Complicated destructive appendicitis: finding the optimal treatment method

Abstract

Aim. To analyze the current practice for the surgical treatment of destructive acute appendicitis complicated by typhlitis and periappendicular abscess.

Methods. This study analyzed the treatment outcomes in 84 patients with acute destructive appendicitis aged 18 to 79 years who were treated in the Department of Surgery No. 2 of the City Clinical Hospital No. 7 of Kazan between 2016 and 2021 years. According to the method for completion of surgical intervention, patients were divided into 2 groups, similar in age, duration of the disease and morphological changes in the appendix. In the comparison group, 54 patients had the surgical intervention completed by gauze-glove drainage of the appendix bed. In 30 patients of the main group, the appendix stump and the adjacent intestinal wall was covered with a Tachocomb plate. Then the VAC system with the Vivano device and supplies from “Hartmann Group” (Germany) was connected. The statistical significance of the differences between the indicators was assessed by using the Student's t-test.

Results. The analysis of the surgical techniques used showed that in the main group, postoperative wound complications decreased by 3 times (23.3% of patients, p=0.04), intra-abdominal fluid collections decreased by 2 times (6.7% of patients, p=0.02), the hospital lengths of stay decreased by 1.8 times (p=0.02) compared with the comparison group.

Conclusion. The use of ligature appendectomy in combination with plastic closure of the appendix stump with a TachoComb and the technology of local vacuum-assisted laparostomy in patients with destructive appendicitis complicated by periappendicular abscess contributes to a 3-fold reduction in wound postoperative complications and reduces the hospital lengths of stay in this group of patients by 1.8 times.

Keywords

acute appendicitis / typhlitis / periappendicular abscess / vacuum system / Vivano device / vacuum therapy

References

[1] Revishvili A.Sh., Fedorov A.V., Sazhin V.P., Olovyannyi V.E. Emergency surgery in Russian Federation. Khirurgiya. Zhurnal im. N.I. Pirogova. 2019; (3): 88–97. (In Russ.) DOI: 10.17116/hirurgia201903188.

[2] Ревишвили А.Ш., Фёдоров А.В., Сажин В.П., Оловянный В.Е. Состояние экстренной хирургической помощи в Российской Федерации. Хирургия. Ж. им. Н.И. Пирогова. 2019; (3): 88–97. DOI: 10.17116/hirurgia201903188.

[3] Kriger A.G., Fedorov A.V., Voskresenskij P.K., Dronov A.F. Ostryj appendicit. (Acute appendicitis.) M.: Medpraktika-M. 2002; 244 p. (In Russ.)

[4] Кригер А.Г., Фёдоров А.В., Воскресенский П.К., Дронов А.Ф. Острый аппендицит. М.: Медпрактика-М. 2002; 244 с.

[5] Iartsev P.A., Ermolov A.S., Pakho­mova G.V., Guliaev A.A., Levitskiy V.D. Laparoscopy for the diagnostic and treatment of the acute appendicitis. Khirurgiya. Zhurnal im. N.I. Pirogova. 2010; (4): 21–25. (In Russ.)

[6] Ярцев П.А., Ермолов А.С., Пахомова Г.В., Гуляев А.А., Левитский В.Д. Лапароскопия в диагностике и лечении острого аппендицита. Хирургия. Ж. им. Н.И. Пирогова. 2010; (4): 21–25.

[7] Kolesov V.I. Klinika i lechenie ostrogo appendicita. (Clinic and treatment of acute appendicitis.) L.: Medgiz. 1959; 290 p. (In Russ.)

[8] Колесов В.И. Клиника и лечение острого аппендицита. Л.: Медгиз. 1959; 290 с.

[9] Rukovodstvo po neotlozhnoj hirurgii. (Emergency surgery manual.) Ed. by V.S. Savel'ev. M.: Triada-H. 2005; 640 p. (In Russ.)

[10] Руководство по неотложной хирургии. Под ред. В.С. Савельева. М.: Триада-Х. 2005; 640 с.

[11] Komorovskij Ju.T. Peritonization or extraperitonization of the “difficult” stump of the appendix? Klinicheskaya khirurgiya 1982; (4): 54–57. (In Russ.)

[12] Коморовский Ю.Т. Перитонизация или экстраперитонизация «трудной» культи червеобразного отростка? Клин. хир. 1982; (4): 54–57.

[13] Saidhanov A.S., Karimov G.Z. Appendectomy in the spread of inflammatory tissue infiltration on the dome of the cecum. Khirurgiya. Zhurnal im. N.I. Pirogova. 1989; (10): 117–120. (In Russ.)

[14] Саидханов А.С., Каримов Г.З. Аппендэктомия при распространении воспалительной инфильтрации тканей на купол слепой кишки. Хирургия. Ж. им. Н.И. Пирогова. 1989; (10): 117–120.

[15] Tatti Ja.Ja., Vanjukova O.V. Peritonization of the appendix stump during inflammatory infiltration of the caecum dome. Vestn. hirurgii. 2001; 160 (3): 79–80. (In Russ.)

