Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage .
Drainage may lower the risk of treatment failure but entails a risk of complications .
INTRODUCTION The treatment strategy for appendiceal mass is controversial , ranging from operation or image-guided drainage to conservative treatment with or without antibiotics .
The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure .
Influence of Risk Factors on the Safety of Ileocolic Anastomosis in Crohn’s Disease Surgery
BACKGROUND : Ileocecal resection is the most commonly performed operation in patients with Crohn ’s disease . Anastomotic-associated complications , with their associated morbidity , are the most feared risks of surgery . OBJECTIVE : This study aim ed to assess the influence of a variety of putative risk factors in a homogenous group of patients undergoing first or subsequent surgery for Crohn ’s disease to quantify the cumulative risk for anastomotic-associated complications . DESIGN AND PATIENTS : All patients undergoing ileocecal or ileocolic resections for Crohn ’s disease from 2000 to 2010 were studied with the use of a prospect i ve data base . Demographics , operative details , possible risk factors , and anastomotic-associated complications were recorded . Patients having strictureplasties , multiple resections , or subtotal colonic resections were excluded from analysis . Statistical analysis was by univariate analysis ( Mann-Whitney U test ) and binary logistic regression . OUTCOMES : An anastomotic-associated complication was defined as a proven anastomotic leak , postoperative fistulation , or intra-abdominal abscess formation . RESULTS : Two hundred seven patients ( 109 female ) with a median age of 35 years ( range , 13 - 75 years ) were identified . One hundred seventy-three underwent primary anastomosis , 94 as an emergency procedure . Fifty-three had laparoscopic ( 5 converted ) procedures . Nineteen of 173 anastomotic complication events ( 11 % ) were recorded . Steroid usage ( OR 2.67 , 95 % CI 1.0 - 7.2 ) and the presence of preoperative abscess formation ( OR 3.4 , 95 % CI 1.2 - 9.8 ) were identified as independent predictors of anastomotic-associated complications . In the absence of both steroids and intra-abdominal abscess , the risk of anastomotic complications was 6 % , which increased to 14 % if either risk factor was present . When both risk factors were present , complication rates reached 40 % . CONCLUSION : Steroid usage and preoperative abscess were associated with higher rates of anastomotic complications following ileocolic resection for Cohn ’s disease . When both risk factors are present , it is best to avoid primary anastomosis
Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage .
Drainage may lower the risk of treatment failure but entails a risk of complications .
INTRODUCTION The treatment strategy for appendiceal mass is controversial , ranging from operation or image-guided drainage to conservative treatment with or without antibiotics .
The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure .