Doctoral defence: Edgar Lipping "Postoperative antibacterial therapy in complicated appendicitis and appendectomy in pregnancy"

On 8 March at 12:00, Edgar Lipping will defend his thesis "Postoperative antibacterial therapy in complicated appendicitis and appendectomy in pregnancy".

Supervisors:
Professor Peep Talving, University of Tartu
Professor Urmas Lepner, University of Tartu
Assistant Sten Saar, University of Tartu

Opponent:
Professor Paulina Salminen, Univserity of Turku (Finland)

Summary:

Usually patients do not need antibiotics following the removal of the appendix. About every third appendicitis is complicated – the wall of the appendix is disrupted. Such patients need antibiotics following surgery in order to prevent complications. However, there is no consensus on the length or need of antibacterial treatment following appendectomy in complicated cases. Also, it is not clear how an inflamed appendix should be removed when the patient is pregnant. 

In a randomized controlled trial patients were allocated to receive a short course or a longer course of antibiotics following the removal of a perforated appendix. The trial demonstrated that patients in the short group were discharged earlier and had similar rate of complications when compared to patients in the traditional group. This means that shorter courses on antibiotics offer the same treatment results but help to cut treatment costs. 

Also, in a randomized controlled trial patients were randomized to receive a short course of oral antibiotics or a short course of intravenous antibiotics following appendectomy in complicated appendicitis. The trial demonstrated that oral administration was no associated with worse treatment outcomes than intravenous administration of antibiotics. 

Finally, by using all the data of pregnant patients undergoing appendectomy in Estonia from 2010 to 2020, we compared outcomes in open and laparoscopic appendectomy. The study demonstrated that laparoscopic appendectomy was associated with a shorter operative time and shorter hospital length of stay when compared to open appendectomy. The rate of fetal loss or preterm delivery did not differ among the two groups. 

To sum up, it may be concluded that a few tablets of antibiotics after surgery in a burst appendicitis is all it takes. Also, pregnant patients may safely have their appendix removed laparoscopically.

You can also watch defense via Teams.