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Appendicitis in children: a systematic approach for a low incidence of complications
1Division of Pediatric Surgery, University of Texas Health Science Center, Southwestern Medical School, Dallas.
Insights
This study of pediatric appendectomies found excellent outcomes with a low complication rate. A standardized protocol reduced hospital stays and antibiotic use, even for perforated appendicitis cases.
Area of Science:
- Pediatric Surgery
- Infectious Disease
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis and effective treatment are crucial to minimize complications and hospital stays.
Purpose of the Study:
- To evaluate the outcomes of a standardized protocol for pediatric appendectomies.
- To assess the effectiveness of the protocol in reducing negative explorations and improving patient recovery.
Main Methods:
- A retrospective review of 414 pediatric appendectomies.
- Implementation of a protocol including fluid resuscitation, antibiotic administration, and primary wound closure without drains.
- Collection of aerobic and anaerobic cultures from the peritoneal cavity and appendiceal stump.
Main Results:
- Acute nonperforated appendicitis occurred in 57.1%, perforated in 18.6%, and normal appendix in 14.3%.
- Negative explorations were reduced to 7% with identification of other pathologies.
- Excellent results with no mortality and <1% complication rate.
- Shorter hospitalization and antibiotic treatment for perforated appendicitis.
Conclusions:
- The standardized protocol for pediatric appendectomies is safe and effective.
- The protocol leads to excellent outcomes, reduced hospital stays, and fewer complications.
- Early identification of alternative pathologies can reduce negative appendectomies.
Abstract:
Four hundred fourteen appendectomies in children have been described. Acute nonperforated appendicitis was seen in 57.1 percent of the patients and perforated appendicitis in 18.6 percent. A histologically normal appendix was seen in 14.3 percent of the patients. In 31 of these patients, other pathologic abnormalities were found to account for the symptoms, thus the number of negative explorations was reduced to 7 percent. The average length of hospitalization was 5.3 days for patients with acute nonperforated appendicitis and 7.3 days for patients with perforated appendicitis. A protocol was followed which consisted of fluid resuscitation, preoperative and postoperative administration of antibiotics, and surgical exploration with appendectomy in all patients. No interval appendectomies were performed. The peritoneal cavity was not irrigated and the use of drains was avoided as much as possible. All wounds were closed primarily without wound drains. Topical cefamandole powder was used in all cases. Aerobic and anaerobic culture specimens were obtained in all cases from the peritoneal cavity and appendiceal stump. Twenty-eight different organisms were recovered, B. fragilis being the most common followed by E. coli. Excellent results were obtained without mortality and a less than 1 percent complication rate. There was a shorter period of hospitalization for patients with perforated appendicitis and a shorter period of antibiotic treatment.