BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides dire...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficult...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.展开更多
BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic ...BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.展开更多
BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investig...BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.展开更多
BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the sec...BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation.Various closure techniques are employed,including endoloops(ELs),staplers,clips,and energy devices;however,the optimal method remains unclear due to inconsistent evidence.AIM To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA.By assessing outcomes such as postoperative complications,operative time,and length of hospital stay,this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.METHODS This systematic review and network meta-analysis,conducted according to PRISMA and Cochrane guidelines,compared the effectiveness and safety of stump closure methods in pediatric LA.Databases searched included PubMed,Cochrane Central,Web of Science,and Scopus up to May 1,2025.Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients.Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale.A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications(primary outcome),as well as operative time and hospital stay(secondary outcomes).P-scores were used to rank the effectiveness of treatments.RESULTS Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA.No significant differences in total postoperative complications or hospital stay were observed among techniques,including EL,endostapler,polymer clip,LigaSure,harmonic scalpel(HS),and sutures.HS showed a statistically significant reduction in operative time compared to EL(mean difference:-13.5 minutes),while other methods did not demonstrate significant time savings.No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay.Publication bias was minimal,and the methodological quality of included studies was moderate to good.CONCLUSION While all closure techniques show similar safety profiles,HS offers shorter operating times.These findings support tailoring stump closure method selection based on operative efficiency and resource availability.展开更多
BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposi...BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.展开更多
BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp ex...BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.展开更多
Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical h...Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.展开更多
BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patie...BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.展开更多
Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rat...Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.展开更多
BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with ...BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.展开更多
BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical...BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical approach remains to be improved.Thus,the exploration and implementation of surgical refinements are necessary.AIM To elucidate the therapeutic effectiveness and influencing factors of laparoscopic appendectomy(LA)with mesoappendix dissection in the treatment of AP.METHODS First,150 patients with AP who visited Shangrao Municipal Hospital between January 2022 and June 2024 were enrolled in this study.Among them,72 patients were assigned to the control group to receive conventional LA,whereas 78 cases were included in the observation group for LA with mesoappendix dissection.Subsequently,indicators such as therapeutic effectiveness,surgical indices(ope-ration time,intraoperative blood loss,and hospital stay),postoperative recovery indices(time to ambulation,gastrointestinal function recovery time,and time to food intake),incidence of adverse events(postoperative bleeding,pelvic infection,puncture site infection,and ileus),and serum inflammatory factors[tumor necro-sis factor(TNF)-α,interleukin(IL)-6,and C-reactive protein(CRP)]were collected and comparatively analyzed,and the influencing factors of therapeutic effecti-veness in patients with AP were analyzed.RESULTS Compared with the control group,the observation group had higher clinical the-rapeutic effectiveness,less operation time,intraoperative blood loss,and hospital stay;shorter time to ambulation,gastrointestinal function recovery,and food intake;and a lower total incidence of adverse events,and this difference is statistically significant.In addition,the expression levels of various serum inflammatory factors in the observation group were significantly reduced postoperatively,which were markedly lower than those in the control group.Moreover,sex,age,body mass index,time from acute onset to admission,family medical history,preoperative TNF-α,preoperative IL-6,preoperative CRP,and treatment modality were identified to be not independent factors affecting the therapeutic effectiveness of LA with mesoappendix dissection in patients with AP.CONCLUSION Overall,LA with mesoappendix dissection has a remarkable curative effect in treating patients with AP,which is worthy of clinical promotion.展开更多
Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is abo...Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is about 11%. Objective: To compare laparoscopic vs open appendectomy with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission. Methods: This prospective comparative study is performed in the Department of Surgery, North West Aramed Forced Hospital, Tabuk, Kingdom of Saudi Arabia. All patients between 13 and 60 years of age admitted through the accident and emergency (A&E) department with a clinical diagnosis of acute appendicitis and those who completed follow-up are included in the study. All those patients in whom a clinical diagnosis of acute appendicitis was not established or have a palpable mass in the right lower quadrant, suggesting an appendiceal abscess and those who does not give consent are excluded from the study. We reviewed the medical records of all patients who underwent a laparoscopic and open appendectomy in King Salman Armed Forces Hospital, Saudi Arabia from 1/1/2012 to 31/12/2015. Result: A total of 502 patients underwent Appendectomy at King Salman Armed Forces Hospital from 1/1/2012 till 31/12/2015. Of these, 203 were male (40.4%) and 299 were female (59.6%). The mean age was 18 years. Alvarado Score more than 7 in 93% of patients diagnosed with appendicitis. Comorbidities included diabetes 21 (5.56%) and hypertension 7 (1.39%). The mean Body Mass Index (BMI) was 20 kg/m<sup>2</sup>. 328 patients (65.3%) underwent Open Appendectomy (OA). None of Laproscopic appendectomy(LA) had a conversion. The mean operative time was 76 minutes (44 minutes and 50 minutes for OA and LA, respectively). Mean hospital stay in OA 2 days and one day LA. Eight cases (1.6%) developed seroma (6 cases in OA and 2 cases in LA with rates of 1.2% and 0.4% respectively). Nine patients (1.6%) had wound infection, 8 in OA and one in LA with rate of 1.5% and 0.2% respectively). Four patients (0.8%) develop the hematoma (3 cases in OA and one case in LA with rates of 0.6% and 0.2% respectively). Seven cases of reported appendectomy develop the pelvic abscess (1.4%) (5 cases in OA and 2 cases in LA with rates of 1% and 0.4% respectively). Conclusion: Alvarado Score carries high significance in the diagnosis of acute appendicitis. Laparoscopic appendectomy has improved diagnostic accuracy along with advantages in terms of fewer seroma, hematoma, wound infections, faster recovery, and earlier retention to normal activity but longer operative time.展开更多
Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made ba...Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.展开更多
Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary trea...Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.展开更多
BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recover...BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.展开更多
Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights...Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights into the clinicopathological characteristics of SA.The study compared 136 cases of SA to 5418 cases of non-SA over a ten-year period.Key findings include a higher average age of SA patients(61.73 years vs 35.8 years for non-SA),a higher proportion of acute on chronic appendicitis(33.1%vs 16%),and a significantly higher incidence of colorectal cancer(11.7%vs 2.2%).Despite these differences,SA remains a diagnostic challenge due to its nonspecific clinical presentation and lack of specific laboratory findings.The study also highlights the persistent prevalence of SA,accounting for 1.6%-3.4%of all appendicitis cases each year from 2013 to 2023.These findings underscore the need for enhanced awareness,early detection,and prompt treatment of SA in endemic regions.Given the association with colorectal cancer,patients with SA require thorough screening and follow-up.Further research into the pathogenesis and diagnostic markers of SA is warranted.As the global battle against schistosomiasis continues,targeted efforts to diagnose and manage SA can significantly improve patient outcomes.展开更多
Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence manag...Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence management pathways.This narrative review synthesizes contemporary evidence and consensusbased imaging protocols for appendicitis,with a focus on computed tomography,magnetic resonance imaging,and ultrasound.The article explores advanced diagnostic criteria,interpretation challenges,imaging algorithms derived from professional society guidelines,and special considerations including pregnancy and pediatric populations.Clinical practice recommendations by the World Society of Emergency Surgery,European Association of Endoscopic Surgery,American College of Radiology,and Infectious Diseases Society of America are incorporated to frame best practices.展开更多
基金Supported by Guangdong Province Clinical Teaching Base Teaching Reform Research Project,No.2021JD086.
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)offers an appendix-pre-serving approach;however,visual and specificity challenges persist.Conversely,endoscopic direct appendicitis therapy(EDAT)provides direct visual observation with diagnostic and therapeutic capabilities.AIM To assess the efficacy and feasibility of EDAT and compare them with those of ERAT in uncomplicated appendicitis.METHODS In this retrospective cohort study,patients diagnosed with uncomplicated appendicitis and treated with ERAT or EDAT between January 2021 and November 2024 were reviewed.The primary outcome was intervention success.Secondary outcomes were guidewire use,stent placement,hospitalization duration,recurrence,and endoscopic direct-view features.Outcomes were compared between groups via appropriate statistical tests.RESULTS Of 170 patients,136 underwent EDAT and 34 ERAT.EDAT showed higher intervention success than ERAT(99.3%vs 82.4%,P<0.001),with less guidewire assistance and fewer stent placements(both P<0.001).Hospital stay was shorter with EDAT(P=0.039).The overall cumulative recurrence rates at 1 year were 10%in EDAT and 24%in ERAT;in the appendicolith subgroup,the recurrence rates were 5%and 14%in EDAT and ERAT,respectively.Findings were consistent in the propensity score-matched(PSM)cohort.CONCLUSION EDAT was demonstrated to be a more effective and feasible approach than ERAT,with a lower overall cumulative recurrence risk and within the appendicolith subgroup.Consistent results after PSM further supported the robustness of these findings.
