General Surgery Research

The following are ongoing General Surgery academic projects. Please get in touch to collaborate.

PRESAPPICE 1 Study

Predicting severity of acute appendicitis by investigating immune and microbiome signatures – a translational observational cohort study

Background

Acute appendicitis (inflammation of the appendix) is one of the most common abdominal emergencies in the world, with a reported lifetime risk of between 7-8%1. Appendicectomy (surgical removal of the appendix) is one of the most frequently performed operations worldwide. Despite this, our understanding of the causes, severity and ability to accurately diagnose appendicitis remains poor. Diagnosis relies on clinical, haematological, biochemical, and radiological assessment. Despite this, a number of individuals undergo surgery for suspected appendicitis and have a normal appendix removed (negative appendicectomy rate of 20.6% in the UK)2. The severity of appendicitis is also variable, ranging from inflammation only to gangrene, perforation and abscess formation. The ability to predict severity and personalise treatment to individuals remains difficult3. Recently, there has been a move to offer treatment with antibiotics alone for uncomplicated appendicitis, although with a 5-year failure rate of 39%, our ability to do this remains somewhat inadequate4.

Aims and Objectives

1.1 Primary Objective

To determine if an immune and microbiome signature can distinguish between complicated and uncomplicated acute appendicitis in patients undergoing surgery in the UK

1.2 Secondary Objective

To determine:· Correlation between radiological, surgical and pathological findings of severity of appendicitis in a UK cohort· Predictive valves of Alvarado, AIR and NoCtApp score in a UK cohort· Incidence of appendiceal adenocarcinoma as a cause of appendicitis in a UK cohort· Genetic factors that may predispose individuals to developing complicated or uncomplicated appendicitis in a UK cohort· If biomarker(s) can be developed to test in future randomised controlled trials:

Treatment stratification (PRESAPPICE 2 – Patient stratification for treatment in acute appendicitis utilising an immune and microbiome signature)
Diagnosis in patients presenting with right iliac fossae pain (PRESAPPICE 3 – Diagnosis of acute appendicitis in individuals presenting with right iliac fossae pain using an immune and microbiome signature).

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