THE ROLE OF EMERGENCY SURGERY IN GANGRENOUS APPENDICITIS
DOI:
https://doi.org/10.56238/arev7n9-055Keywords:
Gangrenous Appendicitis, Emergency Appendectomy, Laparoscopic Surgery Versus Open Surgery, Timing of Surgical Intervention. Post-operative Results and Clinical ProtocolsAbstract
Gangrenous appendicitis represents the most severe form of acute appendicitis, characterized by transmural necrosis of the appendix and high risk of systemic complications. This article critically reviews the fundamental role of emergency surgery in managing this condition, analyzing the most recent evidence on surgical techniques, timing of intervention, and adjuvant strategies. The methodology consisted of a systematic literature review of the last five years, encompassing randomized clinical trials, prospective cohorts, and international guidelines. Results demonstrate that early surgical intervention, preferably within the first 12 hours after diagnosis, reduces the risk of perforation and associated complications by up to 60%. The laparoscopic approach has emerged as the technique of choice in specialized centers, showing significant advantages in postoperative recovery, with a mean hospital stay of 2.3 days versus 4.7 days for open surgery. However, the analysis reveals that the safety of this approach is directly linked to surgical team experience, with conversion rates to open surgery ranging between 8-15% across studies. Adjuvant antibiotic protocols proved essential, with beta- lactam/beta-lactamase inhibitor regimens showing over 90% efficacy in preventing infections. Special attention was given to vulnerable populations, such as elderly and immunocompromised patients, who demonstrate 3-5 times higher mortality and require individualized strategies. The study also identified significant knowledge gaps, particularly concerning conservative treatment in high-risk patients and long-term follow-up. The conclusions reinforce the need for standardized institutional protocols ensuring rapid and appropriate intervention, integrating technical advances with expert clinical judgment. This work not only consolidates current evidence but also points to future research directions, particularly the development of early severity biomarkers and refinement of minimally invasive techniques. The clinical relevance of this study lies in its comprehensive and critical approach, providing valuable insights for both daily practice and future scientific investigations in this crucial area of emergency surgery.
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1. Benini, R.L.D.P., de Almeida, A.J.M.P., da Silva, I.T., de Medeiros, J.G., Faria, J.R., Vidal, L.G.C., Gonçalves, M.L.S.V., Fernandes, M.M., Araújo, M.F., Fogolin, V.T. Apendicite aguda complicada e não complicada - uma revisão abrangente sobre a fisiopatologia, manifestações clínicas, microbiota intestinal e sua relevância, diagnóstico clínico, diagnóstico imagiológico, tratamento, prognóstico e perspectivas futuras. Braz. J. Hea. Rev. [Internet]. 2023 Aug. 30 [cited 2025 Apr. 5];6(4):19233-50. Available from: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/62596.
2. Patel SV, Zhang L, Mir ZM, Lemke M, Leeper WR, Allen LJ, et al. Delayed Versus Early Laparoscopic Appendectomy for adult patients with acute appendicitis: A randomized controlled trial: A randomized controlled trial. Ann Surg [Internet]. 2024;279(1):88–93. Disponível em: http://dx.doi.org/10.1097/SLA.0000000000005996.
3. Juremeira, L.T.S., Mantovan L.B., da Silva V.P., Leite K.D., de Oliveira L.L.D. Apendicite aguda: revisão de literatura. REP [Internet]. 17º de abril de 2023 [citado 5º de abril de 2025];6(1). Disponível em: https://revistaensaiospioneiros.usf.edu.br/ensaios/article/view/264.
4. Borruel Nacenta S, Ibáñez Sanz L, Sanz Lucas R, Depetris MA, Martínez Chamorro E. Actualización de la apendicitis aguda: hallazgos típicos y atípicos. Radiología. 2023;65:S81–91. Disponível em: https://www.elsevier.es/es-revista-radiologia-119-articulo-actualizacion-apendicitis- aguda-hallazgos-tipicos-S003383382200203X.
5. Torres-Criollo L., Abad W., Portilla A. Apendicitis aguda. Tesla Revista Científica. 4 de julho de 2022; Disponível em: https://www.researchgate.net/publication/361847768_APENDICITIS_AGUDA.
6. Veloz Estrada,, L.S., Cervantes Moyano, K.P., Macias Cedeño, Y.L., Reyes Murillo, K.K.. Estudio comparativo de la isquemia en apendicectomia convencional vs laparoscópica. Factores de riesgo y complicaciones. Anál comport las líneas crédito través corp financ nac su aporte al desarro las PYMES Guayaquil 2011-2015 [Internet]. 2019;4(1):219–35. Disponível em: http://dx.doi.org/10.26820/recimundo/4.(1).enero.2020.219-235.
7. Garro Urbina V, Rojas Vázquez S, Thuel Gutiérrez M. Diagnóstico, evaluación y tratamiento de la apendicitis aguda en el servicio de emergencias. Rev Medica Sinerg [Internet]. 2019;4(12):e316. Disponível em: http://dx.doi.org/10.31434/rms.v4i12.316.
8. Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg [Internet]. 2020;15(1):27. Disponível em: http://dx.doi.org/10.1186/s13017-020-00306-3.
9. Roshanaei G, Salimi R, Mahjub H, Faradmal J, Yamini A, Tarokhian A. Accurate diagnosis of acute appendicitis in the emergency department: an artificial intelligence-based approach. Intern Emerg Med [Internet]. 2024;19(8):2347–57. Disponível em: http://dx.doi.org/10.1007/s11739-024- 03738-w.
10. Di Saverio, S., Podda, M., De Simone, B. et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 15, 27 (2020). https://doi.org/10.1186/s13017-020-00306-3.
11. Li, J., Xu, R., Hu, D-M., Zhang, Y., Gong, T-P., Wu, X-L. Effect of delay to operation on outcomes in patients with acute appendicitis: A systematic review and meta-analysis. J Gastrointest Surg [Internet]. 2019;23(1):210–23. Disponível em: http://dx.doi.org/10.1007/s11605-018-3866-y.
12. Bom, W.J., Scheijmans, J.C.G., Salminen, P., Boermeester, M.A. Diagnosis of uncomplicated and complicated appendicitis in adults. Scand J Surg [Internet]. 2021;110(2):170–9. Disponível em: http://dx.doi.org/10.1177/14574969211008330.
13. Teng TZJ, Thong XR, Lau KY, Balasubramaniam S, Shelat VG. Acute appendicitis-advances and controversies. World J Gastrointest Surg [Internet]. 2021;13(11):1293–314. Disponível em: http://dx.doi.org/10.4240/wjgs.v13.i11.1293.
14. Skjold-Ødegaard B, Søreide K. The diagnostic differentiation challenge in acute appendicitis: How to distinguish between uncomplicated and complicated appendicitis in adults. Diagnostics (Basel) [Internet]. 2022;12(7):1724. Disponível em: http://dx.doi.org/10.3390/diagnostics12071724.
15. Nimmagadda, N., Matsushima, K., Piccinini, A., Park, C., Strumwasser, A., Lam, L., et al. Complicated appendicitis: Immediate operation or trial of nonoperative management? Am J Surg [Internet]. 2019;217(4):713–7. Disponível em: http://dx.doi.org/10.1016/j.amjsurg.2018.12.061.
16. Bianchi V, Giambusso M, De Iacob A, Chiarello MM, Brisinda G. Artificial intelligence in the diagnosis and treatment of acute appendicitis: a narrative review. Updates Surg [Internet]. 2024;76(3):783–92. Disponível em: http://dx.doi.org/10.1007/s13304-024-01801-x.
