2015;386:1278–1287. DIAGNÓSTICO Y TRATAMIENTO DE LA APENDICITIS AGUDA. Park HC, Kim MJ, Lee BH. a laparoscópica apendicecomía, ano en adulos como ahora ambién en casos de pediaría. Allaway MGR, Eslick GD, Cox MR. Las palabras clave utilizadas para las búsquedas elecrónicas se Am J Obstet Gynecol. J Mater Fetal Neonat Med. In a prospective study conducted by Kinner et al., when the diagnostic accuracy of MRI was compared to CT, sensitivity and specificity were 85.9% and 93.8% for non-enhanced MRI, 93.6% and 94.3% for contrast-enhanced MRI, and 93.6% and 94.3% for CT [98]. 2018;229:234–42. In the multivariate analysis, only the APPY1 test and ANC > 7500/mL were significant risk factors for AA [55]. Ann Emerg Med. Minneci PC, Mahida JB, Lodwick DL, et al. US reliability for the diagnosis of AA can be improved through standardized results reporting. Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm. 2016;160:1599–604. found a strong positive correlation between IMA levels and CT findings in distinguishing gangrenous/perforated AA from uncomplicated AA [53]. Ital J Pediatr. Sippola S, Grönroos J, Tuominen R, et al. Such algorithm increased the diagnostic yield without increasing the proxies of maternal or fetal morbidity. Relación hombre/mujer de aproximadamente 1,4:1. Of the 70 patients randomized to antibiotic treatment who subsequently underwent appendectomy, 82.9% had uncomplicated AA, 10.0% had complicated AA, and 7.1% did not have AA but received appendectomy for suspected recurrence. Several clinical scoring systems have been developed, the two most popular for use in children being the Alvarado score and Samuel’s Pediatric Appendicitis Score (PAS). Al-Katib S, Sokhandon F, Farah M. MRI for appendicitis in pregnancy: is seeing believing? Br J Surg. Gorter RR, Eker HH, Gorter-Stam MA, Abis GS, Acharya A, Ankersmit M, Antoniou SA, Arolfo S, Babic B, Boni L, Bruntink M, van Dam DA, Defoort B, Deijen CL, DeLacy FB, Go PM, Harmsen AM, van den Helder RS, Iordache F, Ket JC, Muysoms FE, Ozmen MM, Papoulas M, Rhodes M, Straatman J, Tenhagen M, Turrado V, Vereczkei A, Vilallonga R, Deelder JD, Bonjer J. Surg Endosc. 2020;15:27. . Shafi S, Aboutanos M, Brown CV-R, et al. Statement 2.2 NOM for uncomplicated acute appendicitis in children is feasible, safe, and effective as initial treatment. 2017;47:186–96. CONTEXTO. Google Scholar. Serres SK, Cameron DB, Glass CC, et al. Cameron DB, Williams R, Geng Y, et al. Appendicolith appendicitis is clinically complicated acute appendicitis—is it histopathologically different from uncomplicated acute appendicitis. Role of emergency magnetic resonance imaging for the workup of suspected appendicitis in pregnant women. Surg Laparosc Endosc Percutan Tech. Of 6,190 children having an appendiceal abscess, 1,225 patients received non-operative treatment. including seven retrospective cohort studies and one randomized controlled trial, LA in obese patients was associated with reduced mortality (RR 0.19), reduced overall morbidity (RR 0.49), reduced superficial SSI (RR 0.27), and shorter operating times and postoperative length of hospital stay, compared to OA [156]. Estos puntajes típicamente incorporar características clínicas de la historia y física examen y parámetros de laboratorio. Recommendation 7.1 We recommend a single preoperative dose of broad-spectrum antibiotics in patients with acute appendicitis undergoing appendectomy. Therefore, the board of the WSES decided to convene an update of the 2016 Jerusalem guidelines. Vaos G, Dimopoulou A, Gkioka E, et al. imporane en la gestión aún esá abiero a debae es el momeno de la apendicecomía y la seguridad The current evidence-based guidelines are the updated 2020 International Comprehensive Clinical Guidelines for the diagnosis and management of acute appendicitis. Recommendation 1.6.2 In pediatric patients with suspected acute appendicitis, we suggest adopting both biomarker tests and scores in order to predict the severity of the inflammation and the need for imaging investigation [QoE: Very Low; Strength of recommendation: Weak: 2D]. 