Comparison of the Laparoscopic Appendicitis (LAPP) score with the Alvarado and Appendicitis Inflammatory Response(AIR) scores and computed tomography and pathology results

Yıl 2022, Cilt: 3 Sayı: 2, 147 - 153, 31.05.2022

Hüseyin Fahri Martlı , Hacı Bolat

Öz

Background: Acute appendicitis is the most commonly encountered and operated group among general surgery emergency patients. Various scoring and algorithms are used in diagnosis and treatment. This study aimed to compare the Laparoscopic Appendicitis (LAPP) score, which is used to reduce negative appendectomy, according to the pathology and preoperative computed tomography results and investigate its correlation with other clinical scoring systems.

Methods: Patients who underwent appendectomy in our clinic between June 2020 and March 2021 were retrospectively reviewed. The obtained LAPP scores were compared with the preoperative imaging results, Alvarado score, appendicitis inflammatory response (AIR) score, and pathology results.

Results: The study included a total of 109 patients, of whom 22 (20.18%) had a pathology result that was not consistent with appendicitis. The LAPP score was determined as 1.41 for this 22 patients who underwent negative appendectomy (p<0.001), 2.45 for 74 patients with suppurative appendicitis (p<0.001), and 3.54 for 13 patients with gangrenous or perforated appendicitis (p<0.001).

Conclusions: The purpose of the LAPP score is to reduce the rate of negative appendectomy. Appendectomy is also performed in some patients who may have spontaneous resolution if they present to the hospital in the early period. We also consider that the frequency of familial Mediterranean fever in Turkey may be another reason for the high rate of negative appendectomy. In addition, the correlation of high Alvarado and AIR scores with a high LAPP score indicates that it is more reliable in the diagnosis of complicated appendicitis.