基金Supported by National Key R and D Program of China-Key Special Project on Diagnostic and Therapeutic Equipment and Biomedical Materials,No.2023YFC2412005。
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.
文摘BACKGROUND Retrocecal appendicitis,the most common anatomical type,presents diagnostic and surgical challenges.Single-port laparoscopic appendectomy(SPLA)has been proposed as an alternative to multi-port laparoscopic appendectomy(MPLA)with advancements in minimally invasive surgery.However,few studies have compared the perioperative outcomes between the SPLA and MPLA for retrocecal appendicitis.AIM To compare the efficacy and safety between the SPLA and MPLA in treating retrocecal appendicitis,focusing on perioperative outcomes.METHODS This retrospective study analyzed data from 1041 patients who underwent SPLA or MPLA at Konyang University Hospital between October 2011 and February 2023.Propensity score matching(PSM)was used to minimize selection bias,resulting in 235 patients in each group.Additionally,non-inferiority tests,post-hoc analysis,and multivariable regression analysis were performed to validate the results and assess factors affecting postoperative outcomes.RESULTS After PSM,SPLA showed shorter operation time(43.8±15.8 minutes vs 51.6±18.7 minutes;P<0.001)and lower estimated blood loss(EBL,6.5±7.8 mL vs 8.6±8.3 mL;P<0.001)than MPLA.No significant differences were observed in complications,pain scores,or length of hospital stay.SPLA was not inferior to MPLA in the main outcomes,except for the complication rate,where statistical power was insufficient.Multivariable regression confirmed SPLA as an independent factor for operation time and EBL.CONCLUSION SPLA is more feasible than MPLA for retrocecal appendicitis,offering advantages in operation time and estimated blood loss.This study supports SPLA as a viable alternative that enhances postoperative recovery.
文摘BACKGROUND Non-operative management(NOM)for uncomplicated acute appendicitis(AA)has been gaining popularity in recent years.One of the major concerns with NOM is the recurrence rate of AA following NOM.AIM To investigate the impact of the presence of an appendicolith and its specific characteristics on the recurrence rate of AA following NOM.METHODS A retrospective analysis identified all patients treated with NOM for AA,at our institute between 2016 and 2024.Patients with an appendicolith on imaging were identified and their course and outcomes were compared with patients who were treated with NOM without an appendicolith.The primary outcome was defined as a recurrence of AA.RESULTS During the study period,797 patients were treated with NOM for AA.Their mean age was 25.4 years±14.4 years,and 45.4%were females.Only 68 patients(8.5%)had an appendicolith identified on imaging.Patients with an appendicolith had a larger appendix diameter(10.2 mm±4 mm vs 8.5 mm±2.1 mm,P=0.001).There was no difference in the recurrence rate of patients with and without an appendicolith(26.5%vs 19.1%,P=0.14),however patients with an appendicolith presented with a shorter time to recurrence of appendicitis(3.9 months±10.4 months vs 5.9 months±8.1 months,P=0.04).In a sub analysis,the number of appendicoliths,its size,and its location,did not influence the recurrence rate.CONCLUSION This study demonstrates that patients with appendicoliths have a shorter time to recurrence after NOM of AA,but do not experience higher overall recurrence rates.