2019;43:439–46. Magnetic resonance imaging in pediatric appendicitis: a systematic review. The incidence of AA has been declining steadily since the late 1940s. FOIA Davis Ortiz. No differences in total complications, intra-operative complications, or postoperative complications between ligature and all types of mechanical devices were found. Regarding second-line CT, the pooled sensitivities and specificities were 96.2% and 94.6%. Los esudios de Hernandez MC, Aho JM, Habermann EB, et al. Bonadio W, Shahid S, Vardi L, et al. This is the reason why Macco et al. Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review. Cochrane Database Syst Rev. Según el puntaje, dos puntos de corte puntos fueron identificados para obtener tres pruebas de diagnóstico zonas: una puntuación 8 (alta probabilidad) tiene una alta especificidad (0.99) para apendicitis y puede usarse para gobernar en apendicitis. LA lowers overall hospital and social costs [138], improves cosmesis, and significantly decreases postoperative complications, in particular SSI. Actualización y consenso en el manejo de la apendicitis aguda: actualización de las guías de Jerusalén julio 5, 2020; Se debe realizar preparación mecánica del colon previo a cirugía programada?. stated that ERAS implementation for appendectomy is associated with a significantly shorter LOS, allowing for the ambulatory management of patients with uncomplicated AA. After reaching consensus on each of the above mentioned, the panel experts and the scientific committee members developed two WSES flow-chart algorithm for the diagnosis and management of acute appendicits to be used for adults and pediatric patient population, reported respectively in Figs. Online ahead of print. 2017 Oct;15(5):303-314. doi: 10.1016/j.surge.2017.02.001. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Statement 7.4 Postoperative antibiotics after appendectomy for uncomplicated acute appendicitis in children seems to have no role in reducing the rate of surgical site infection. Fever, right lower quadrant tenderness, and neutrophilia were found to be the three most sensitive markers in predicting complicated AA (88.6%, 82.3%, and 79.7%). A systematic review of all evidence available comparing appendectomy to NOM for uncomplicated AA in children included 13 studies, 4 of which were retrospective studies, 4 prospective cohort studies, 4 prospective non-randomized comparative trials, and 1 RCT. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis. Durante la Conferencia de Consenso, se desarrolló un algoritmo integral para el tratamiento de AA basado en los resultados de la primera sesión del CC y votó para aprobación definitiva (Fig. Sammalkorpi HE, Mentula P, Leppäniemi A. Statement 1.13 In patients with normal investigations and symptoms unlikely to be acute appendicitis but which do not settle, cross-sectional imaging is recommended before surgery. Aneiros Castro B, Cano I, García A, et al. Surg Infect. Young KA, Neuhaus NM, Fluck M, et al. Duration of surgery was longer following LA, and the length of hospital stay was shorter following LA [154]. The comparison between early versus delayed open appendectomy for appendiceal phlegmon included 40 participants (pediatric and adults), randomized either to early appendectomy (appendectomy as soon as appendiceal mass resolved within the same admission, n = 20) or to delayed appendectomy (initial conservative treatment followed by interval appendectomy 6 weeks later, n = 20). Eng KA, Abadeh A, Ligocki C, et al. including nine systematic reviews and meta-analyses (all moderate to high quality), the pooled duration of surgery was 7.6 to 18.3 min shorter with OA. Could an abdominal drainage be avoided in complicated acute appendicitis? Andersson M, Andersson RE. Gorter RR, The S-MML, Gorter-Stam MAW, et al. Recommendation 2.1.1 We recommend discussing NOM with antibiotics as a safe alternative to surgery in selected patients with uncomplicated acute appendicitis and absence of appendicolith, advising of the possibility of failure and misdiagnosing complicated appendicitis [QoE: High; Strength of Recommendation: Strong; 1A]. In the same way, the large systematic review and meta-analysis by Ceresoli et al. Int J Surg. A model to select patients who may benefit from antibiotic therapy as the first line treatment of acute appendicitis at high probability. JAMA Pediatr. Surg Endosc. 