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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.
Insights
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).
- 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.
Abstract:
Wound infection is the most common source of morbidity in appendicitis. Most recent pediatric series use protocols of preoperative antibiotics with aerobic and anaerobic coverage, intraoperative lavage, no peritoneal or wound drains, and continuation of antibiotics postoperatively with complicated appendicitis. There still remains controversy concerning skin closure and the duration of antibiotic therapy. We report the results of a prospective protocol followed over 2 years with 420 children. The protocol was designed to determine whether the skin could be closed primarily in all patients undergoing appendectomy. Preoperatively all patients received triple antibiotics (ampicillin, gentamicin, and clindamycin) that were continued postoperatively for two doses if there was a normal appendix or simple acute appendicitis, for at least 3 days with gangrenous appendicitis, and at least 5 days with perforated appendicitis. Antibiotics were continued if the patient remained febrile or had a white count greater than 10,000. No drains were used and the skin was closed primarily. The overall infectious complication rate was 1.0% (4/420). Among those with a normal appendix or simple acute appendicitis there were no infectious complications. Among those with gangrenous or perforated appendicitis there were 1.7% wound infections (2/117) and 1.7% intraabdominal abscesses (2/117). Duration of hospitalization was 2.1 days (range, 1 to 5 days) after simple acute appendicitis and 6.9 days (range, 3 to 40 days) after gangrenous or perforated appendicitis. These results set new standards in terms of wound management, infectious complications, and length of hospital stay.