Bringing surgeons together across the world: diagnosis and management of acute appendicitis

Despite appendicitis being one of the most common surgical emergencies in the pediatric population, there is still a great deal of debate among pediatric surgeons regarding the workup and treatment.

In an interactive Web symposium consisting of 130 pediatric surgeons from various regions of the world, questions about diagnosis and management of appendicitis were displayed on the screen. The audience was asked to respond to the poll questions. The questions asked to the participants pertained to an example case of a 12-year-old boy presenting to the emergency department with the classic history and exam for appendicitis.

The total number of respondents varied between 30 and 37, giving response rates of 23%-28%. Sixty-six percent of respondents would not order imaging. Thirty-one percent said that they would order ultrasound. No participant would order a computed tomography scan, whereas 5% would order some other form. Ninety-five percent of respondents said that they would treat the patient operatively. The majority (89%) of the participants felt comfortable waiting until morning to operate on the patient if the patient arrived at 11 p.m. Fifty-seven percent stated that they would use a three-port laparoscopic approach, and 38% would use a single port, whereas 5% would use an open surgical approach. The majority (34%) reported being able to visualize the appendix as the greatest benefit to using laparoscopy. Fifty-seven percent would give the patient one additional dose of antibiotics and then discharge him 24 hours later following treatment for acute, nonperforated appendicitis. Twenty percent of respondents would give no further antibiotics and would discharge the patient from the recovery room or soon after. Sixteen percent would not give any additional antibiotics and would discharge him 24 hours postoperatively, whereas 6% would give one additional dose of antibiotics and discharge him soon after.

The use of virtual broadcasts affords a unique opportunity to surgeons around the world to share and learn from each other.