2016;27:142–6. Compared with patients who did not develop an SSI, patients who developed an SSI had similar times between emergency department triage and appendectomy (11.5 h vs 9.7 h, P = 0.36) and similar times from admission to appendectomy (5.5 h vs 4.3 h, P = 0.36). Forty-four studies including 9,298 patients were included in this review. Therapeutic effectiveness of percutaneous drainage and factors for performing an interval appendectomy in pediatric appendiceal abscess. Golebiewski A, Anzelewicz S, Wiejek A, et al. Chung PHY, Dai K, Yang Z, et al. Fallon SC, Orth RC, Guillerman RP, et al. Despite all the improvements in the diagnostic process, the crucial decision as to whether to operate or not remains challenging. El diagnóstico de AA sigue siendo un desafío y algunas controversias sobre su manejo todavía están presentes entre diferentes entornos y patrones de práctica en todo el mundo. Surg Infect. Guía de practica clínica (acceso gratuito) de la Sociedad Americana de Cirujanos del Colon y el Recto: Manejo de la Patología Hemorroidal. de esos daos [11]. World J Emerg Surg 15, 27 (2020). A 10-year experience. 2019;19:54. In this updated document, quality of evidence and strength of recommendations have been evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. [QoE: Moderate; Strength of recommendation: Weak; 2B]. Al-Temimi MH, Berglin MA, Kim EG, et al. Still, the negative appendectomy rate was 17.7% [130]. In particular, pooled sensitivities and specificities of second-line US for the diagnosis of AA in children were 91.3% and 95.2%, respectively. 8,6% a 12% en varones y del 6,7% al 23,1% en las mujeres. 2015;50:1880–4. Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Singh JP, Mariadason JG. Esa heerogeneidad, las dierencias en los 2017;214:1143–8. A computerized search of different databases (MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials), and new citations were included for the period April 2015 to June 2019. 2016;264:164–8. Statement 4.1 Laparoscopic appendectomy offers significant advantages over open appendectomy in terms of less pain, lower incidence of surgical site infection, decreased length of hospital stay, earlier return to work, overall costs, and better quality of life scores. Surg Endosc. PAS includes similar clinical findings to the Alvarado score in addition to a sign more relevant in children: right lower quadrant pain with coughing, hopping, or percussion. 2016;16:37. Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis. Am J Med. La apendicitis aguda (AA) es una de las causas más comunes de dolor abdominal agudo. The highest quality of evidence studies (systematic reviews with meta-analysis of randomized controlled trials) was assessed first. Acute abdominal pain accounts for 7–10% of all emergency department accesses [1]. Archivio Istituzionale della Ricerca Unimi, Cervellin G, Mora R, Ticinesi A, et al. Nonoperative management in children with early acute appendicitis: A systematic review. The positive and negative predictive values were 91% and 94%, respectively [66]. However, costs for primary wound closure were lower than delayed primary wound closure [180]. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. Universidad Nacional de Rosario. Pediatr Surg Int. Fetal loss was significantly higher among those who underwent LA compared with those who underwent OA, with a pooled OR of 1.72. Effects of Timing of Appendectomy on the Risks of Perforation and Postoperative Complications of Acute Appendicitis. 2014;18:961–7. 2014;14:114. Simple ligation is associated with shorter operative times, less postoperative ileus and quicker recovery. Surg Laparos Endo Percutaneous Techniques. Guía Práctica Español (Ortografía y Gramática) Héctor Montes Alonso. Xu J, Adams S, Liu YC, et al. The Alvarado score can be higher in pregnant women due to the higher WBC values and the frequency of nausea and vomiting, especially during the first trimester, implicating lower accuracy compared to the non-pregnant population. Follow this publisher. p. CD001546. El diagnóstico de AA es un desafío; una Se ha utilizado una combinación variable de signos y síntomas clínicos junto con hallazgos de laboratorio en varios puntajes. Strong S, Blencowe N, Bhangu A. The meta-analysis by Huang et al. Farach SM, Danielson PD, Walford NE, et al. Abdom Radiol (NY). Ann Surg. Love BE, Camelo M, Nouri S, et al. Dalsgaard Jensen T, Penninga L. Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area. MRI has at least the same sensitivity and specificity as CT and, although higher costs, should be preferred over CT as second-line imaging in children. If this significant rate of neoplasms after periappendicular abscess is validated by future studies, it would argue for routine interval appendectomy in this setting. Epub 2020 Mar 13. Moreover, early transition to oral antibiotics allows shorter hospital times and decreased hospital charges, with similar total antibiotic days and readmission rate [234]. objetivos: • La apendicitis aguda (AA) es una de las causas más comunes de dolor abdominal agudo. A randomized trial to compare the conventional three-port laparoscopic appendectomy procedure to single-incision and one-puncture procedure that was safe and feasible, even for surgeons in training. A recent retrospective cohort study by Wright et al. Luo et al. The stump closure may vary widely in practice and the associated costs can be significant. A significant difference favoring the laparoscopic procedure in the rate of removal of normal appendix compared to open appendectomy was found [201]. Lancet Gastroenterol Hepatol. Rosenbaum DG, Askin G, Beneck DM, et al. Recommendation 1.8 We suggest proceeding with timely and systematic diagnostic imaging in patients with intermediate-risk of acute appendicitis [QoE: Moderate; Strength of recommendation: Weak; 2B]. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. 2016;26:508–12. 2019;33:2960–6. AAST grade in emergency for AA determined by preoperative imaging strongly correlated with operative findings [189]. The APPAC III multicenter, double-blind, placebo-controlled, superiority RCT comparing antibiotic therapy with placebo in the treatment of CT scan-confirmed uncomplicated AA is now in its enrollment phase. 2017;104:1451–61. Regarding complicated appendicitis, some authors support initial antibiotics with delayed operation whereas others support immediate operation. Patients with a score below 11 were classified as low probability of AA. .l Successful nonoperative management of uncomplicated appendicitis: predictors and outcomes. 2019;85:397–402. Tartaglia D, Bertolucci A, Galatioto C, et al. Second- or third-generation cephalosporins, such as cefoxitin or cefotetan, may be used in uncomplicated cases. In the 2016 Jerusalem guidelines, the Oxford classification was used to grade the evidence level (EL) and the grade of recommendation (GoR) for each statement. Más popular y ejemplos validados incluyen el puntaje de Alvarado (también conocido como la puntuación MANTRELS) [4], el Pediátrico Puntaje de apendicitis (PAS) [5], el puntaje de respuesta inflamatoria de apendicitis (AIR) [6], Raja Isteri Pengiran Puntuación de Anak Saleha Apendicitis (RIPASA) [7] y, la mayoría recientemente, la puntuación de apendicitis en adultos (AAS) [8]. Schünemann HJ. BMC Surg. La sensibilidad y especicidad de la punuación diagnóstica. Nearly all clinical signs and symptoms, as isolated parameters, do not significantly discriminate between those pregnant women with and without AA [37,38,39]. Am Surg. Those between 8 and 15 were defined at intermediate-risk [61]. Statement 7.1 A single dose of broad-spectrum antibiotics given preoperatively (from 0 to 60 min before the surgical skin incision) has been shown to be effective in decreasing wound infection and postoperative intra-abdominal abscess, with no apparent difference in the nature of the removed appendix. NOM avoided an appendectomy in 62–81% of children after 1-year follow-up. Statement 7.3 Administering postoperative antibiotics orally in children with complicated appendicitis for periods shorter than 7 days postoperatively seems to be safe and it is not associated with increased risk of complications. Prospective observational study on acute appendicitis worldwide (POSAW). Tanaka Y, Uchida H, Kawashima H, et al. Accuracy of low dose CT in the diagnosis of appendicitis in childhood and comparison with USG and standard dose CT. J Pediatria. There is also evidence that NOM for uncomplicated AA does not statistically increase the perforation rate in adult patients receiving antibiotic