Our Summary

This research paper is about a study that was carried out on patients who were suspected to have acute appendicitis (AA), which is the most common emergency surgery, but hard to diagnose accurately. To make diagnosis easier, several scoring systems have been created which provide a high, medium or low chance of a patient having AA.

The study involved 433 patients who were treated for suspected AA using a method of surgery called laparoscopy. The four scoring systems were used on each patient to see how accurate they were in predicting AA.

The study found that 381 out of 433 patients (88.0%) actually had AA. 12 of these patients (2.8%) had to have their surgery switched to an open surgery, and 54 patients (12.5%) experienced complications. The scoring systems did show significant differences between actual AA and false diagnoses. However, for patients with medium chance scores, the scoring systems were not accurate enough.

The study concludes that laparoscopic surgery can be used as a way to diagnose patients who have a medium chance of having AA. This is because this type of surgery has a low risk of complications or death, and it allows doctors to see directly whether or not the patient has AA, and therefore decide on the best treatment.

FAQs

  1. What is the purpose of the clinical prediction rules (CPRs) in diagnosing acute appendicitis?
  2. What were the results of the study on laparoscopic surgery for suspected acute appendicitis?
  3. Can laparoscopic surgery serve as a diagnostic tool for patients with intermediate acute appendicitis probability scores?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic appendectomy is that it is a minimally invasive procedure that typically results in less pain, faster recovery, and smaller scars compared to traditional open surgery. Additionally, laparoscopic surgery allows for a more accurate diagnosis of appendicitis, which can lead to the appropriate treatment being administered sooner. It is important to follow post-operative instructions provided by your healthcare team to ensure a smooth recovery process.

Suitable For

Patients who are typically recommended for laparoscopic appendectomy are those with a high probability of suffering from acute appendicitis based on clinical prediction rules. This includes patients with symptoms such as abdominal pain, fever, and elevated inflammatory markers. Laparoscopic appendectomy is particularly useful for patients with intermediate probability scores, as it allows for a direct diagnosis and appropriate treatment with low associated morbidity and mortality.

Timeline

  • Before laparoscopic appendectomy:
  1. Patient experiences symptoms of acute appendicitis such as abdominal pain, nausea, vomiting, and fever.
  2. Patient visits the emergency department and undergoes physical examination and possibly imaging tests such as ultrasound or CT scan.
  3. Clinical prediction rules (CPRs) like the Alvarado, Raja Isteri Pengiran Anak Saleha Appendicitis, appendicitis inflammatory response, and adult appendicitis score scales are applied to determine the probability of suffering from appendicitis.
  4. Based on the CPR scores, the decision is made to proceed with laparoscopic appendectomy surgery.
  • After laparoscopic appendectomy:
  1. Laparoscopic appendectomy is performed on the patient, typically under general anesthesia.
  2. The appendix is removed using minimally invasive techniques through small incisions in the abdomen.
  3. In some cases, the surgery may be converted to an open procedure if complications arise.
  4. Post-operative complications may occur in some cases, but laparoscopic surgery is associated with lower morbidity and mortality rates compared to open surgery.
  5. Laparoscopic surgery provides a direct diagnosis of appendicitis, allowing for appropriate treatment to be administered promptly.

What to Ask Your Doctor

  1. What is the likelihood that I have acute appendicitis based on my symptoms and medical history?
  2. What are the potential risks and benefits of undergoing a laparoscopic appendectomy compared to other treatment options?
  3. How experienced are you in performing laparoscopic appendectomies?
  4. What is the typical recovery time and post-operative care for a laparoscopic appendectomy?
  5. Will I need to follow any specific dietary or activity restrictions after the surgery?
  6. What are the potential complications associated with a laparoscopic appendectomy?
  7. How will I know if the surgery was successful in removing my appendix and resolving my symptoms?
  8. Are there any specific signs or symptoms I should watch for after the surgery that may indicate a complication?
  9. How soon after the surgery can I expect to return to normal activities, such as work or exercise?
  10. Are there any long-term implications or considerations I should be aware of after undergoing a laparoscopic appendectomy?

Reference

Authors: Gómez López JR, Martín Del Olmo JC, Montenegro Martín MA, Concejo Cutoli P, Martín Esteban ML, Toledano Trincado M, López Mestanza IC, Vaquero Puerta C. Journal: J Laparoendosc Adv Surg Tech A. 2019 Feb;29(2):184-191. doi: 10.1089/lap.2018.0707. Epub 2018 Dec 26. PMID: 30585754