Evaluating the Efficacy of a Safety Algorithm for Laparoscopic Access in Severe Acute Appendicitis
Laparoscopic appendectomy for complicated forms of acute appendicitis remains a subject of debate due to concerns related to the high incidence of intra-abdominal abscesses. The aim of this study was to evaluate the effectiveness of a developed “Safety Algorithm” incorporating standardized risk stratification criteria, intraoperative irrigation protocol, and dynamic postoperative monitoring. A retrospective analysis of data from 81 patients with destructive forms of acute appendicitis (ICD-10 code K35.2 – acute appendicitis with generalized peritonitis) treated during 2024–2025 using laparoscopic approach according to the authors’ algorithm. The study evaluated hospitalization duration, conversion rate, postoperative complications, dynamics of inflammatory markers, and outcome structure. The Safety Algorithm, based on objective severity stratification (WSES scale), standardized irrigation technique, and “Red Flags” dynamic monitoring protocol, enables laparoscopic appendectomy even in cases of diffuse peritonitis with zero conversion rate, minimal mortality, and reduced hospitalization duration. This standardized approach demonstrates reproducible results independent of individual surgeon experience, offering a transformative paradigm for managing complicated acute appendicitis through evidence-based risk stratification, comprehensive intraoperative debridement protocols, and structured postoperative surveillance utilizing objective inflammatory biomarkers.
Gallyamov E.A., Shalygin A.B., Majidova L.A., Rumyantsev I.A., Soslaev R.M. 2026. Evaluating the Efficacy of a Safety Algorithm for Laparoscopic Access in Severe Acute Appendicitis. Challenges in Modern Medicine, 49(2): 184–198 (in Russian). DOI: 10.52575/2687-0940-2026-49-2-184-198. EDN: HVFZAE
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Список литературы
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Kumar S.S., Collings A.T., Lamm R., Haskins I.N., Scholz S., Nepal P., Train A.T., Athanasiadis D.I., Pucher P.H., Bradley J.F. 3rd, Hanna N.M., Quinteros F., Narula N., Slater B.J. 2024. SAGES Guideline for the Diagnosis and Treatment of Appendicitis. Surg Endosc. 38(6): 2974–2994. doi: 10.1007/s00464-024-10813-y
Liao Y.T., Huang J, Wu C.T., Chen P.C., Hsieh T.T., Lai F., Chen T.C., Liang J.T. 2022. The Necessity of Abdominal Drainage for Patients with Complicated Appendicitis Undergoing Laparoscopic Appendectomy: A Retrospective Cohort Study. World J Emerg Surg. 17(1): 16. doi: 10.1186/s13017-022-00421-3
Schildberg C., Weber U., König V., Linnartz M., Heisler S., Hafkesbrink J., Fricke M., Mantke R. 2025. Laparoscopic Appendectomy as the Gold Standard: What Role Remains for Open Surgery, Conversion, and Disease Severity? : An Analysis of 32,000 Cases with Appendicitis in Germany. World J Emerg Surg. 20(1): 53. doi: 10.1186/s13017-025-00626-2
Yuen A. 2025. Validation of the APPEND Clinical Decision Tool for the Diagnosis of Acute Appendicitis // International Surgery Journal. doi: 10.18203/2349-2902.isj20250811
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Andersen D.K., Billiar T.R., Dunn D.L. 2019. The Appendix // Schwartz’s Principles of Surgery, 11th Edition. New York: McGraw-Hill Education. Chapter 30. ISBN: 978-1-260-45335-5
Di Saverio S., Podda M., De Simone B. 2020. Diagnosis and Treatment of Acute Appendicitis: 2020 Update of the WSES Jerusalem Guidelines // World Journal of Emergency Surgery. doi: 10.1186/s13017-020-00306-3
Duan C., Li Y, Ma J, Song Y, Zhou L. 2024. The Impact of Laparoscopic Appendectomy and Open Appendectomy on B7-H3-Mediated Intrinsic Immune Response in Children with Acute Suppurative Appendicitis. J Inflamm Res. 17: 1577–1587. doi: 10.2147/JIR.S446199
Elvira López J., Sales Mallafré R., Padilla Zegarra E., Carrillo Luna L., Ferreres Serafini J., Tully R., Memba Ikuga R., Jorba Martin R. 2022. Outpatient Management of Acute Uncomplicated Appendicitis after Laparoscopic Appendectomy: A Randomized Controlled Trial. World J Emerg Surg. 17(1): 59. doi: 10.1186/s13017-022-00465-5
Kumar S.S., Collings A.T., Lamm R., Haskins I.N., Scholz S., Nepal P., Train A.T., Athanasiadis D.I., Pucher P.H., Bradley J.F. 3rd, Hanna N.M., Quinteros F., Narula N., Slater B.J. 2024. SAGES Guideline for the Diagnosis and Treatment of Appendicitis. Surg Endosc. 38(6): 2974–2994. doi: 10.1007/s00464-024-10813-y
Liao Y.T., Huang J, Wu C.T., Chen P.C., Hsieh T.T., Lai F., Chen T.C., Liang J.T. 2022. The Necessity of Abdominal Drainage for Patients with Complicated Appendicitis Undergoing Laparoscopic Appendectomy: A Retrospective Cohort Study. World J Emerg Surg. 17(1): 16. doi: 10.1186/s13017-022-00421-3
Schildberg C., Weber U., König V., Linnartz M., Heisler S., Hafkesbrink J., Fricke M., Mantke R. 2025. Laparoscopic Appendectomy as the Gold Standard: What Role Remains for Open Surgery, Conversion, and Disease Severity? : An Analysis of 32,000 Cases with Appendicitis in Germany. World J Emerg Surg. 20(1): 53. doi: 10.1186/s13017-025-00626-2
Yuen A. 2025. Validation of the APPEND Clinical Decision Tool for the Diagnosis of Acute Appendicitis // International Surgery Journal. doi: 10.18203/2349-2902.isj20250811