文摘BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation.Various closure techniques are employed,including endoloops(ELs),staplers,clips,and energy devices;however,the optimal method remains unclear due to inconsistent evidence.AIM To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA.By assessing outcomes such as postoperative complications,operative time,and length of hospital stay,this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.METHODS This systematic review and network meta-analysis,conducted according to PRISMA and Cochrane guidelines,compared the effectiveness and safety of stump closure methods in pediatric LA.Databases searched included PubMed,Cochrane Central,Web of Science,and Scopus up to May 1,2025.Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients.Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale.A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications(primary outcome),as well as operative time and hospital stay(secondary outcomes).P-scores were used to rank the effectiveness of treatments.RESULTS Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA.No significant differences in total postoperative complications or hospital stay were observed among techniques,including EL,endostapler,polymer clip,LigaSure,harmonic scalpel(HS),and sutures.HS showed a statistically significant reduction in operative time compared to EL(mean difference:-13.5 minutes),while other methods did not demonstrate significant time savings.No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay.Publication bias was minimal,and the methodological quality of included studies was moderate to good.CONCLUSION While all closure techniques show similar safety profiles,HS offers shorter operating times.These findings support tailoring stump closure method selection based on operative efficiency and resource availability.
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
文摘BACKGROUND Chronic schistosomiasis causes multiple organ and multiple system diseases,especially the digestive system.Schistosome eggs are mainly deposited in the stomach,liver and colorectal,but a few eggs are deposited in the appendix and cause disease.At present,there are few studies on schistosomal appendicitis.AIM To explore the differences in epidemiological,clinical and pathological characteristics between schistosomal appendicitis and non-schistosomal appendicitis over the past decade in order to assess the impact of schistosomiasis on appendicitis.METHODS The differences of general data,clinical data and laboratory examination data of patients with appendicitis from October 2013 to October 2023 were retrospectively analyzed.All patients were divided into two groups for analysis.There were 136 patients in schistosomal appendicitis group and 5418 patients in non-schistosomal appendicitis group.RESULTS Schistosomal appendicitis accounted for 2.45%of all patients with appendicitis,and the annual proportion in the past decade was 2.2%,2.9%,1.8%,1.9%,3.4%,3.1%,1.9%,1.6%,3%,2.6%,respectively.The prevalence of schistosomal appendicitis was middle-aged and elderly males,with an average age of 61.73±15.335 years.The main population of non-schistosomal appendicitis was middle-aged men,with an average age of 35.8±24.013 years(P<0.001).The distribution of pathological types of appendicitis was different between the two groups(P<0.001).The incidence of acute suppurative appendicitis in non-schistosomal appendicitis was higher than that in schistosomal appendicitis[odds ratio(OR)=0.504;95%confidence interval(CI):0.349-0.728;P<0.001].The proportion of acute attack of chronic appendicitis in schistosomal appendicitis was higher than that in non-schistosomal appendicitis(OR=2.614;95%CI:1.815-3.763;P<0.001).The proportion of schistosomal appendicitis patients complicated with colorectal cancer was higher than that of nonschistosomal appendicitis patients(OR=5.087;95%CI:1.427-18.132;P=0.012).There was no difference in clinical symptoms between the two groups.In the laboratory examination,there was a significant difference in white blood cells between schistosomal appendicitis and non-schistosomal appendicitis.The level of white blood cells in schistosomal appendicitis group was slightly higher than the upper limit of the normal range.Other statistically significant indicators were in the normal range.CONCLUSION Schistosomal appendicitis is a severe condition that is often associated with intestinal malignancies,potentially leading to a poor prognosis.Schistosomal appendicitis is more likely to be misdiagnosed and missed diagnosed in clinical work because of its nonspecific clinical manifestations and laboratory examination.It is crucial to differentiate schistosomal appendicitis in middle-aged and elderly male patients presenting with appendicitis,and to ensure early detection and treatment.
