Validation of Anderson Score for Diagnosis of Acute Appendicitis by Histopathology: A Prospective Observational Study | Chapter 5 | Medicine and Medical Research: New Perspectives Vol. 12

Background: Appendicectomy is a very common operation performed. Because of advances in ultrasonography and CT Scanning, there is improvement in the diagnosis of appendicitis, but still, clinical observation and experience of the surgeon matters a lot. Removing normal appendix leads to multiphasic problems. Furthermore, appendix has proved to be a useful structure in reconstructive surgeries.

Aim: This study evaluates the validation of the Anderson score for diagnosis of acute appendicitis by histopathology.

Methods: This prospective observational study was performed in the Surgery Department at SGT Medical College, Gurugram, Haryana. The study included a total of 100 patients. Informed consent was taken for examination and investigations giving due respect to maintain the patient’s privacy and keep them comfortable. A detailed history was taken, clinical examination and investigations were done. All patients were subjected to Anderson's score. Appendix was sent for Histopathology examination. Sensitivity, specificity, positive predictive value and negative predictive values were found out. Statistical analysis was carried out using statistical SPSS version 23 software by using the Chi-square test.

Results: In 70 patients, Anderson score was >8, which was in favor of acute appendicitis. It means these patients should require surgery. In 30 patients score was <8. The sensitivity, specificity, positive predictive value and overall accuracy of clinical examination have been found to be 63.2%, 81.8%, 62.2% and 70.8% respectively. The most common histopathology finding was acute appendicitis then diffuse suppurative appendicitis followed by gangrenous appendicitis still followed by diffuse suppurative appendicitis with peri appendicitis.

Conclusions: The study found out that if Anderson's score is ≥8, appendicectomy should be done. But if Anderson's score is 0-4, the patient should be managed conservatively, if the score is 5-8, the final decision will depend on further investigations, observations and a second opinion.

 

 

Author (s) Details

Kanwar Singh Goel
Department of General Surgery, SGT Medical College, Budhera, Gurugram, Haryana, India.

 

Sapna Goel
Department of Pathology, Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India.

Nikhil Goel
Department of Psychiatry, Shaheed Hasan Khan Mewati Government Medical College, Nuh, Haryana, India.

 

Tarun Aggarwal
Department of General Surgery, SGT Medical College, Budhera, Gurugram, Haryana, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v12/2871

An Audit of Laparoscopic Surgery in a Developing Country in East Africa at the Beginning of a Surgeon's Learning Curve | Chapter 16 | Highlights on Medicine and Medical Research Vol. 5

 Background: Laparoscopic surgery has been used for surgical access in a variety of situations. The gold standard treatment for cholecystitis in the West is laparoscopic cholecystectomy. Laparoscopic appendicectomy, on the other hand, has sparked debate due to its high cost and time-consuming existence, as well as the numerous trocar sites, which all add up to the duration of an open appendicectomy incision.Laparoscopic surgery has many benefits, including a faster return to daily life, a shorter hospital stay, and less postoperative analgesia. The aim of this study is to evaluate the initial experience of laparoscopic units in a developing country in East Africa.

The thesis was performed retrospectively in the Department of Surgery. This research included all patients who agreed to laparoscopic cholecystectomy and laparoscopic appendicectomy within the first 13 months.

Ten (10) patients consented to laparoscopic cholecystectomies with a male:female ratio of 1:2.33, and twenty (20) patients consented to laparoscopic appendicectomies with a male:female ratio of 1:1.2. The average operating time for laparoscopic cholecystectomy was 58.5 minutes and for laparoscopic appendicectomy was 40.45 minutes. For laparoscopic cholecystectomy, post-operative admission lasted 3 to 5 days, with a mean of 4.2 days, and for laparoscopic appendicectomy, it lasted 2 to 5 days, with a mean of 2.65 days. Aside from a spinal headache in two patients (2.6 percent) out of the total laparoscopic procedures, no other complications were identified. During the one-month follow-up period, there were no readmissions.

Conclusions: Laparoscopic cholecystectomy and appendicectomy are safe and allow for early discharge. The low incidence of cholecystitis in Uganda, relative to the higher incidence of appendicitis, supports the use of laparoscopic appendicectomy for hand and eye coordination training rather than cholecystectomy. The surgeons' initial cases of laparoscopic procedures have shown an acceptable degree of protection, indicating that laparoscopic appendicectomy is a viable option for learning the fundamentals of laparoscopic surgery.

Author (s) Details

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Surgery, Habib Medical School, IUIU University, Kampala, Uganda.

View Book :- https://stm.bookpi.org/HMMR-V5/article/view/703