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Appendicitis in children: current therapeutic recommendations.

I R Neilson1, J M Laberge, L T Nguyen

  • 1Department of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada.

Journal of Pediatric Surgery
|November 1, 1990
PubMed
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This study shows primary skin closure after appendectomy in children is safe, with low infection rates. This approach simplifies wound management and reduces hospital stays for pediatric appendicitis patients.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease Management
  • Surgical Protocols

Background:

  • Wound infection is a significant cause of morbidity in pediatric appendicitis.
  • Current management protocols involve preoperative antibiotics, intraoperative lavage, and variable antibiotic continuation.
  • Controversy exists regarding optimal skin closure techniques and antibiotic duration in pediatric appendectomies.

Purpose of the Study:

  • To evaluate the safety and efficacy of primary skin closure in all pediatric appendectomy patients.
  • To assess the impact of a standardized protocol on infectious complications and hospital stay.

Main Methods:

  • A prospective protocol was followed for 2 years involving 420 children undergoing appendectomy.
  • All patients received preoperative triple antibiotics (ampicillin, gentamicin, clindamycin).

Related Experiment Videos

  • Antibiotic duration varied based on appendicitis severity; primary skin closure and no drains were employed.

    • Main Results:

    • The overall infectious complication rate was low at 1.0% (4/420).
    • No infectious complications occurred in patients with normal or simple acute appendicitis.
    • Patients with gangrenous or perforated appendicitis had a 1.7% rate of wound infections and intraabdominal abscesses, with an average hospital stay of 6.9 days.

    Conclusions:

    • Primary skin closure in pediatric appendectomy is associated with a low incidence of infectious complications.
    • The protocol effectively managed wound infections and reduced length of hospital stay, particularly for uncomplicated cases.
    • This approach establishes new standards for wound management and infectious complication reduction in pediatric appendicitis.