文摘BACKGROUND Acute appendicitis(AAp)is a prevalent medical condition characterized by inflammation of the appendix that frequently necessitates urgent surgical procedures.Approximately two-thirds of patients with AAp exhibit characteristic signs and symptoms;hence,negative AAp and complicated AAp are the primary concerns in research on AAp.In other terms,further investigations and algorithms are required for at least one third of patients to predict the clinical condition and distinguish them from uncomplicated patients with AAp.AIM To use a Stochastic Gradient Boosting(SGB)-based machine learning(ML)algorithm to tell the difference between AAp patients who are complicated and those who are not,and to find some important biomarkers for both types of AAp by using modeling to get variable importance values.METHODS This study analyzed an open access data set containing 140 people,including 41 healthy controls,65 individuals with uncomplicated AAp,and 34 individuals with complicated AAp.We analyzed some demographic data(age,sex)of the patients and the following biochemical blood parameters:White blood cell(WBC)count,neutrophils,lymphocytes,monocytes,platelet count,neutrophil-tolymphocyte ratio,lymphocyte-to-monocyte ratio,mean platelet volume,neutrophil-to-immature granulocyte ratio,ferritin,total bilirubin,immature granulocyte count,immature granulocyte percent,and neutrophil-to-immature granulocyte ratio.We tested the SGB model using n-fold cross-validation.It was implemented with an 80-20 training-test split.We used variable importance values to identify the variables that were most effective on the target.RESULTS The SGB model demonstrated excellent performance in distinguishing AAp from control patients with an accuracy of 96.3%,a micro aera under the curve(AUC)of 94.7%,a sensitivity of 94.7%,and a specificity of 100%.In distinguishing complicated AAp patients from uncomplicated ones,the model achieved an accuracy of 78.9%,a micro AUC of 79%,a sensitivity of 83.3%,and a specificity of 76.9%.The most useful biomarkers for confirming the AA diagnosis were WBC(100%),neutrophils(95.14%),and the lymphocyte-monocyte ratio(76.05%).On the other hand,the most useful biomarkers for accurate diagnosis of complicated AAp were total bilirubin(100%),WBC(96.90%),and the neutrophil-immature granulocytes ratio(64.05%).CONCLUSION The SGB model achieved high accuracy rates in identifying AAp patients while it showed moderate performance in distinguishing complicated AAp patients from uncomplicated AAp patients.Although the model's accuracy in the classification of complicated AAp is moderate,the high variable importance obtained is clinically significant.We need further prospective validation studies,but the integration of such ML algorithms into clinical practice may improve diagnostic processes.
文摘Acute appendicitis(AAp)remains one of the most common abdominal emergencies,requiring rapid and accurate diagnosis to prevent complications and unnecessary surgeries.Conventional diagnostic methods,including medical history,clinical assessment,biochemical markers,and imaging techniques,often present limitations in sensitivity and specificity,especially in atypical cases.In recent years,artificial intelligence(AI)has demonstrated remarkable potential in enhancing diagnostic accuracy through machine learning(ML)and deep learning(DL)models.This review evaluates the current applications of AI in both adult and pediatric AAp,focusing on clinical data-based models,radiological imaging analysis,and AI-assisted clinical decision support systems.ML models such as random forest,support vector machines,logistic regression,and extreme gradient boosting have exhibited superior diagnostic performance compared to traditional scoring systems,achieving sensitivity and specificity rates exceeding 90%in multiple studies.Additionally,DL techniques,particularly convolutional neural networks,have been shown to outperform radiologists in interpreting ultrasound and computed tomography images,enhancing diagnostic confidence.This review synthesized findings from 65 studies,demonstrating that AI models integrating multimodal data including clinical,laboratory,and imaging parameters further improved diagnostic precision.Moreover,explainable AI approaches,such as SHapley Additive exPlanations and local interpretable model-agnostic explanations,have facilitated model transparency,fostering clinician trust in AI-driven decision-making.This review highlights the advancements in AI for AAp diagnosis,emphasizing that AI is used not only to establish the diagnosis of AAp but also to differentiate complicated from uncomplicated cases.While preliminary results are promising,further prospective,multicenter studies are required for large-scale clinical implementation,given that a great proportion of current evidence derives from retrospective designs,and existing prospective cohorts exhibit limited sample sizes or protocol variability.Future research should also focus on integrating AI-driven decision support tools into routine emergency care workflows.
