Modified Enhanced Recovery Program in Emergency Surgery (MERES) (MERES)
Acute Appendicitis, Acute Appendicitis With Rupture, Acute Appendicitis With Peritonitis
About this trial
This is an interventional treatment trial for Acute Appendicitis focused on measuring enhanced recovery, fast-track, appendectomy, intraperitoneal anesthesia, low pressure pneumoperitoneum
Eligibility Criteria
Inclusion Criteria:
- Patients with any stage of acute appendicitis except 3B according to Gomes classification;
- Class I-II surgical patients according to the classification of The American Society of Anesthesiologists (ASA).
Exclusion Criteria:
- Patient refusal to participate in the study or to sign the informed consent form;
- Language barrier;
- Transfer to the intensive care unit (ICU) after surgery;
- ASA class ≥ III;
- Conversion to open procedure;
- Appendicular mass found during laparoscopy;
- Gomes 3B appendicitis requiring immersion of the appendicular stump;
- Pregnancy.
Sites / Locations
- Taras Nechay
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Modified ERAS protocol group
Standard care group
Laparoscopic appendectomy with modified ERAS protocol group Preadmission. Not available due to the emergency setting. Preoperative care. 1) Patient brochure with a detailed description of the type of pathology, surgery procedure, rehabilitation process, possible complications, and other. Surgery. Low pressure (8-9 mmHg) pneumoperitoneum. Routinely remove of appendix mesentery in presence of any signs of its inflammation. Additional local anesthesia with 0.25% ropivacaine. Abdominal cavity draining only in patients with perforated appendicitis and diffuse peritonitis (Gomes 5). Postoperative care. Early mobilization (2 h after surgery) Early fluid intake (2 h after surgery) Early liquid food (6 h after surgery)
Standard care laparoscopic appendectomy. Preadmission. Not available due to emergency setting. Preoperative care. 1) Patient oral informing about the type of pathology, surgery procedure and possible complications. No brochure. Surgery. Standard pressure (12-14 mmHg) pneumoperitoneum Abdominal draining for patients with perforated and not perforated appendicitis complicated by abscess, local or diffuse peritonitis (Gomez ≥ 3A). Appendix mesentery removing in the appearance of its necrotic changes. No intraabdominal anesthesia. Postoperative care. 1) Mobilization in 4-6 h after surgery 2) Fluid intake in 6 hours 3) Liquid food intake in 12 hours