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Title: Frequency of obstructive appendicitis in patients undergoing open appendectomies.
Authors: Fazli Junaid, Muhammad Usama, Syed Usman Shah, Musab Umair, Zain Ul Abadin Malik, Attiya Nasir Siddique
Journal: The Professional Medical Journal (TPMJ)
Publisher: Independent Medical College, Faisalabad- Pakistan
Country: Pakistan
Year: 2022
Volume: 29
Issue: 3
Language: English
DOI: 10.29309/TPMJ/2022.29.03.6441
Keywords: AppendicitisOpen appendectomyNegative appendectomyNon-Obstructive AppendicitisObstructive Appendicitis
Objectives: To determine the frequency of obstructive appendicitis in patients undergoing open appendectomies for acute appendicitis. Negative appendectomy rate will also be calculated. Study Design: Cross-Sectional study. Setting: Department of General Surgery of Ayub Teaching Hospital Abbottabad. Period: September 2019 to February 2020. Material & Methods: The study population included patients of any gender, age from 10 years to 45 years found to have acute appendicitis diagnosed by clinical and ultrasound findings and confirmed by open appendectomy. Sample size of 174 was calculated, using WHO software for sample size calculation. After detailed examination and investigations, patients who underwent open appendectomy as per advice of visiting consultants were included; by filling predesigned research per forma. Results: Mean age of the patients was 26.33±11.177 and more than half were male i-e 106 (60.9%). Where majority i-e 93(53.4%) of appendices were of obstructed type, this wasn’t statistically higher than the non-obstructed type (p=0.363). In frequency of operative findings, acutely inflamed appendix was most common with 71(40.8%) patients. While suppurative, gangrenous and perforated samples were noted in 55(31.6%), 13(7.5%) and 8(4.6%) cases respectively. Negative appendectomy was done in 27(15.5%) patients. Conclusion: This study concluded that obstruction was noted in more than half of the cases i-e 93(53.4%), but it was not statistically higher from the other subtype. Negative appendectomy rate was 15.5%; higher than globally set target, but was similar to the one noted in Pakistan by previous researchers.
To determine the frequency of obstructive appendicitis in patients undergoing open appendectomies for acute appendicitis and to calculate the negative appendectomy rate.
Cross-sectional study conducted in the Department of General Surgery of Ayub Teaching Hospital Abbottabad from September 2019 to February 2020. A sample size of 174 patients aged 10 to 45 years, diagnosed with acute appendicitis by clinical and ultrasound findings and confirmed by open appendectomy, were included. Data was analyzed using SPSS (16.0), with frequencies, percentages, mean±standard deviation, and chi-square tests.
graph TD
A[Patient Selection Acute Appendicitis] --> B[Clinical & Ultrasound Diagnosis];
B --> C[Open Appendectomy];
C --> D[Specimen Analysis Obstructive/Non-Obstructive];
D --> E[Data Collection];
E --> F[Statistical Analysis SPSS];
F --> G[Results & Conclusion];
The study found that obstruction was present in over half of the appendicitis cases operated on, though this was not statistically significant compared to non-obstructed cases. The negative appendectomy rate of 15.5% is higher than the globally set target of 5-10% but aligns with previous findings in Pakistan. The authors suggest that efforts should be made to reduce this rate. Limitations include the non-utilization of advanced scoring systems like Appendicitis Inflammatory Response and the absence of CT scans for diagnosis.
- Out of 174 patients, 93 (53.4%) had obstructive appendicitis, which was not statistically higher than non-obstructed types (p=0.363).
- The most common operative finding was acutely inflamed appendix (40.8%), followed by suppurative appendix (31.6%).
- Gangrenous and perforated appendices were found in 7.5% and 4.6% of cases, respectively.
- The negative appendectomy rate was 15.5% (27 patients).
- There were no statistically significant differences in age or gender between obstructive and non-obstructive appendicitis groups.
Obstruction is a common factor in appendicitis cases requiring surgery, but its prevalence is not significantly different from non-obstructed cases. The negative appendectomy rate in this region is higher than global targets, necessitating interventions to improve diagnostic accuracy and reduce unnecessary surgeries.
- Sample size calculated was 174. (Confirmed in Material & Methods)
- Majority of appendices were of obstructed type: 93 (53.4%). (Confirmed in Results)
- Negative appendectomy rate was 15.5%. (Confirmed in Results)
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