文摘BACKGROUND Acute abdominal pain is often easy to be diagnosed because of acute abdomen,and can be treated reasonably and effectively.It is more difficult to establish the cause of chronic abdominal pain,and some patients repeatedly visit several hos-pitals and still cannot be diagnosed.Chronic abdominal pain caused by chronic appendicitis is such a case.If the degree of abdominal pain is mild and there is no sign of peritonitis,chronic appendicitis is not performed unless the patient re-quests it.CASE SUMMARY We report an extremely rare case of chronic appendicitis caused by a foreign body in the appendix in a 35-year-old woman.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.After antibiotic treatment,the abdominal pain was gradually relieved,but abdominal pain often recurs.We conducted abdominal computed tomography examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal spe-cimen.Histopathological examination confirmed chronic appendicitis with fo-reign body giant cell reaction.The patient recovered and was discharged from the hospital.After 2 months of follow-up,abdominal pain did not recur,and the patient had a complete recovery.Core Tip:We report an extremely rare case of chronic appendicitis caused by a chicken bone in the appendix.The patient was 35-year-old woman,and had a long-term abdominal pain of unknown cause.Abdominal computed tomography examination suggested foreign bodies in the appendix,and laparoscopic appendectomy was performed.The postoperative specimen revealed chicken bones in the appendix cavity,and histopathological examination confirmed chronic appendicitis with giant cell reaction of foreign bodies.The patient recovered and was followed up for two months without abdominal pain.Citation:Huang T,Li SK,Wang W,Zhang R.Chronic abdominal pain caused by foreign bodies in the appendix:A case report.World INTRODUCTION Appendicitis is one of the common diseases that cause abdominal pain[1].Appendicitis can be diagnosed and treated effectively when patients with acute abdominal pain are admitted to hospital because of factors such as blockage and infection of appendicitis[2,3].However,the diagnosis of chronic appendicitis is difficult.Acute appendicitis caused by foreign bodies in the appendix is easy to diagnose because of the final surgical treatment[4-6],while chronic appendicitis caused by foreign bodies in the appendix is more difficult to diagnose because of the mild degree of abdominal pain.We here report an extremely rare case of chronic appendicitis caused by foreign bodies in the appendix.The patient had a long-term abdominal pain of unclear cause,and she was repeatedly treated in several hospitals.Abdominal color ultrasound examination indicated a coprolith in the appendiceal cavity and the appendix was normal,so the patient could not be treated with surgery.We conducted abdominal computed tomography(CT)examination,and upon the advice of radiologists,we considered the possibility of foreign bodies in the appendix,and excluded other causes of abdominal pain.The patient requested and consented to laparoscopic appendectomy,and a chicken bone was found in the appendiceal cavity by postoperative incision of the appendiceal specimen.The patient recovered and was discharged from hospital.After 2 months of follow-up,abdominal pain did not recur and the patient had a full recovery.
文摘Appendicoliths are frequently encountered in acute appendicitis(AA)and historically considered a risk factor for treatment failure in nonoperative management(NOM).However,the impact of appendicoliths on recurrence rates in uncomplicated AA remains controversial.This editorial critically appraises the study by Kupietzky et al,which explored the relationship between appendicolith characteristics and NOM outcomes.Kupietzky et al conducted a retrospective analysis of 797 patients with uncomplicated AA,comparing recurrence rates between those with and without appendicoliths.The study focused on long-term follow-up(median 44.2 months)and subgroup analyses of stone characteristics.The study revealed no significant difference in overall recurrence rates between groups(26.5%vs 19.1%,P=0.14).However,patients with appendicoliths experienced earlier recurrence(3.9 months vs 5.9 months,P=0.04)and had larger appendix diameters(10.2 mm vs 8.5 mm,P=0.001).Subgroup analyses showed no correlation between stone size,location,or number and recurrence risk.Appendicoliths do not independently increase the overall recurrence risk after NOM for uncomplicated AA but may accelerate recurrence timelines.Clinical decisions should prioritize individualized risk assessment,considering patient age,symptom severity,and radiological features.These findings challenge traditional paradigms and advocate for shared decision-making between clinicians and patients.
基金Supported by the Natural Science Foundation of Liaoning Province,No.2023-MS-354the Science and Technology Project for Youth of Chaoyang Central Hospital,China Medical University,Liaoning Province,China.
