Biology and Medicine

Abstrait

Prognostic Factors for Extended Cecectomy in Complicated Appendicitis

Ki Hoon Kim

Introduction: Some patients with complicated appendicitis and no periappendiceal abscess on preoperative computed tomography may need the extended cecectomy, including ileocecectomy and right hemicolectomy. In this study, we determined if there are predictive factors for extended cecectomy in these patients, to assist the preoperative decision-making.

Material and Methods: This retrospective study included 44 patients with complicated appendicitis who underwent surgical treatment beyond simple appendectomy, despite the absence of periappendiceal abscess on preoperative computed tomography of the abdomen. Patients were divided into two groups: those who underwent partial cecectomy (partial cecectomy group, n=23) and those who underwent ileocecectomy or right hemicolectomy (extended cecectomy group, n=21). Several clinical and laboratory variables including Alvarado score were compared between these two groups.

Results: The time from the onset of symptoms was shorter (p=0.015), Alvarado score higher (p=0.018), white blood cell count higher (p=0.046), and C-reactive protein level lower (p=0.011) in the partial cecectomy group compared to the extended cecectomy group. Twenty one patients in the partial cecectomy group and 17 patients in the extended cecectomy group had appendiceal perforation. The length of stay in hospital in the group of extended cecectomy was significantly longer than that in the group of partial cecectomy (p=0.015).

Conclusion: The present study suggests that low leukocyte counts, high C-reactive protein levels, low Alvarado scores, and long time from the onset of symptoms may be predictive factors for the extended cecectomy in patients with complicated appendicitis.