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Khirurgii

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Year 2023 Vol. 31 No 4

SCIENTIFIC PUBLICATIONS

SH. V. TIMERBULATOV, R.B. SAGITOV, M. V. TIMERBULATOV, I.Z. AKCHURIN, R.R. AKHMEROV, I.D. GAYAZOV, A.R. GAFAROVA, V. M. TIMERBULATOV

SOME ISSUES OF REFINED DIAGNOSIS AND CHOICE OF TREATMENT METHOD FOR COMPLICATED ACUTE APPENDICITIS IN RECENT YEARS

BSMU of the Ministry of Health of Russia, Ufa,
Russian Federation

Objective. To study the trends in the refined diagnosis and in the case of choice of surgical treatment methods over the past 4 years.
Methods. A retrospective observational study of 1095 patients with acute appendicitis for 2019-2022 was conducted. The article presents data indicating a significant impact of comorbid pathologies on an increase iof the number of complications and mortality; in 2020 by 10.2%, in 2021 – by 19% compared with the pre-COVID 2019 year, there was no statistically significant increase in the proportion of patients hospitalized later than 24 hours from the onset of the disease. Clinical and laboratory evaluations at admission of patient were performed according to Alvarado scoring system. The Alvarado Score for acute apendicitis predicts likelihood of appendicitis diagnosis.. Ultrasound was performed for the vast majority of patients (up to 94%), laparoscopy was considered not only as a diagnostic, but also as a therapeutic method. CT of abdominal organs was performed in diagnostically difficult cases, with severe co-morbid pathology which associated with increased morbidity and mortality (colon cancer (5.3-11.4% in various years).
Results. The informativeness of an assessment according to the Alvarado Score, is quite high (86%), according to its results, from 7% to 14% patients were sent for ambulatory observation. The sensitivity and specificity of ultrasound in acute appendicitis was 83% and 70%, respectively, especially this method is informative for the diagnosis of peritonitis and abscesses. Determining the complexity of diagnosis was associated with the need to clarify the presence or complications of SARS-CoV-2 infection. Laparoscopic appendectomy was performed in 60.35%, open – 36.95% of patients (74.2% in 2022). An increase of laparoscopic operations during the COVID-19 pandemic was reported.. Laparoscopic appendectomy of complicated appendicitis changed in various years - from 57.6% to 77.4%, in the case of peritonitis - from 24.07% to 57.6%. Postoperative complications were more common after laparoscopic appendectomy – 4.9% versus 2.35% in the case of the open appendectomy. There were no fatal cases during the study period.
Conclusion. Over the past 3 years of the pandemic, approaches to the diagnosis and treatment of acute appendicitis have not changed, except for the wider use of imaging methods. The immediate results of treatment for 2020-2022 were compared with the «pre-pandemic» 2019. It could influence the frequency of laparoscopic surgery in 2020-2022. As such, the Alvarado scoring system may be utilized to better predict whether a patient has appendicitis.

Keywords: acute appendicitis, complicated appendicitis, diagnosis, laparoscopic appendectomy, open-method appendectomy, postoperative complications.
p. 288-300 of the original issue
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Address for correspondence:
450008, Russian Federation,
Ufa, Lenin st., 3,
Bashkir State Medical University,
Department of Surgery with
a Course of Endoscopy, IDPO,
tel.: +73472555457,
e-mail: argafarova@yandex.ru,
Gafarova Aigul R.
Information about the authors:
Timerbulatov Shamil V., MD, Professor of the Department of Surgery with the course of Endoscopy at the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0000-0002-4832-6363
Sagitov Ravil B., MD, Associate Professor at the Department of Surgery with the course of Endoscopy at the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0000-0001-7459-388X
Timerbulatov Mahmud V., MD, Professor, Head of the Department of Faculty Surgery of the Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0000-0002-6664-1308;
Akchurin Ildar Z., Assistant of the Department of Surgery with the course of Endoscopy Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0009-0003-3358-8592
Akhmerov Ruslan R., PhD, Assistant of the Department of Surgery with the Course of Endoscopy Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org / 0000-0002-9351-4582
Gayazov Ilmir D, Graduate Student of the Department of Surgery with a Course of Endoscopy of the Bashkir State Medical University of the Ministry of Health of Russia. Ufa, Russian Federation.
https://orcid.org/0009-0005-4710-7299
Gafarova Aigul Radikovna, Assistant of the Department of Surgery with a Course of Endoscopy Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0000-0003-2874-7213
Timerbulatov Vil M, MD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Surgery with the course of Endoscony IDPO Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russian Federation.
https://orcid.org/0000-0003-1696-3146
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