BACKGROUND: The mini-invasive techniques have revolutionized the surgery; however, the superiority of laparoscopic access for complicated appendicitis is still controversial. The most critical point has been the dismal quality of the methodology found in the series comparing laparoscopic and laparotomic procedures. The lack of stratification criteria to evaluate the inflammation in the appendix and abdomen has been pointed out by several authors. PURPOSE: To validate the laparoscopic grading system for acute appendicitis. METHODS: Prospective study of 186 patients with presumed acute appendicitis who underwent an appendectomy if diagnostic laparoscopy showed appendicitis or normal-looking appendix without any other intra-abdominal disease. The appendix was graded as to different levels based upon its visual appearance: grade 0 (normal looking), 1 (redness and edema), 2 (fibrin), 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis), and 5 (diffuse peritonitis). This was then compared with a histologic assessment of the removed appendix supplemented by a biochemical study of collected peritoneal fluid (gold standard) to determine the diagnostic indexes. Besides that, the κ coefficient confirmed concordance between them. RESULTS: Laparoscopic sensitivity, specificity, and accuracy for acute appendicitis diagnosis were 100%, 63.3%, and 84.1%, respectively, and presented substantial concordance [κ=0.74 (95% confidence interval, 0.60-0.88)]. Sensitivity, specificity, and accuracy of the laparoscopic grading system were 63%, 83.3%, and 80.1%, respectively, and presented moderate concordance [κ=0.39 (95% confidence interval, 0.23-0.55)]. The biochemical-histologic grading system changed for 48 (25.8%) patients who had been previously classified by surgeons during laparoscopy. Most incorrect graduation occurred in grades 0 and 1. The presence of exudates was confirmed in all cases classified as grades 4A, 4B, and 5. CONCLUSIONS: Laparoscopy showed good to excellent accuracy for diagnosis and grading of acute appendicitis. The better grading system allowed the evaluation of patients with acute appendicitis in the same clinical stage.
BACKGROUND: The mini-invasive techniques have revolutionized the surgery; however, the superiority of laparoscopic access for complicated appendicitis is still controversial. The most critical point has been the dismal quality of the methodology found in the series comparing laparoscopic and laparotomic procedures. The lack of stratification criteria to evaluate the inflammation in the appendix and abdomen has been pointed out by several authors. PURPOSE: To validate the laparoscopic grading system for acute appendicitis. METHODS: Prospective study of 186 patients with presumed acute appendicitis who underwent an appendectomy if diagnostic laparoscopy showed appendicitis or normal-looking appendix without any other intra-abdominal disease. The appendix was graded as to different levels based upon its visual appearance: grade 0 (normal looking), 1 (redness and edema), 2 (fibrin), 3A (segmental necrosis), 3B (base necrosis), 4A (abscess), 4B (regional peritonitis), and 5 (diffuse peritonitis). This was then compared with a histologic assessment of the removed appendix supplemented by a biochemical study of collected peritoneal fluid (gold standard) to determine the diagnostic indexes. Besides that, the κ coefficient confirmed concordance between them. RESULTS: Laparoscopic sensitivity, specificity, and accuracy for acute appendicitis diagnosis were 100%, 63.3%, and 84.1%, respectively, and presented substantial concordance [κ=0.74 (95% confidence interval, 0.60-0.88)]. Sensitivity, specificity, and accuracy of the laparoscopic grading system were 63%, 83.3%, and 80.1%, respectively, and presented moderate concordance [κ=0.39 (95% confidence interval, 0.23-0.55)]. The biochemical-histologic grading system changed for 48 (25.8%) patients who had been previously classified by surgeons during laparoscopy. Most incorrect graduation occurred in grades 0 and 1. The presence of exudates was confirmed in all cases classified as grades 4A, 4B, and 5. CONCLUSIONS: Laparoscopy showed good to excellent accuracy for diagnosis and grading of acute appendicitis. The better grading system allowed the evaluation of patients with acute appendicitis in the same clinical stage.
