Gelpke, K. (2018) Reductie van het percentage negatieve appendectomieën met de laparoscopische appendicitis score. thesis, Medicine.
Full text available on request.Abstract
BACKGROUND: Acute appendicitis is the most common intra-abdominal infection. About 9% of all appendectomies is based on an appendix sana. A negative appendectomy is associated with higher morbidity and mortality, longer admission, and higher costs than appendectomy for uncomplicated appendicitis. During a prior pilot study, the laparoscopic appendicitis (LAPP) score was introduced in order to systematically evaluate the appendix on the presence of inflammation. Goal of this study is to determine whether the LAPP score can reduce the negative appendectomy rate by 50%, without an increase in missed appendicitis. METHODS: From September 2013 through May 2016, 322 adult patients with the clinical suspicion of acute appendicitis and an indication for diagnostic laparoscopy were included and analyzed in this multicenter prospective validation study. In case of a positive LAPP score (n = 300), the appendix was removed. In case of a negative LAPP score (n = 22), the appendix stayed in situ. Patients in the intervention group were compared to a historical control group of 584 patients in the same hospitals. The appendix was examined by a pathologist and the negative appendectomy rate was determined. RESULTS: The negative appendectomy rate was significantly lower in the intervention group than in the control group (4,7% and 8,4% respectively; P = 0,034). There was no significant difference in operation time, complications, and readmissions between both groups. None of the patients with a negative LAPP score developed acute appendicitis within three months. Patients in the intervention group had significantly more preoperative radiological imaging than in the control group (98% and 70% respectively; P < 0,001). CONCLUSION: The LAPP score can be used safe and quickly to reduce the negative appendectomy rate during laparoscopic surgery without missing an episode of acute appendicitis. The increase in radiological imaging may have contributed to the reduction in negative appendectomies in this study.
| Item Type: | Thesis (Thesis) |
|---|---|
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1125 |
Actions (login required)
 |
View Item |