Bài giảng viêm ruột thừa (APPENDICITIS) môn ngoại

Recommendation 1.3 We suggest against the use of Alvarado score to positively confirm the clinical suspicion of acute appendicitis in adults [QoE: Moderate; Strength of recommendation:

APPENDICITIS

Dr Alfredo Alvarado

in Philadelphia, Pennsylvania

in Annals of Emergency Medicine in 1986  

Appendicitis Inflammatory Response

Recommendation 1.3 We suggest against the use of   Alvarado score to positively confirm the clinical suspicion of acute appendicitis in adults [QoE: Moderate; Strength of recommendation: Weak; 2B].

Recommendation 1.4 We recommend the use of   AIR score and AAS score as clinical predictors of acute appendicitis [QoE: High; Strength of recommendation: Strong; 1A].

Recommendation 2.3 In the case of NOM, we recommend   initial intravenous antibiotics with a subsequent switch to oral antibiotics based on patient's clinical conditions [QoE: Moderate; Strength of recommendation: Strong; 1B].

Recommendation 3.1 We recommend planning laparoscopic appendectomy for the next   available operating list within 24 h in case of uncomplicated acute appendicitis, minimizing the delay wherever possible [QoE: Moderate; Strength of recommendation: Strong; 1B]

Recommendation 4.1 We recommend   laparoscopic appendectomy as the preferred approach over open appendectomy for both uncomplicated and complicated acute appendicitis, where laparoscopic equipment and expertise are available [QoE: High; Strength of recommendation: Strong; 1A]

Recommendation 4.3 We recommend conventional   three-port laparoscopic appendectomy over single-incision laparoscopic appendectomy, as the conventional laparoscopic approach is associated with shorter operative times, less postoperative pain, and lower incidence of wound infection [QoE: High; Strength of recommendation: Strong; 1A]

Recommendation 4.7 We suggest laparoscopic appendectomy should be preferred to open   appendectomy in pregnant patients when surgery is indicated Laparoscopy is technically safe and feasible during pregnancy where expertise of laparoscopy is available [QoE: Moderate; Strength of recommendation: Weak; 2B]

Recommendation 4.12 We   recommend against the use of drains following appendectomy for complicated appendicitis in adult patients [QoE: Moderate; Strength of recommendation: Strong; 1B].

Recommendation 5.3 We suggest   appendix removal if the appendix appears

“normal” during surgery and no other disease is found in symptomatic patients [QoE: Low; Strength of recommendation: Weak; 2C].

Recommendation 7.1 We recommend a   single preoperative dose of broad-spectrum antibiotics

in patients with acute appendicitis undergoing appendectomy We recommend against postoperative antibiotics for patients with uncomplicated appendicitis [QoE: High; Strength of recommendation: Strong; 1A]

Recommendation 7.2 We recommend   against prolonging antibiotics longer than 3–

5 days postoperatively in case of complicated appendicitis with adequate source-control [QoE: High; Strength of recommendation: Strong; 1A].

Recommendation 7.3 We recommend early   switch (after 48 h) to oral administration of postoperative antibiotics in children with complicated appendicitis, with an overall length of therapy shorter than 7 days [QoE: Moderate; Strength of recommendation: Strong; 1B].

Single Port Laparoscopic Appendectomy

Three Port Laparoscopic Appendectomy