Appendectomy

This research aims to improve how appendicitis, a common emergency surgery condition, is managed worldwide by studying different emergency care systems. Appendicitis requires quick diagnosis and treatment to avoid complications. Using appendicitis as a marker, the study looks at access, quality, and efficiency across hospitals in various countries, including low- and middle-income regions, to find ways to enhance emergency surgical care. The study collects data from about 500 hospitals globally between February and May 2025, focusing on patients undergoing appendicectomy using any surgical method, including open, laparoscopic, or robotic approaches. Hospitals will record information for consecutive patients over 14-day periods. The study includes two sub-studies: one on sustainability and waste management in operating rooms and another on the financial impact of surgery on patients, especially in resource-limited settings. Participants will have their care observed through routine health records without extra follow-up visits. Researchers will measure key factors such as time from symptoms to surgical assessment, rates of minimally invasive surgery, complications within 30 days, and hospital stay length. This data will help identify gaps and guide improvements in emergency surgical care worldwide, aiming to make treatment safer, faster, and more affordable.

Researchers are evaluating the safety and effectiveness of the Symani Surgical System in microsurgical anastomosis during free tissue transfer surgery and lymphovenous anastomosis surgery. This observational study aims to assess the device's performance in real-world settings, focusing on the rate of successful vessel connection in the first surgical attempt and the absence of device-related adverse events. Participants will receive standard surgical care using the Symani Surgical System, which offers articulated, interchangeable instruments designed for open microsurgery procedures. The study includes patients undergoing free tissue transfer of the breast or extremities and those having lymphovenous anastomosis surgery for lymphedema. During the trial, participants will have their surgical procedures assessed and may complete questionnaires if undergoing lymphedema procedures. Throughout the study, researchers will monitor the safety and effectiveness of the device by evaluating intraoperative vessel patency and tracking any adverse events up to 30 days after surgery. Participants will be asked to allow access to their medical information, attend follow-up visits, and complete all study procedures and questionnaires. The total participation covers the surgery period and a 30-day post-surgery follow-up to ensure comprehensive safety and outcome monitoring.

Researchers are comparing the effects of intraperitoneal bupivacaine instillation versus a placebo as preemptive pain relief in patients undergoing open appendectomy. The study focuses on evaluating pain management outcomes after surgery, specifically looking at postoperative pain within 24 hours. This is a phase 1 trial involving adult patients aged 20 to 60 undergoing emergency open appendectomy. Participants are randomly assigned to receive either 0.25% bupivacaine or 10 ml of normal saline instilled into the peritoneal cavity at the end of the operation. Both groups will have surgery duration noted, and pain relief and analgesic use will be monitored at 2, 6, 12, and 24 hours postoperatively. Rescue medications like ketorolac and nalbuphine will be used if pain scores reach certain levels. All patients will receive intravenous paracetamol as first-line analgesia. Patients are expected to be discharged two days after surgery once diet and pain are manageable, with additional oral pain medications provided if needed. During the study, researchers will closely record analgesic consumption and pain scores using a visual analogue scale. Follow-up will continue according to protocol to monitor ongoing pain and recovery. All information will be collected on a standardized form. The main outcome measured is postoperative pain within the first 24 hours. The trial aims to determine whether bupivacaine instillation offers better pain control compared to placebo during open appendectomy procedures.

Researchers are evaluating the effects and safety of dexamethasone palmitate compared to traditional dexamethasone for preventing postoperative nausea and vomiting (PONV) after open surgery. Although dexamethasone is commonly used to reduce PONV, some patients still experience symptoms within 24 hours after surgery. Dexamethasone palmitate has a longer-lasting anti-inflammatory effect and fewer side effects, making it a promising option for managing PONV. Participants will be randomly assigned to one of two groups. One group will receive an intravenous injection of dexamethasone palmitate 8 mg (containing 5 mg dexamethasone) after anesthesia induction and before surgical incision. The other group will receive an intravenous injection of dexamethasone 5 mg at the same time. The trial compares these treatments in patients undergoing elective open surgeries such as spinal, chest, or abdominal surgery. During the study, researchers will monitor participants for the incidence and severity of PONV at multiple time points within 72 hours after surgery. They will also track the use of rescue antiemetic medications, participant satisfaction with PONV management, pain levels using the VAS scale, quality of postoperative recovery, length of hospital stay, and safety outcomes up to one month after surgery. The main outcome is the occurrence of PONV within the first 24 hours postoperatively. Participation lasts through the surgery and follow-up periods as described.

This research aims to analyze data from the Fitbit wearable device to predict infections after surgery in children with complicated appendicitis. The study focuses on how this prediction affects clinical decision-making, time to first contact with healthcare, and postoperative healthcare use. The study involves children aged 3 to 18 who have undergone laparoscopic appendectomy for complicated appendicitis, with the goal of improving early infection detection and patient care. Participants will wear Fitbit devices that collect heart rate, physical activity, and sleep data in near-real time. Machine learning methods will be applied to this data to develop and validate an algorithm that detects postoperative infection. The study has two main parts: first, developing and validating the infection prediction algorithm using Fitbit data; second, assessing how access to real-time infection alerts influences clinicians’ decisions and healthcare use. This includes daily reports and alerts sent to surgeons for patients in the implementation phase. Throughout the study, Fitbit data and daily symptom diaries will be collected for 30 days from enrollment to monitor recovery. Researchers will analyze changes in physical activity, heart rate, sleep patterns, symptom reports, healthcare visits, and clinician decision-making. The study includes surveys and qualitative assessments to understand the impact of Fitbit data on care. Participants are monitored for postoperative infection and healthcare utilization during this period, supporting early detection and improved management.