Authors: Salomone Di Saverio; Arianna Birindelli; Micheal D Kelly; Fausto Catena; Dieter G Weber; Massimo Sartelli; Michael Sugrue; Mark De Moya; Carlos Augusto Gomes; Aneel Bhangu; Ferdinando Agresta; Ernest E Moore; Kjetil Soreide; Ewen Griffiths; Steve De Castro; Jeffry Kashuk; Yoram Kluger; Ari Leppaniemi; Luca Ansaloni; Manne Andersson; Federico Coccolini; Raul Coimbra; Kurinchi S Gurusamy; Fabio Cesare Campanile; Walter Biffl; Osvaldo Chiara; Fred Moore; Andrew B Peitzman; Gustavo P Fraga; David Costa; Ronald V Maier; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Roberto Cirocchi; Valeria Tonini; Alice Piccinini; Gregorio Tugnoli; Elio Jovine; Roberto Persiani; Antonio Biondi; Thomas Scalea; Philip Stahel; Rao Ivatury; George Velmahos; Roland Andersson Journal: World J Emerg Surg Date: 2016-07-18 Impact factor: 5.469
Authors: Massimo Sartelli; Gian L Baiocchi; Salomone Di Saverio; Francesco Ferrara; Francesco M Labricciosa; Luca Ansaloni; Federico Coccolini; Deepak Vijayan; Ashraf Abbas; Hariscine K Abongwa; John Agboola; Adamu Ahmed; Lali Akhmeteli; Nezih Akkapulu; Seckin Akkucuk; Fatih Altintoprak; Aurelia L Andreiev; Dimitrios Anyfantakis; Boiko Atanasov; Miklosh Bala; Dimitrios Balalis; Oussama Baraket; Giovanni Bellanova; Marcelo Beltran; Renato Bessa Melo; Roberto Bini; Konstantinos Bouliaris; Daniele Brunelli; Adrian Castillo; Marco Catani; Asri Che Jusoh; Alain Chichom-Mefire; Gianfranco Cocorullo; Raul Coimbra; Elif Colak; Silvia Costa; Koray Das; Samir Delibegovic; Zaza Demetrashvili; Isidoro Di Carlo; Nadezda Kiseleva; Tamer El Zalabany; Mario Faro; Margarida Ferreira; Gustavo P Fraga; Mahir Gachabayov; Wagih M Ghnnam; Teresa Giménez Maurel; Georgios Gkiokas; Carlos A Gomes; Ewen Griffiths; Ali Guner; Sanjay Gupta; Andreas Hecker; Elcio S Hirano; Adrien Hodonou; Martin Hutan; Orestis Ioannidis; Arda Isik; Georgy Ivakhov; Sumita Jain; Mantas Jokubauskas; Aleksandar Karamarkovic; Saila Kauhanen; Robin Kaushik; Alfie Kavalakat; Jakub Kenig; Vladimir Khokha; Desmond Khor; Dennis Kim; Jae I Kim; Victor Kong; Konstantinos Lasithiotakis; Pedro Leão; Miguel Leon; Andrey Litvin; Varut Lohsiriwat; Eudaldo López-Tomassetti Fernandez; Eftychios Lostoridis; James Maciel; Piotr Major; Ana Dimova; Dimitrios Manatakis; Athanasio Marinis; Aleix Martinez-Perez; Sanjay Marwah; Michael McFarlane; Cristian Mesina; Michał Pędziwiatr; Nickos Michalopoulos; Evangelos Misiakos; Ali Mohamedahmed; Radu Moldovanu; Giulia Montori; Raghuveer Mysore Narayana; Ionut Negoi; Ioannis Nikolopoulos; Giuseppe Novelli; Viktors Novikovs; Iyiade Olaoye; Abdelkarim Omari; Carlos A Ordoñez; Mouaqit Ouadii; Zeynep Ozkan; Ajay Pal; Gian M Palini; Lars I Partecke; Francesco Pata; Michał Pędziwiatr; Gerson A Pereira Júnior; Tadeja Pintar; Magdalena Pisarska; Cesar F Ploneda-Valencia; Konstantinos Pouggouras; Vinod Prabhu; Padmakumar Ramakrishnapillai; Jean-Marc Regimbeau; Marianne Reitz; Daniel Rios-Cruz; Sten Saar; Boris Sakakushev; Charalampos Seretis; Alexander Sazhin; Vishal Shelat; Matej Skrovina; Dmitry Smirnov; Charalampos Spyropoulos; Marcin Strzałka; Peep Talving; Ricardo A Teixeira Gonsaga; George Theobald; Gia Tomadze; Myftar Torba; Cristian Tranà; Jan Ulrych; Mustafa Y Uzunoğlu; Alin Vasilescu; Savino Occhionorelli; Aurélien Venara; Andras Vereczkei; Nereo Vettoretto; Nutu Vlad; Maciej Walędziak; Tonguç U Yilmaz; Kuo-Ching Yuan; Cui Yunfeng; Justas Zilinskas; Gérard Grelpois; Fausto Catena Journal: World J Emerg Surg Date: 2018-04-16 Impact factor: 5.469
Authors: Carlos Augusto Gomes; Cleber Soares Junior; Evandro de Freitas Campos Costa; Paula de Assis Pereira Alves; Carolina Vieira de Faria; Igor Vitoi Cangussu; Luisa Pires Costa; Camila Couto Gomes; Felipe Couto Gomes Journal: J Clin Med Res Date: 2014-05-22