treatment. The use of imaging diagnostics is recommended in patients with suspected appendicitis after an initial assessment and risk stratification using clinical scores [QoE: Moderate; Strength of recommendation: Strong; 1B]. una de las declaraciones juno con LoE, GoR y La lieraura que respalda cada armación. Statement 4.8 Peritoneal irrigation does not have any advantage over suction alone in complicated appendicitis in both adults and children. As the value of individual clinical variables to determine the likelihood of acute appendicitis in a patient is low, a tailored individualized approach is recommended, depending on disease probability, sex, and age of the patient. Risk stratification of patients with suspected AA by clinical scoring systems could guide decision-making to reduce admissions, optimize the utility of diagnostic imaging, and prevent negative surgical explorations. 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 seven days [QoE: Moderate; Strength of recommendation: Strong; 1B]. Overall, endostapler use was associated with a similar IAA rate but a lower incidence of SSI, whereas the length of stay and readmission and reoperation rates were similar [169]. These data support that early appendectomy is the best management in complicated AA [136]. World J Pediatr. Yi DY, Lee KH, Park SB, et al. nales, juno con su LoE y GoR, esán disponibles en el Apéndice. 1-s2.-S1198743X20303037-main.en.es. Measuring anatomic severity of disease in emergency general surgery. 2016 Nov;30(11):4668-4690. doi: 10.1007/s00464-016-5245-7. acoplado con investigaciones de laboraorio, complemenadas por selectiva Imagen enocada. A systematic review and meta-analysis. C-reactive protein value is a strong predictor of acute appendicitis in young children. The RIPASA score has a specificity (cutoff 7.5 points) of 96%, but the score should be validated in larger studies. Summary sensitivity for low-dose CT (0.94) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95). This long-term follow-up supports the feasibility of NOM with antibiotics as an alternative to surgery for uncomplicated AA [104]. :I ., Recently, the cumulative meta-analysis by Gavriilidis et al. Comparison of US and CT on the effect on negative appendectomy and appendiceal perforation in adolescents and adults: a post-hoc analysis using propensity-score methods: US Versus CT Using Propensity-Score Methods. ACTUALIZACIÓN 2020 DE LAS PAUTAS DE WSES JERUSALE. A population-level study with a 1-year follow-up period found that children undergoing late appendectomy were more likely to have a complication than those undergoing early appendectomy. 2017;27:262–6. 2009;19:392–4. Early appendectomy is the best management in complicated appendicitis. Guias de Jerusalem 2020 - Free download as PDF File (.pdf), Text File (.txt) or read online for free. Patients in the laparoscopy group had a 10% risk of bowel resection and 13% risk of incomplete appendectomy. Pediatr Surg Int. Recommendation 4.13 We suggest against the prophylactic use of abdominal drainage after laparoscopic appendectomy for complicated appendicitis in children [QoE: Low; Strength of recommendation: Weak; 2C]. Value in Health. Scoring system to distinguish uncomplicated from complicated acute appendicitis. apendicitis aguda. J Pediatr Surg. 2018;192:229–33. Clinical scores alone seem sufficiently sensitive to identify low-risk patients and decrease the need for imaging and negative surgical explorations (such as diagnostic laparoscopy) in patients with suspected AA. The authors reported that extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated AA [230]. Resultados Eficiencia diagnóstica de los sistemas de puntuación clínica. both scores failed to meet the performance benchmarks of CRP (C-reactive protein). Surgery for uncomplicated acute appendicitis can be planned for the next available list minimizing delay wherever possible (better patient comfort, etc.). 