APPENDICULAR PERITONITIS – REVIEW ON THE TREATMENT ALGORITHM

摘要

BACKGROUND: TREATMENT OF APPENDICULAR PERITONITIS CONSISTS OF TWO MAIN ACTION TOOLS: SURGICAL THERAPY AND ANTIBIOTHERAPY. DECISION ON THE MOST APPROPIATE ALGORITHM FOR COMBINING THE TWO IS NOT ALWAYS EASY TO DO, BUT IS ESSENTIAL FOR THE IMMEDIATE AND LATE RESULTS OF TREATMENT. THE PURPOSE OF THIS STUDY WAS TO EVALUATE THE TREATMENT ALGORITHMS APPLIED IN PRACTICE IN PATIENTS WITH APPENDICULAR PERITONITIS. MATERIALS AND METHODS: A RETROSPECTIVE STUDY OF PATIENTS ADMITTED IN THE 1ST SURGERY CLINIC OF THE UNIVERSITY EMERGENCY HOSPITAL OF BUCHAREST WITH THE DIAGNOSIS OF ACUTE APPENDICITIS AND WHO UNDERWENT APPENDECTOMY, CONFIRMING COMPLICATED ACUTE APPENDICITIS, BETWEEN 2005 AND 2012; THE DATA COLLECTED INCLUDED LABORATORY AND HISTOLOGICAL RESULTS, LENGTH OF STAY, ANTIBIOTIC TREATMENT AND COMPLICATIONS ASSOCIATED WITH APPENDECTOMY. RESULTS: 264 PATIENTS UNDERWENT APPENDECTOMY FOR COMPLICATED APPENDICITIS IN THE TIME INTERVAL OF THE STUDY. THE SURGICAL INTERVENTION CONSISTED OF APPENDECTOMY, MAINLY OPEN (OPEN 92%, LAPAROSCOPIC 8%), AND DRAINAGE IN MOST CASES. PREOPERATIVE ANTIBIOTHERAPY WAS ADMINISTERED IN 40.91% OF CASES, THE MOST FREQUENT ANTIBIOTIC REGIMEN INCLUDING CARBAPENEMS. POSTOPERATIVE ANTIBIOTHERAPY WAS ADMINISTERED TO ALL PATIENTS, THE MEAN LENGTH OF ANTIBIOTIC TREATMENT WAS 4.65 DAYS (RANGE 2 -25). POSTOPERATIVE COMPLICATIONS OCCURED IN 23.48% OF CASES, THE MOST FREQUENT BEING WOUND INFECTION (17%). THE MEAN HOSPITAL STAY WAS 6.9 DAYS (RANGE 3-38). MORTALITY IN THE STUDY GROUP WAS 2.65%.THE ALGORITHM OF PREOPERATIVE ANTIBIOTHERAPY – SURGICAL INTERVENTION HAS PROTECTIVE VALUE FOR WOUND-RELATED COMPLICATIONS: p<0.05, OR=2.1463, RR=1.90, RD=10.04, x2 =4.55, p=0.03288. CONCLUSIONS: PATIENTS WITH ACUTE APPENDICITIS AND HIGH RISK FOR POSTOPERATIVE INFECTIOUS COMPLICATIONS SHOULD BE ADMINISTERED PREOPERATIVE ANTIBIOTHERAPY AND UNDERGO SURGICAL INTERVENTION IN ORDER TO REDUCE POSTOPERATIVE MORBIDITY. OPEN APPENDECTOMY IS STILL PREFERRED BY MOST SURGEONS, BUT LAPAROSCOPIC APPENDECTOMY WILL PROBABILLY DOMINATE IN THE NEAR FUTURE, AS EXPERIENCE AND SKILLS ACCUMULATE.