[16] Татти Я.Я., Ванюкова О.В. Перитонизация культи червеобразного отростка при воспалительной инфильтрации купола слепой кишки. Вестн. хир. 2001; 160 (3): 79–80.

[17] Gataullin N.G., Plechev V.V., Nartajlakov M.A., Kornilaev P.G. Suture-adhesive method of processing the stump of the appendix. Klin. hir. 1988; (4): 75–79. (In Russ.)

[18] Гатауллин Н.Г., Плечев В.В., Нартайлаков М.А., Корнилаев П.Г. Шовно-клеевой способ обработки культи червеобразного отростка. Клин. хир. 1988; (4): 75–79.

[19] Acute appendicitis in adults. Clinical recommendations. 2020; 42 p. http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/klinicheskie-rekomendaci/urgentnaja-abdominalnaja-hirurgija/-ostryi-apendicit-u-vzroslyh-2020.html (access date: 02.03.2021). (In Russ.)

[20] Острый аппендицит у взрослых. Клинические рекомендации. 2020; 42 с. http://xn----9sbdbejx7bdduahou3a5d.xn--p1ai/stranica-pravlenija/klinicheskie-rekomendaci/urgentnaja-abdominalnaja-hirurgija/-ostryi-apendicit-u-vzroslyh-2020.html (дата обращения: 02.03.2021).

[21] Shurkalin B.K., Faller A.P., Gorskiy V.A. Surgical aspects of the treatment of generalized peritonitis. Khi­rurgiya. Zhurnal im. N.I. Pirogova. 2007; (2): 24–28. (In Russ.)

[22] Шуркалин Б.К., Фаллер А.П., Горский В.А. Хирургические аспекты лечения распространённого перитонита. Хирургия. Ж. им. Н.И. Пирогова. 2007; (2): 24–28.

[23] Obolenskiy V.N., Ermolov A.A., Aronov L.S., Rodoman G.V., Serov R.A. The application of topical negative pressure in the complex treatment of acute suppurative di­seases of soft tissues. Khirurgiya. Zhurnal im. N.I. Pirogova. 2012; (12): 50–55. (In Russ.)

[24] Оболенский В.Н., Ермолов А.А., Аронов Л.С., Родоман Г.В., Серов Р.А. Применение метода локального отрицательного давления в комплексном лечении острых гнойно-воспалительных заболеваний мягких тканей. Хирургия. Ж. им. Н.И. Пирогова. 2012; (12): 50–55.

[25] D’Hondt M., D’Haeninck A., Dedrye L., Penninckx F., Aerts R. Can vacuum-assisted closure and instillation therapy (VAC-Instill therapy) play a role in the treatment of the infected open abdomen? Techniques in coloproctol. 2011; 15 (1): 75–77. DOI: 10.1007/s10151-010-0662-4.

[26] Barker D.E., Green J.M., Maxwell R.A., Smith P.W., Mejia V.A., Dart B.W., Burns R.P. Experience with vacuum-pack temporary abdominal wound closure in 258 trauma and general and vascular surgical patients. J. Am. Coll. Surg. 2007; 204 (5): 784–792. DOI: 10.1016/j.jamcollsurg.2006.12.039.

[27] Vargo D. Negative pressure wound therapy in the prevention of wound infection in high risk abdominal wound closures. Am. J. Surg. 2012; 204 (6): 1021–1024. DOI: 10.1016/j.amjsurg.2012.10.004.

[28] Aver'yanova Yu.V., Makarov S.P., Stepanov A.E., Razumovsky A.Yu., Vasiliev K.G. Vacuum-therapy for complicated anterior abdominal wall wounds and intestinal fistulas in children. Khirurgiya. Zhurnal im. N.I. Pirogova. 2016; (2): 39–44. (In Russ.) DOI: 10.17116/hirurgia2016239-44.

[29] Аверьянова Ю.В., Макаров С.П., Степанов А.Э., Разумовский А.Ю., Васильев К.Г. Возможности вакуум-терапии при лечении осложнённых ран передней брюшной стенки и кишечных свищей у детей. Хирургия. Ж. им. Н.И. Пирогова. 2016; (2): 39–44. . DOI: 10.17116/hirurgia2016239-44.

[30] Morozov A.M., Sergeev A.N., Zhukov S.V., Askerov E.M., Belyak M.A., Pakhomov M.A., Morozova A.D., Shishkin N.V. About the possibility of ­using scales of pain in the conditions of a hospital. Mo­dern problems of science and education. 2020; (4): 147. (In Russ.) DOI: 10.17513/spno.29862.

[31] Морозов А.М., Сергеев А.Н., Жуков С.В., Аскеров Э.М., Беляк М.А., Пахомов М.А., Морозова А.Д., Шишкин Н.В. О возможности использования шкал боли в условиях стационара. Соврем. пробл. науки и образования. 2020; (4): 147. DOI: 10.17513/spno.29862.

RIGHTS & PERMISSIONS

Eco-Vector