2014;31:517–29. Luego se presentaron las declaraciones provisionales y sus pruebas de apoyo. cada una de las pregunas principales, juno con el Nivel de evidencia (LoE) y el grado de 2018;222:212–218.e2. Thus, there is no evidence for any clinical improvement by using abdominal drainage in patients undergoing OA for complicated AA [174]. PubMed According to the retrospective study by Grimes et al., including 203 appendectomies performed with normal histology, fecaliths may be the cause of right iliac fossa pain in the absence of obvious appendiceal inflammation. further corroborates the previous clinical hypothesis showing that the presence of an appendicolith is an independent predictive factor for both perforation and the failure of NOM of uncomplicated AA [106,107,108]. Bookshelf Todas las declaraciones se informan en la siguiente sección de Resultados, subdividido por cada una de las ocho preguntas, con el relativo discusión y evidencia de apoyo. The diagnostic performance of staged algorithms involving US followed by conditional MRI imaging for the diagnostic workup of pediatric AA has proven to be high (98.2% sensitive and 97.1% specific) [90]. The optimal course of antibiotics remains to be identified, but current evidence suggests that longer postoperative courses do not prevent SSI compared with 2 days of antibiotics. Statement 5.3 Surgeon's macroscopic judgment of early grades of acute appendicitis is inaccurate and highly variable. In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96), CT with rectal contrast (0.97), and CT with intravenous and oral contrast enhancement (0.96) than for non-enhanced CT (0.91). World J Emerg Surg. (Ml J Am Coll Radiol. sharing sensitive information, make sure you’re on a federal Guía clínica de la ASCRS. World J Emerg Surg. However, the mean radiation dose of low-dose CT was significantly lower compared with standard CT (3.33 and 4.44 mSv, respectively) [12]. Analysis of the primary outcome measure indicated that treatment failure rates in patients presenting with CT-confirmed uncomplicated AA were similar among those receiving supportive care with either a non-antibiotic regimen or a 4-day course of antibiotics, with no difference in the rates of perforated AA between the two groups reported [126]. Recommendation 4.5 We suggest the adoption of outpatient laparoscopic appendectomy for uncomplicated appendicitis, provided that an ambulatory pathway with well-defined ERAS protocols and patient information/consent are locally established [QoE: Moderate; Strength of recommendation: Weak; 2B]. Recommendation 4.2 We recommend laparoscopic appendectomy should be preferred over open appendectomy in children where laparoscopic equipment and expertise are available [QoE: Moderate; Strength of recommendation: Strong; 1B]. A combination of clinical parameters, laboratory tests, and US may significantly improve diagnostic sensitivity and specificity and eventually replace the need for CT scan in both adults and children [54]. 2019;35:329–33. J Surg Res. [EL 1 , GoR A]. corroborated the known clinical association of an appendicolith to complicated AA. Only 2.3% of patients who had surgery for recurrent AA were diagnosed with complicated forms of the disease. Apendicitis Guias de Jerusalen. Guía clínica ASCRS: Manejo de los abscesos perianales, fistulas anales y fistulas rectovaginales. puede alcanzar suciene especicidad para identicarse con absolua cereza qué pacienes Hall NJ, Eaton S, Stanton MP, et al. Am J Epidemiol. El diagnóstico de AA es un desafío; una Se ha utilizado una combinación variable de signos y síntomas clínicos junto con hallazgos de laboratorio en varios puntajes. Rushing A, Bugaev N, Jones C, et al. J Traum Acute Care Surg. Simillis C, Symeonides P, Shorthouse AJ, et al. Statement 2.4 Uncomplicated acute appendicitis may safely resolve spontaneously with similar treatment failure rates and shorter length of stay and costs compared with antibiotics. Although a negative or inconclusive MRI does not exclude AA during pregnancy, many authors suggest MRI as the gold standard in all female patients during their reproductive years, mostly because of its high specificity and sensitivity (100% and 89%, respectively) and the high negative (96–100%) and positive (83.3–100%) predictive values [73, 83, 84]. Haz clic aquí para cancelar la respuesta. Yang H-R, Wang Y-C, Chung P-K, et al. BMC Surg. Apendicitis aguda Menú Cerrar . Considering these results, NOM can be suggested only for selected pediatric patients presenting with uncomplicated AA. 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