文摘BACKGROUND Single-port laparoscopic appendectomy is an advanced minimally invasive surgery that involves the use of upgraded instruments and equipment.We previously modified single-port laparoscopic appendectomy with needle-type grasping forceps(mSLAN)for patients with simple appendicitis,but the feasibility and safety of our modified procedure need further evaluation in a highquality clinical study.AIM To compare the short-term clinical outcomes of mSLAN with those of conventional three-port laparoscopic appendectomy(CLA)for patients with acute uncomplicated appendicitis.METHODS This single-center,single-blind,prospective,randomized controlled trial included patients who underwent emergency laparoscopic appendectomy for acute uncomplicated appendicitis at our center between April 2024 and August 2024.Patients were randomly divided into the mSLAN group or the CLA group via computergenerated randomization.The primary endpoint was the 24-hour postoperative visual analog scale(VAS)score,and the secondary endpoints included the operative time,24-hour postoperative inflammatory response biomarkers(including white blood cells,the neutrophil ratio,interleukin-6,and C-reactive protein),time to first postoperative exhaust,time to first out-of-bed activity,postoperative length of hospital stay,cost of hospitalization,and incidence of postoperative complications.RESULTS A total of 72 patients were enrolled and randomly divided into 2 groups:The mSLAN group(n=36)and the CLA group(n=36).The 24-hour VAS scores,24-hour postoperative inflammatory response marker levels,first postoperative exhaust times,first out-of-bed activity times,postoperative lengths of hospital stay,operative times,or hospitalization costs did not significantly differ between the two groups.No postoperative complications,including incision infection or hernia,abdominal abscess or intestinal obstruction,were observed during the 1-month postoperative follow-up in either group.CONCLUSION Compared with the CLA protocol,the mSLAN protocol for acute uncomplicated appendicitis yielded comparable short-term clinical outcomes,with a similar operative time and better cosmetic outcomes,indicating its potential for clinical application and superiority for patients with high cosmetic requirements.Further research is needed to evaluate the long-term outcomes.
文摘BACKGROUND Acute appendicitis(AP)is a frequently encountered surgical emergency,and appendectomy is conventionally regarded as the predominant treatment moda-lity.Nevertheless,the therapeutic efficacy of this surgical approach remains to be improved.Thus,the exploration and implementation of surgical refinements are necessary.AIM To elucidate the therapeutic effectiveness and influencing factors of laparoscopic appendectomy(LA)with mesoappendix dissection in the treatment of AP.METHODS First,150 patients with AP who visited Shangrao Municipal Hospital between January 2022 and June 2024 were enrolled in this study.Among them,72 patients were assigned to the control group to receive conventional LA,whereas 78 cases were included in the observation group for LA with mesoappendix dissection.Subsequently,indicators such as therapeutic effectiveness,surgical indices(ope-ration time,intraoperative blood loss,and hospital stay),postoperative recovery indices(time to ambulation,gastrointestinal function recovery time,and time to food intake),incidence of adverse events(postoperative bleeding,pelvic infection,puncture site infection,and ileus),and serum inflammatory factors[tumor necro-sis factor(TNF)-α,interleukin(IL)-6,and C-reactive protein(CRP)]were collected and comparatively analyzed,and the influencing factors of therapeutic effecti-veness in patients with AP were analyzed.RESULTS Compared with the control group,the observation group had higher clinical the-rapeutic effectiveness,less operation time,intraoperative blood loss,and hospital stay;shorter time to ambulation,gastrointestinal function recovery,and food intake;and a lower total incidence of adverse events,and this difference is statistically significant.In addition,the expression levels of various serum inflammatory factors in the observation group were significantly reduced postoperatively,which were markedly lower than those in the control group.Moreover,sex,age,body mass index,time from acute onset to admission,family medical history,preoperative TNF-α,preoperative IL-6,preoperative CRP,and treatment modality were identified to be not independent factors affecting the therapeutic effectiveness of LA with mesoappendix dissection in patients with AP.CONCLUSION Overall,LA with mesoappendix dissection has a remarkable curative effect in treating patients with AP,which is worthy of clinical promotion.
