Paediatric Surgery (Ukraine).2022.2(75):43-51; doi 10.15574/PS.2022.75.43
Skyba V. V.^1,3,4, Rybalchenko V. F.^2,3, Lisytsya V. V.^3,4, Voytyuk N. V.^1,4, Dar Yasin Ahmed^3
1Bogomolets National Medical University, Kyiv, Ukraine
²Shupyk National Healthcare University of Ukraine, Kyiv
³Kyiv Medical University, Ukraine
⁴Kyiv Regional Clinical Hospital No. 1, Ukraine

.For citation: Skyba VV, Rybalchenko VF, Lisytsya VV, Voytyuk NV, Dar Yasin Ahmed. (2022). The eternal problem of surgery is appendicitis: of its complications and the results of treatment of patients. Paediatric Surgery (Ukraine). 2(75): 43-51; doi 10.15574/PS.2022.75.43.
Article received: Jan 31, 2022. Accepted for publication: Apr 19, 2022.

Purpose – to improve the treatment of patients with appendicitis on the basis of the introduction of the latest imaging methods and surgical technologies.
Materials and methods. In the clinic of the surgery center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019, 30,627 patients were treated, of which acute appendicitis with various forms of inflammation in 2697 (49.18%). The age of the patients ranged from 16 to 92 years old. Depending on the time of the hospitalization (by year), the patients were divided into two groups: the control group (2006-2012) – 1379 (51.13%) patients; the studied group (2013-2019) – 1318 (48.87%) patients. The reason for division into groups was the use of modern technologies for diagnostics (visualization) of the disease and improved methods of surgical treatment in the studied group.
Results. Surgical access in 1846 (68.45%) cases was laparotomy, in 851 (31.55%) cases laparoscopic of which 69 (8.10%) cases had a conversion. Appendix location: typical in 692 (25.66%) cases, pelvic in 986 (36.56%) cases, retrocaecal in 293 (10.86%) cases, retroperitoneal in 277 (10.27%) cases, subhepatic in 228 (8.45%) cases, medial in 221 (8.19%) cases. In the postoperative period, complications from the abdominal cavity were established in 89 (3.30%) cases and wounds in 125 (4.63%) cases. 6 patients (0.22%) died, out of 1379 patients of the control group in 4 (0.29%) cases, and among 1318 patients of the study group 2 (0.15%) cases. Early adhesion obstruction in 18 (0.67%) cases, and subsequently the disease was found in 72 (2.67%) patients, which was restored surgically, as well as concomitant hernias in 45 (1.67%) cases.
Conclusions. The use of modern imaging and treatment technologies has improved the results and reduced postoperative mortality from 0.29% to 0.15% with an average of 0.22%. According to the results of the study, it was found that the quality of life after laparoscopic appendectomy is statistically significantly (p<0.01) higher than in patients operated on by the open method.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: appendicitis, adults, adolescents, open appendectomy, laparoscopic appendectomy, adhesive obstruction, hernias.
REFERENCES

1. Bakhshandeh T, Maleknejad A, Sargolzaie N, Mashhadi A, Zadehmir M. (2022). The utility of spectral Doppler evaluation of acute appendicitis. Emerg Radiol. https://doi.org/10.1007/s10140-021-02010-4; PMid:35013851

2. Balogun OS, Osinowo A, Afolayan M, Olajide T, Lawal A, Adesanya A. (2019). Acute Perforated Appendicitis in Adults: Management and Complications in Lagos, Nigeria. Ann Afr Med. 18 (1): 36-41. https://doi.org/10.4103/aam.aam_11_18; PMid:30729931 PMCid:PMC6380116

3. Branson H, Butler FRCS. (1909). Fulminating appendicitis. Br. Med. J. 2: 1273. https://doi.org/10.1136/bmj.2.2548.1273; PMid:20764719 PMCid:PMC2321306

4. Fomin PD, Usenko OIu, Bereznytskyi YaS. (2018). Nevidkladna khirurhiia orhaniv cherevnoi porozhnyny (standarty orhanizatsii ta profesiino oriientovani alhorytmy nadannia medychnoi dopomohy). K.: Biblioteka «Zdorov'ia Ukrainy»: 354.

5. Livingston EH, Woodward WA, Sarosi GA et al. (2007). Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg. 245 (6): 886-892. https://doi.org/10.1097/01.sla.0000256391.05233.aa; PMid:17522514 PMCid:PMC1876946

6. Madhuripan N, Jawahar A, Jeffrey RB, Olcott EW. (2020). The Borderline-Size Appendix: Grayscale, Color Doppler, and Spectral Doppler Findings That Improve Specificity for the Sonographic Diagnosis of Acute Appendicitis. Ultrasound Q. 36 (4): 314-320. https://doi.org/10.1097/RUQ.0000000000000536; PMid:33136933

7. Molina V, Escobar L, Ballester E, Medrano R. (2021). Laparoscopic TAPP for strangulated right obturator hernia. Cir Esp (Engl Ed). S2173-5077 (21) 00179-4. https://doi.org/10.1016/j.cireng.2021.04.020; PMid:34210655

8. Rusak PS, Tolstanov OK, Rybalchenko VF, Stakhov VV, Voloshyn YL. (2020). Problematic issues of diagnosis and treatment of acute appendicitis in chikdren. Paediatric Surgery, Ukraine. 3 (68): 28-36. https://doi.org/10.15574/PS.2020.68.28

9. Rybalchenko VF. (2013). Analiz roboty dytiachoi khirurhichnoi sluzhby Ukrainy u 2012 rotsi. Khirurhiia dytiachoho viku. 3 (40): 24-33.

10. Sallinen V, Akl EA, You JJ, Agarwal A, Shoucair S, Vandvik PO et al. (2016). Meta-analysis of antibiotics versus appendicectomy for non-perforated acute appendicitis. Br J Surg. 103 (6): 656-667. https://doi.org/10.1002/bjs.10147; PMid:26990957 PMCid:PMC5069642

11. Salomone DI, Saverio, Mauro Podda, Fausto Catena. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World Journal of Emergency Surgery. 15: 27. URL: https://wjes.biomedcentral.com/articles/10.1186/s13017-020-00306-3.

12. Sartelli M, Chichom-Mefire A, Catena F. (2017). The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World Journal of Emergency Surgery. 12 (29): 36.

13. Skiba VV, Rybalchenko VF, Ivanko OV, Zinchuk АG, Badakh VM, Bocharov VP. (2017). The surgical treatment of an abdominal сavity infiltrations among adolescents using jet hydro scalpel Paediatric Surgery. Ukraine. 1 (54): 32-38. https://doi.org/10.15574/PS.2017.54.32