Anahtar Kelimeler

Acute appendicitis, Lapp Score, Alvarado Score

Kaynakça

• 1. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015 Sep 26;386(10000):1278-1287.
• 2. Song MY, Ullah S, Yang HY, Ahmed MR, Saleh AA, Liu BR. Long-term effects of appendectomy in humans: is it the optimal management of appendicitis? Expert Rev Gastroenterol Hepatol. 2021 Jun;15(6):657-664.
• 3. Köhler F, Hendricks A, Kastner C, Müller S, Boerner K, Wagner JC, Lock JF, Wiegering A. Laparoscopic appendectomy versus antibiotic treatment for acute appendicitis-a systematic review. Int J Colorectal Dis. 2021 Oct;36(10):2283-2286.
• 4. O’Leary DP, Walsh SM, Bolger J, Baban C, Humphreys H, O’Grady S et al. A Randomized Clinical Trial Evaluating the Efficacy and Quality of Life of Antibiotic-only Treatment of Acute Uncomplicated Appendicitis: Results of the COMMA Trial. Ann Surg. 2021 Aug 1;274(2):240-247.
• 5. Sippola S, Haijanen J, Grönroos J, Rautio T, Nordström P, Rantanen T et al. Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial. JAMA. 2021 Jan 26;325(4):353-362.
• 6. Podda M, Gerardi C, Cillara N, Fearnhead N, Gomes CA, Birindelli A et al. Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis. Ann Surg. 2019 Dec;270(6):1028-1040.
• 7. 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. 2020 Apr 15;15(1):27.
• 8. Babakhanov AT, Dzhumabekov AT, Zhao AV, Kuandykov YK, Tanabayeva SB, Fakhradiyev IR et al. Impact of Appendectomy on Gut Microbiota. Surg Infect (Larchmt). 2021 Sep;22(7):651-661.
• 9. Vanhatalo S, Munukka E, Sippola S, Jalkanen S, Grönroos J, Marttila H et al. Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial. BMJ Open. 2019 Sep 6;9(9):e031137. doi: 10.1136/ bmjopen-2019-031137.
• 10. Slotboom T, Hamminga JT, Hofker HS, Heineman E, Haveman JW; Apple Study Group Appendicitis and Laparoscopic Evaluation. Intraoperative motive for performing a laparoscopic appendectomy on a postoperative histological proven normal appendix. Scand J Surg. 2014 Dec;103(4):245-8.
• 11. Drake FT, Mottey NE, Castelli AA, Florence MG, Johnson MG, Steele SR et al. Time-of-day and appendicitis: Impact on management and outcomes. Surgery. 2017 Feb;161(2):405-414.
• 12. Jeon BG. Predictive factors and outcomes of negative appendectomy. Am J Surg. 2017 Apr;213(4):731-738.
• 13. Hamminga JT, Hofker HS, Broens PM, Kluin PM, Heineman E, Haveman JW. Evaluation of the appendix during diagnostic laparoscopy, the laparoscopic appendicitis score: a pilot study. Surg Endosc. 2013 May;27(5):1594-600.
• 14. Gelpke K, Hamminga JTH, van Bastelaar JJ, de Vos B, Bodegom ME, Heineman E et al. Reducing the negative appendectomy rate with the laparoscopic appendicitis score; a multicenter prospective cohort and validation study. Int J Surg. 2020 Jul;79:257-264.
• 15. Niu R, Mei Z. The value of LAPP score: strengths and limitations. An Invited Commentary on “reducing the negative appendectomy rate with the laparoscopic appendicitis score: A multicenter prospective cohort and validation study”. Int J Surg. 2020 Jul;79:269-270.
• 16. Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol. 2000 Feb;4(1):46-58.
• 17. Ding W, Du Z, Zhou X. Endoscopic retrograde appendicitis therapy for management of acute appendicitis. Surg Endosc. 2022 Apr;36(4):2480- 2487.
• 18. Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E et al. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol. 1998 Dec;25(12):2445-9.
• 19. Ozdogan H, Ugurlu S, Hatemi G, Ozgun E, Can G, Ozgon G et al. Is Familial Mediterranean Fever a clinical diagnosis? Results of a field survey. Pediatr Rheumatol 13, P126 (2015). https://doi.org/10.1186/1546-0096-13-S1-P126 20.
• 20. Onen F, Sumer H, Turkay S, Akyurek O, Tunca M, Ozdogan H. Increased frequency of familial Mediterranean fever in Central Anatolia, Turkey. Clin Exp Rheumatol. 2004 Jul-Aug;22(4 Suppl 34):S31-3.
• 21. Barie PS. Non-Operative Management of Appendicitis: Evolution, not Revolution. Surg Infect (Larchmt). 2021 Dec;22(10):991-1003.
• 22. Patel VK, Ye K, In H, Scheinfeld MH. Non-operative Management for Acute Appendicitis During the COVID-19 Pandemic Does Not Increase the Rate of Complications. J Gastrointest Surg. 2021 May;25(5):1327-1329. doi: 10.1007/s11605-020-04844-8. Epub 2020 Nov 2. PMID: 33140319; PMCID: PMC7605731.
• 23. Emile SH, Hamid HKS, Khan SM, Davis GN. Rate of Application and Outcome of Non-operative Management of Acute Appendicitis in the Setting of COVID-19: Systematic Review and Meta-analysis. J Gastrointest Surg. 2021 Jul;25(7):1905-1915.
• 24. Park HC, Kim MJ, Lee BH. Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis. Br J Surg. 2017 Dec;104(13):1785-1790.
• 25. Sippola S, Grönroos J, Sallinen V, Rautio T, Nordström P, Rantanen T, et al. A randomised placebo-controlled double-blind multicentre trial comparing antibiotic therapy with placebo in the treatment of uncomplicated acute appendicitis: APPAC III trial study protocol. BMJ Open. 2018 Nov 3;8(11):e023623.
• 26. Mock K, Lu Y, Friedlander S, Kim DY, Lee SL. Misdiagnosing adult appendicitis: clinical, cost, and socioeconomic implications of negative appendectomy. Am J Surg. 2016 Dec;212(6):1076-1082.
• 27. Gomes CA, Nunes TA, Fonseca Chebli JM, Junior CS, Gomes CC. Laparoscopy grading system of acute appendicitis: new insight for future trials. Surg Laparosc Endosc Percutan Tech. 2012 Oct;22(5):463-6.