文摘Background: Appendicitis is one of the most common surgical emergencies requiring an appendectomy, with a life-time risk of 6%. The overall mortality rate for open appendectomy (OA) is around 0.3% and morbidity is about 11%. Objective: To compare laparoscopic vs open appendectomy with regard to postoperative pain and nausea, operative results, perioperative and postoperative complications, hospital admission. Methods: This prospective comparative study is performed in the Department of Surgery, North West Aramed Forced Hospital, Tabuk, Kingdom of Saudi Arabia. All patients between 13 and 60 years of age admitted through the accident and emergency (A&E) department with a clinical diagnosis of acute appendicitis and those who completed follow-up are included in the study. All those patients in whom a clinical diagnosis of acute appendicitis was not established or have a palpable mass in the right lower quadrant, suggesting an appendiceal abscess and those who does not give consent are excluded from the study. We reviewed the medical records of all patients who underwent a laparoscopic and open appendectomy in King Salman Armed Forces Hospital, Saudi Arabia from 1/1/2012 to 31/12/2015. Result: A total of 502 patients underwent Appendectomy at King Salman Armed Forces Hospital from 1/1/2012 till 31/12/2015. Of these, 203 were male (40.4%) and 299 were female (59.6%). The mean age was 18 years. Alvarado Score more than 7 in 93% of patients diagnosed with appendicitis. Comorbidities included diabetes 21 (5.56%) and hypertension 7 (1.39%). The mean Body Mass Index (BMI) was 20 kg/m<sup>2</sup>. 328 patients (65.3%) underwent Open Appendectomy (OA). None of Laproscopic appendectomy(LA) had a conversion. The mean operative time was 76 minutes (44 minutes and 50 minutes for OA and LA, respectively). Mean hospital stay in OA 2 days and one day LA. Eight cases (1.6%) developed seroma (6 cases in OA and 2 cases in LA with rates of 1.2% and 0.4% respectively). Nine patients (1.6%) had wound infection, 8 in OA and one in LA with rate of 1.5% and 0.2% respectively). Four patients (0.8%) develop the hematoma (3 cases in OA and one case in LA with rates of 0.6% and 0.2% respectively). Seven cases of reported appendectomy develop the pelvic abscess (1.4%) (5 cases in OA and 2 cases in LA with rates of 1% and 0.4% respectively). Conclusion: Alvarado Score carries high significance in the diagnosis of acute appendicitis. Laparoscopic appendectomy has improved diagnostic accuracy along with advantages in terms of fewer seroma, hematoma, wound infections, faster recovery, and earlier retention to normal activity but longer operative time.
文摘Acute appendicitis(AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy(LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Nonoperative management of AA may be tolerated only in children. Postoperative complications increase according to the patient's factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon's skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner(i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
基金Supported by the Construction Fund of Key Medical Disciplines of Hangzhou,No.0020200026Key R&D Program of Zhejiang Province,No.2023C03054.
文摘Acute appendicitis is a common surgical emergency.It is commonly caused by obstruction of the appendiceal lumen due to fecaliths,tumors,or lymphoid hyperplasia.For over a century,appendectomy has been the primary treatment for acute appendicitis.Abraham Groves performed the first open appendectomy in 1883.In 1983,Kurt Semm completed the first laparoscopic appendectomy,heralding a new era in appendectomy.However,appendectomy is associated with certain complications and a rate of negative appendectomies.Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson’s disease,but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer,gallstones,and cardiovascular disease.With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic technology,Liu proposed the endoscopic retrograde appendicitis therapy.It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis.Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis.This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.
文摘BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application.
文摘Schistosomal appendicitis(SA)is a rare but serious complication of schistosomiasis,a parasitic disease affecting over 250 million people worldwide.A recent retrospective study by Wang et al provides important insights into the clinicopathological characteristics of SA.The study compared 136 cases of SA to 5418 cases of non-SA over a ten-year period.Key findings include a higher average age of SA patients(61.73 years vs 35.8 years for non-SA),a higher proportion of acute on chronic appendicitis(33.1%vs 16%),and a significantly higher incidence of colorectal cancer(11.7%vs 2.2%).Despite these differences,SA remains a diagnostic challenge due to its nonspecific clinical presentation and lack of specific laboratory findings.The study also highlights the persistent prevalence of SA,accounting for 1.6%-3.4%of all appendicitis cases each year from 2013 to 2023.These findings underscore the need for enhanced awareness,early detection,and prompt treatment of SA in endemic regions.Given the association with colorectal cancer,patients with SA require thorough screening and follow-up.Further research into the pathogenesis and diagnostic markers of SA is warranted.As the global battle against schistosomiasis continues,targeted efforts to diagnose and manage SA can significantly improve patient outcomes.
文摘Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally.Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence management pathways.This narrative review synthesizes contemporary evidence and consensusbased imaging protocols for appendicitis,with a focus on computed tomography,magnetic resonance imaging,and ultrasound.The article explores advanced diagnostic criteria,interpretation challenges,imaging algorithms derived from professional society guidelines,and special considerations including pregnancy and pediatric populations.Clinical practice recommendations by the World Society of Emergency Surgery,European Association of Endoscopic Surgery,American College of Radiology,and Infectious Diseases Society of America are incorporated to frame best practices.
