Euroasian journal of hepato-gastroenterology

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VOLUME 9 , ISSUE 1 ( January-June, 2019 ) > List of Articles

Original Article

Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study

Maxime Mariage, Charles Sabbagh, Gerard Grelpois, Flavien Prevot, Ilan Darmon, Jean-Marc Regimbeau

Keywords : Appendicitis, Generalized, Localized, Peritonitis

Citation Information : Mariage M, Sabbagh C, Grelpois G, Prevot F, Darmon I, Regimbeau J. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol 2019; 9 (1):1-4.

DOI: 10.5005/jp-journals-10018-1286

License: CC BY-NC 4.0

Published Online: 01-09-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Aim: Definition of the type of appendicitis is based on examination of the peritoneum and appendix. Gomes et al. proposed a laparoscopic grading system of acute appendicitis (grades 1 and 2, noncomplicated appendicitis, grade 3–5 complicated appendicitis). The aim of this study was to evaluate the reproducibility of this score. Patients and methods: All patients managed for acute appendicitis between January 2016 and June 2016 were included in this single-center prospective study. Laparoscopic appendectomy procedures were filmed by analogy to Sugerbaker's peritoneal carcinomatosis score (9 quadrants, all of the abdomen was filmed). The videos were then analyzed by seven staff surgeons blinded to each other and the operative report. The primary endpoint was to determine the concordance between staff surgeons for grading of appendicitis using the laparoscopic grading system of acute appendicitis described by Gomes et al. Results: A total of 40 patients were included in this study. A concordance was observed between the seven staff surgeons in 85% of cases. For regional peritonitis, the mean ± (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 1.44 ± 0.63. For diffuse peritonitis, the mean (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 2.59 ± 0.51. On ROC curve analysis, two quadrants was the best cut-off between grade 4B (local peritonitis) and five (diffuse peritonitis) acute appendicitis (AUC = 0.92, Se = 100%, Sp = 92%, p = 0.005). Conclusion: The classification used to determine the type of appendicitis is reproducible. Clinical significance: To give a definition of complicated appendicitis.


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  1. Horn AE, Ufberg JW. Appendicitis, diverticulitis, and colitis. Emerg Med Clin N Am 2011;29(2):347-368.
  2. Mariage MSC, Yzet T, et al. Fecal appendicular peritonitis: a particular type of appendicitis that must be distinguished. 2017. Under reveiw
  3. Sabbagh C, Brehant O, et al. The feasibility of short-stay laparoscopic appendectomy for acute appendicitis: a prospective cohort study. Surg Endosc 2012;26(9):2630-2638.
  4. Sabbagh C, Cosse C, et al. Ambulatory management of gastrointestinal emergencies: what are the current literature data? J Visc Surg 2014;151(1):23-27.
  5. Grelpois G, Sabbagh C, et al. Management of uncomplicated acute appendicitis as day case surgery: feasibility and a critical analysis of exclusion criteria and treatment failure. J Am College Surg 2016;223(5):694-703.
  6. Atema JJ, van Rossem CC, et al. Scoring system to distinguish uncomplicated from complicated acute appendicitis. Br J Surg 2015;102(8):979-990.
  7. Gomes CA, Nunes TA, et al. Laparoscopy grading system of acute appendicitis: new insight for future trials. Surg Laparosc Endosc Percutan Tech 2012;22(5):463-466.
  8. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 1996;82:359-374.
  9. Montravers P, Dupont H, et al. Guidelines for management of intraabdominal infections. Anaesth, Crit Care Pain Med 2015;34(2):117- 130.
  10. Rogers AP, Zens TJ, et al. A call for a standardized definition of perforated appendicitis. J Pediatr Surg 2017;52 (1):89-92.
  11. Berard F, Gandon J. Postoperative Wound Infections: The Influence of Ultraviolet Irradiation of the Operating Room and of Various Other Factors. Annals of Surgery 1964;160(Suppl 2):1-192.
  12. Wang-Chan A, Gingert C, et al. Clinical relevance and effect of surgical wound classification in appendicitis: Retrospective evaluation of wound classification discrepancies between surgeons, Swissnosotrained infection control nurse, and histology as well as surgical site infection rates by wound class. J Surg Res 2017;215:132-139.
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