Related Experiment Videos
Appendicitis in children: a ten-year update of therapeutic recommendations
Sherif Emil1, Jean-Martin Laberge, Peter Mikhail
1Division of Pediatric General Surgery, Department of Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
This study shows that a simplified protocol for pediatric appendicitis leads to reasonable hospital stays and good outcomes. The evidence-based approach is suitable as a standard of care for treating appendicitis in children.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Infectious Disease Management
Background:
- Previous reports in 1990 indicated excellent outcomes for pediatric appendicitis using a standard protocol.
- The established protocol has undergone further simplification.
- A retrospective review was conducted to evaluate current treatment outcomes.
Purpose of the Study:
- To assess the outcomes of a simplified, evidence-based protocol for treating pediatric appendicitis.
- To evaluate the effectiveness of the current treatment standard in a large patient cohort.
- To analyze complication rates and hospital stays associated with the simplified protocol.
Main Methods:
- A retrospective review of 648 pediatric patients treated for appendicitis between April 1997 and December 1999.
- Standardized preoperative and postoperative antibiotic regimens (gentamicin, clindamycin, ampicillin, metronidazole).
- Primary wound closure without drains; specific discharge criteria for complicated appendicitis.
Main Results:
- Pathological findings included 9.4% normal appendices, 55.6% simple acute, 15.7% gangrenous, and 19.3% perforated.
- Average hospital stays varied: 2.21 days (normal), 1.39 days (simple acute), 2.97 days (gangrenous), 6.31 days (perforated).
- Low infection rates: 0.56% intraabdominal for simple appendicitis; 2.6% wound and 4.4% intraabdominal for complicated appendicitis.
Conclusions:
- The current simplified protocol for pediatric appendicitis yields reasonable hospital stays and favorable outcomes.
- The protocol serves as an evidence-based standard of care for pediatric appendicitis treatment.
- The findings support the continued use and potential refinement of this standardized approach.
Background/Purpose:
In 1990, the authors reported excellent outcomes using a standard protocol to treat pediatric appendicitis. This protocol has been simplified further and a large retrospective review was conducted to assess current outcomes.
Methods:
All patients treated for presumed appendicitis between April 1997 and December 1999 were reviewed. All patients received preoperative gentamicin and clindamycin. Patients with complicated appendicitis received postoperative ampicillin, gentamicin, and clindamycin or metronidazole. All wounds were closed primarily without drains. Patients with complicated appendicitis were discharged when their ileus resolved, they remained afebrile for 24 hours, and had a normal leukocyte count.
Results:
A total of 648 patients were reviewed. A total of 9.4% of appendices were pathologically normal, 55.6% were simple acute, 15.7% were gangrenous, and 19.3% were perforated. Hospital stay was 2.21 +/- 2.04 days for normal, 1.39 +/-.89 for simple acute, 2.97 +/- 1.25 for gangrenous, and 6.31 +/- 3.51 days for perforated appendices. There were no wound infections in patients with normal or simple acute appendices. Two minor intraabdominal infections (0.56%) occurred in patients with simple appendicitis. Patients with complicated appendicitis (gangrenous or perforated) had wound infection and intraabdominal infection rates of 2.6% and 4.4%, respectively.
Conclusions:
The authors' current protocol results in reasonable hospital stays and good outcomes. It serves as an evidence-based standard of care for the treatment of pediatric appendicitis.