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Early appendectomy versus an interval appendectomy for appendiceal abscess in children
N Handa1, K Muramori, S Taguchi
1Department of Pediatric Surgery, Oita Prefectural Hospital, Japan.
Insights
For children with perforated appendicitis and abscess, conservative treatment with antibiotics followed by interval appendectomy is recommended. This approach avoids complications associated with early appendectomy, offering a safer strategy for pediatric appendiceal abscess management.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Appendicitis is a common surgical emergency in children.
- Perforated appendicitis with localized abscess presents treatment challenges.
- Early appendectomy versus conservative management is debated.
Purpose of the Study:
- To compare outcomes of early appendectomy versus interval appendectomy after conservative management in pediatric perforated appendicitis with abscess.
- To evaluate operative time, blood loss, complications, hospital stay, and costs.
Main Methods:
- Retrospective comparative study.
- Two groups: early appendectomy (n=8) and interval appendectomy after conservative treatment (n=6).
- Conservative management included triple antibiotic therapy.
Main Results:
- Early appendectomy group had longer operation times, greater blood loss, and more postoperative complications.
- Interval appendectomy group had successful conservative management without abscess drainage or complications.
- No significant differences in hospital stay or medical costs between groups.
Conclusions:
- Initial conservative treatment followed by interval appendectomy is a useful strategy for pediatric appendiceal abscesses.
- This approach may reduce complications compared to early surgery.
- Further research is needed to determine the applicability of interval appendectomy in all antibiotic-treated cases.
Abstract:
We retrospectively compared the results of an early appendectomy and an interval appendectomy at a later date after initial conservative treatment in children demonstrating perforated appendicitis with a localized abscess. The preoperative conditions were similar for both groups. The early group (n = 8) showed a statistically significant longer operation time and a greater but not significant blood loss were noted while a larger number of postoperative complications were also observed. On the other hand, in the late operation group (n = 6) initial conservative management including triple antibiotic therapy proved successful without the need to drain the abscess, and thus the interval appendectomy was safely completed without any complications. There were no significant differences between the two groups with respect to length of hospital stay or medical costs. Based on these findings, we thus recommend that initial conservative treatment followed by an interval appendectomy about three months later is a useful strategy for the treatment of appendiceal abscesses in children. However, whether or not an interval appendectomy is appropriate in all patients whose inflammation is suppressed with antibiotics still needs to be clarified.