Key result
Pre-operative CT findings of increased intra-abdominal fat density around the appendix and retrocaecal or retro-ascending colon location significantly prolonged operative time for interval appendectomy in children.
Why the study?
The study evaluated the association between operative time and CT findings noted immediately before interval appendectomy in children.
Do specific pre-operative CT findings predict operative time for interval appendectomy in children?
Observational (n=42)
No
Do specific pre-operative CT findings predict operative time for interval appendectomy in children?
Pre-operative CT findings, specifically increased intra-abdominal fat density and retrocaecal appendix location, are important predictors of prolonged operative time for interval appendectomy in children.
Answers are grounded in this paper and cite their sources.
May aid preoperative planning for pediatric interval appendectomy; leaves open need for prospective validation.
PURPOSE: The purpose was to evaluate the association between operative time and findings noted on computed tomography (CT) immediately before interval appendectomy. MATERIALS AND METHODS: Forty-two children who underwent CT before interval appendectomy were included. We evaluated the association between operative time and these image findings: (1) appendicolith, (2) increased intra-abdominal fat density around the appendix, (3) location of the appendix, (4) ascites, (5) abscess formation and (6) maximum appendix outer wall diameter. Appendix location was classified as (#1) just below the anterior abdominal wall; (#2) retrocaecal or retro-ascending colon and (#3) pelvic. Results were analysed using Pearson's correlation coefficient or Mann-Whitney U test. RESULTS: The mean patient age and operative time were 116.24 ± 38.66 months (range, 31-195) and 67.76 ± 31.23 min (range, 30-179), respectively. Ascites was detected in only one case, and no abscess occurred in any patient; therefore, these findings were not analysed. Factors that significantly prolonged the operative time included increased intra-abdominal fat density around the appendix (absent, 59.43 ± 22.14 [range, 30-108] vs. present, 84.43 ± 40.13 [range, 32-179] min; P = 0.03) and retrocaecal or retro-ascending colon appendix (location 1, 40.83 ± 8.35 [range, 30-50]; location 2, 99.25 ± 18.56 [range, 74-135]; location 3, 64.54 ± 30.22 [range, 30-179] min; P < 0.01). There was a weak but significant association between maximum appendix outer wall diameter and operative time (R = 0.353; P = 0.02). CONCLUSION: These pre-operative CT findings are important predictors of operative time for interval appendectomy. Radiologists and surgeons should use these specific image findings to predict the operative time and need for additional procedures during an interval appendectomy.
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Hosokawa et al. (2021) conducted an observational in Acute appendicitis requiring interval appendectomy (n=42). Increased intra-abdominal fat density around the appendix on pre-operative CT vs. Absence of increased intra-abdominal fat density was evaluated on Operative time (minutes) (p=0.03). Pre-operative CT findings of increased intra-abdominal fat density around the appendix and retrocaecal or retro-ascending colon location significantly prolonged operative time for interval appendectomy in children.
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