Researchers are studying how genetic differences affect the pain relief provided by nalbuphine in adults undergoing certain abdominal and pelvic surgeries. This trial aims to identify genes linked to pain and how they influence nalbuphine's effectiveness in postoperative patients, focusing on a Pakistani population to help address opioid use challenges and improve pain management. Participants will receive nalbuphine intravenously during surgery, with doses given at induction and as needed based on heart rate and blood pressure. Standard anesthesia with propofol, atracurium, oxygen, nitrous oxide, and isoflurane will be used. Blood samples will be taken before surgery and after extubation for genetic analysis, focusing on patients with persistent pain or opioid side effects. Pain, sedation, nausea, vomiting, and analgesic needs will be monitored for 24 hours after surgery. Participants will be assessed through vital sign monitoring during surgery and pain and sedation evaluations for 24 hours after. Blood samples will be analyzed genetically to explore links between genes and nalbuphine response. Researchers will measure pain scores as the main outcome and track sedation, nausea, vomiting, and additional pain medication use. The study will follow participants from before surgery through 24 hours postoperatively to understand nalbuphine's clinical effects and genetic influences.

This research aims to evaluate whether a faster postoperative treatment approach called Fast Track can safely shorten hospital stays for children aged 2 to 17 who have complicated acute appendicitis and undergo laparoscopic appendectomy. Complicated appendicitis involves a perforated, gangrenous, or contaminated appendix with a periappendicular abscess. The study compares Fast Track to the standard care model by assessing if adverse events within 30 days after surgery are not worse with the faster approach. Two treatment plans are compared: the Fast Track group receives intravenous antibiotics in the hospital for 3 days followed by oral amoxicillin-clavulanic acid at home for 2 days, while the standard care group receives intravenous antibiotics for 5 days in the hospital. Both treatments follow protocols set by each participating center. This randomized, open-label trial evaluates whether the Fast Track model can reduce hospital stay length without increasing complications. Participants will be monitored for 30 days after surgery to track adverse events such as abdominal abscesses, infections, wound problems, reinterventions, sepsis, or death. Additional assessments include hospital readmissions, antibiotic side effects, quality of life measures on days 2, 5, 14, and 30, satisfaction questionnaires, lab markers like procalcitonin, antibiotic use, and associated costs. The study plans to provide detailed safety and outcome data while potentially benefiting patients and healthcare systems by reducing hospitalization time.

Researchers are investigating the effect of perioperative intravenous nimodipine, a drug that blocks L-type calcium channels and can cross the blood-brain barrier, on pain management and anesthetic requirements in patients undergoing open colectomy for bowel cancer. The trial aims to understand how nimodipine influences opioid use, pain intensity, opioid-related side effects, and early bowel function after surgery. This prospective, double-blind, randomized controlled trial addresses the need for better pain control strategies during and after surgery while minimizing opioid-related complications. Participants are randomly assigned to receive either nimodipine or isotonic saline during the perioperative period. Nimodipine is given continuously at 4 mg/h starting one hour before surgery until one hour after surgery begins, then reduced to 2 mg/h until 24 hours after surgery ends. The control group receives a matching saline infusion at equivalent rates and timing. Both treatments are prepared in blinded syringes to maintain trial integrity. Throughout the study, patients' opioid and anesthetic consumption during surgery and up to 72 hours postoperatively are recorded. Pain intensity, side effects such as sedation, itching, nausea, vomiting, and bowel function recovery are monitored closely. Hospital stay length is also tracked. The study lasts from pre-surgery through 30 days post-surgery, with a focus on detailed pain and medication assessments in the first three days following surgery.

Researchers are conducting a prospective observational multicenter trial to study adult patients undergoing laparoscopic appendectomy for acute appendicitis. The study aims to evaluate the impact of laparoscopic lavage during surgery on the risk of developing postoperative intra-abdominal abscesses. It also introduces a classification system to relate the severity of appendicitis and peritoneal contamination to abscess development, considering surgeons' use of lavage versus suction alone. This trial is resident-driven and involves multiple centers, focusing on improving scientific understanding in a real-world setting. The study examines patients treated with a laparoscopic approach for appendicitis, comparing the use of laparoscopic lavage with suction-only techniques during surgery. Patients are categorized into groups based on the grade of appendicitis and level of peritoneal contamination. Data is collected through online forms by surgical residents and compiled centrally for analysis. The study does not involve randomization or experimental treatment but observes current surgical practices and outcomes. Participants will have their clinical and operative data recorded without personal identifiers. The primary outcome is the occurrence of intra-abdominal abscesses within 90 days after surgery. Secondary outcomes include other postoperative complications during the same period. Statistical methods will identify factors related to abscess risk and help develop a scoring system to classify severity grades. The study is expected to enroll over 1000 patients and will monitor participants for three months post-surgery.

Researchers are evaluating whether adding dexmedetomidine to bupivacaine in a caudal block can provide longer and better pain relief for children aged 2 to 7 years undergoing open appendectomy surgery. The study also aims to assess the effect of this combination on recovery quality, including the rate of emergence delirium, as well as overall safety. Children in the study will be randomly assigned to one of two groups. One group will receive a single-shot caudal block with 1 mL/kg of 0.25% bupivacaine mixed with 1 mL of normal saline. The other group will receive a similar caudal block but with bupivacaine mixed with 1 g/kg of dexmedetomidine diluted in 1 mL of normal saline. All treatments are given under general anesthesia during the surgery. Participants will be monitored for up to 24 hours after the caudal block to measure the time until the first need for additional pain relief. Researchers will also observe recovery quality and any side effects. The study involves careful safety monitoring throughout the post-operative period to assess how well children recover and manage pain after surgery.