography (CT) with MRI and a potential for cost reduction. Reported trends in MRI usage showed minimal utilisation in diagnostic settings even when MRI was available. Conclusions: MRI accurately diagnoses appendicitis in the general adult population and improves the identification of complicated appendicitis or alternative diagnoses compared to other modalities using a single, rapid investigation. [ABSTRACT FROM AUTHOR]

Acute appendicitis is inflammation of the vermiform appendix. It is the commonest general surgical emergency in children and young adults, yet its diagnosis can still confound even the most skilled surgeon due to its highly variable presentation of appendicitis, with fewer than 50% of patients exhibiting classical features. Taking a detailed history and performing a careful examination remains the cornerstone of diagnosis. Urinalysis and blood tests, particularly C-reactive protein, are useful adjuncts and are performed routinely. Radiological imaging, commonly ultrasound and computed tomography scans, also have a role when the diagnosis is unclear and/or other common conditions need to be excluded, such as gynaecological pathology in young females. Nevertheless 20% of appendices removed in UK are histologically normal. Appendicitis scoring systems may further assist in stratifying risk and increasing the accuracy of diagnosis. Recently, there has been growing interest in non-surgical management of appendicitis, particularly during the COVID-19 pandemic. Antibiotics alone have been used to successfully treat uncomplicated appendicitis (without perforation, abscess or gangrene) in the short-term, however nearly 40% of these cases eventually require appendicectomy. Surgery, usually laparoscopic appendicectomy, remains the treatment of choice for acute appendicitis and non-operative management is reserved for specific cases. [ABSTRACT FROM AUTHOR]

Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare malignant neoplasm seen in less than 0.3% of appendectomy specimens. Patients with LAMN can present with abdominal pain, mimicking appendicitis clinically. In later stages, it can rupture, leading to Pseudomyxoma peritonei (PMP). Therefore, a high clinical suspicion is needed for correct diagnosis and management. The prognosis of LAMN depends on the presence or absence of mucin/neoplastic epithelium outside the appendix. For LAMN confined to the appendix, appendectomy alone is sufficient for management, with conservative follow-up. For LAMN with extruded acellular mucin localised to the appendiceal serosa, management involves appendectomy and PMP surveillance. For all mucinous lesions of the appendix, it is essential to submit the entire appendix for histopathologic examination, thoroughly evaluating the presence of mucin/neoplastic epithelium involving the serosa/extra appendiceal tissue for accurate staging and to predict the risk of recurrence and determine further management. Here four cases of LAMN due to their rarity and clinical importance is presented. This study of four cases emphasises that the clinical diagnosis of this rare malignancy is difficult, and radiological investigations were not available as these patients presented with clinical features mimicking appendicitis. Emergency appendectomy was performed in all cases. LAMN should be considered as a differential diagnosis because if not diagnosed and treated in the early stages, it can lead to dreaded complications like PMP. The histopathological examination of all four cases of LAMN showed dissecting acellular mucin in various stages of progression in the appendicular wall, but none involving the serosa. This highlights the importance of timely surgical intervention and histopathological examination for an exact diagnosis and staging of LAMN for further follow-up or treatment. [ABSTRACT FROM AUTHOR]

Background: This study compared the efficacy of prophylactic antibiotics with seven days of conventional antibiotics. Objective: This present study was carried out to evaluate the effectiveness of three doses of prophylaxis with ceftriaxone and metronidazole. Methodology: This parallel arm, randomized control trial was conducted among fifty patients, consisting of 25 cases and 25 controls, with acute appendicitis admitted at Dhaka Medical College Hospital, Popular Medical College Hospital, Dhaka, and Ad-din Barrister Rafique Ul-Haq Hospital, Dhaka, during the period of November 2021 to April 2022. This study was done to evaluate the efficacy of three doses of combined prophylactic antibiotics, ceftriaxone and metronidazole, in acute non-perforated appendicitis cases. The patients in the control group were treated with seven days of conventional antibiotic therapy to compare the efficacy with three doses of prophylactic antibiotics. Results: Among 9 wound infections (15%), 4 patients were in the control group (36.5%), and 5 (40.5%) were in the case group in the study group with combined surgical prophylaxis of ceftriaxone and metronidazole (P=0.001). One patient develops both a wound infection and an intra-abdominal abscess. The study also found that amount to patient (3.3%) with intra-abdominal abscess formation 01 (50%) in control group and 01(50.0%) in combined prophylaxis group (ceftriaxone and metronidazole) (P>0.3). Conclusion: In conclusion no significant difference could be found between the patients who received combined three doses of ceftriaxone and metronidazole and the control groups with regard to age, sex, distribution of symptoms before admission, preoperative temperature, duration of surgery, hospital stay, and concomitant diseases both overall and within each of the three groups of appendiceal examination. [ABSTRACT FROM AUTHOR]

Background: Australia performs more appendicectomies per capita than nearly any other country. The surgical specialty responsible for performing appendicectomies in Australia, General Surgery, has recently undergone a paradigm shift away from traditional models of care and towards Acute Surgical Unit (ASU) models. ASUs are defined by the presence of a dedicated emergency general surgeon and the separation of elective and emergency surgical caseload. The aim of this meta-analysis is to determine the effect of care model type on the rate of negative appendicectomy, as well as other clinical outcomes pertaining to the appendicectomy patient. Methods: A comprehensive literature search of Medline, Embase and Cochrane library was performed to identify studies investigating the effect of ASU care model on the outcomes of appendicectomy for Australian and New Zealand patients. These studies were required to have a comparison to a pre-existing or geographically related traditional care cohort. The PRISMA guidelines were used to identify, screen and analyse papers. Random-effects methods were used to perform a meta-analysis of negative appendicectomy rate and other relevant outcomes. Results were reported in either odds ratio or weighted mean difference. Results: Thirteen studies meeting the inclusion criteria were identified describing the outcomes of 8787 patients undergoing appendicectomy in Australian and New Zealand hospitals. There was no effect on negative appendicectomy rate between the ASU and traditional cohorts (OR: 1.10, CI: 0.944-1.262, p-value 0.20). Furthermore, no significant effect on time-to-theatre (WMD: 1.107, CI: 0.332 – 2.882, p-value 0.22), length of stay (MD: 0.563, CI: 0 – 1.135, p-value 0.13) or complication rate (OR: 0.872, CI: 0.596 – 1.148, p-value 0.36) was observed between the two cohorts. Conclusion: Rates of negative appendicectomy in Australia are similar in both ASU and traditional model cohorts. Significant improvements in appendicectomy outcomes seen under an ASU model in international data, or in data for other emergency conditions, have not been replicated on this meta-analysis of the Australian literature.