European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis
European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis
Aim To define patterns in the management of pediatric appendicitis. Methods A total of 169 delegates from 42 (24 European) countries completed a validated survey administered at the EUPSA 2017 annual congress. Results In the work-up of children with suspected acute appendicitis, most surgeons rely on full blood count (92%), C-reactive protein (82%), and abdominal ultrasonography (76%), but rarely on computed tomography scans or magnetic resonance imaging. In suspected simple appendicitis, most surgeons (76%) do not perform appendectomy at night in clinically stable patients and start antibiotic preoperatively (64%), but only 15% offer antibiotic therapy alone (no appendectomy). In suspected perforated appendicitis, 96% start antibiotic preoperatively, and 92% perform an appendectomy. Presence of phlegmon/abscess is the main contraindication to immediate surgery. In case of appendix mass, most responders (75%) favor a conservative approach and perform interval appendectomy always (56%) or in selected cases (38%) between 2 and 6 months from the first episode (81%). Children with large intraperitoneal abscesses are managed by percutaneous drainage (59% responders) and by surgery (37% responders). Laparoscopy is the preferred surgical approach for both simple (89%) and perforated appendicitis (81%). Most surgeons send the appendix for histology (96%) and pus for microbiology, if present (78%). At the end of the operation, 58% irrigate the abdominal cavity only if contaminated using saline solution (93%). In selected cases, 52% leave a drain in situ. Conclusion Some aspects of appendicitis management lack consensus, particularly appendix mass and intraperitoneal abscess. Evidence-based guidelines should be developed, which may help standardize care and improve clinical outcomes.
antibiotics, appendectomy, children, pediatric, perforated
53-61
Zani, Augusto
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Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Rahman, Abidur
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Morini, Francesco
86a194e9-6792-42c6-b5be-61e079453f18
Pini Prato, Alessio
5fca1b95-4dd8-47cb-b1bd-1b224e1d305a
Friedmacher, Florian
2c66356f-34cb-40a2-8034-ebd90c23d3d8
Koivusalo, Antti
56039c6f-cf11-40dc-89ef-05b4a20b6ef2
Van Heurn, Ernest
3f67cfb3-da9a-484a-b2af-ce52bef6f97d
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
2019
Zani, Augusto
219e67b0-b2c1-49e0-af38-a179993eb83d
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Rahman, Abidur
c63b9f91-bf29-49ed-b7e0-4355652a07e2
Morini, Francesco
86a194e9-6792-42c6-b5be-61e079453f18
Pini Prato, Alessio
5fca1b95-4dd8-47cb-b1bd-1b224e1d305a
Friedmacher, Florian
2c66356f-34cb-40a2-8034-ebd90c23d3d8
Koivusalo, Antti
56039c6f-cf11-40dc-89ef-05b4a20b6ef2
Van Heurn, Ernest
3f67cfb3-da9a-484a-b2af-ce52bef6f97d
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Zani, Augusto, Hall, Nigel J., Rahman, Abidur, Morini, Francesco, Pini Prato, Alessio, Friedmacher, Florian, Koivusalo, Antti, Van Heurn, Ernest and Pierro, Agostino
(2019)
European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis.
European Journal of Pediatric Surgery, 29 (1), .
(doi:10.1055/s-0038-1668139).
Abstract
Aim To define patterns in the management of pediatric appendicitis. Methods A total of 169 delegates from 42 (24 European) countries completed a validated survey administered at the EUPSA 2017 annual congress. Results In the work-up of children with suspected acute appendicitis, most surgeons rely on full blood count (92%), C-reactive protein (82%), and abdominal ultrasonography (76%), but rarely on computed tomography scans or magnetic resonance imaging. In suspected simple appendicitis, most surgeons (76%) do not perform appendectomy at night in clinically stable patients and start antibiotic preoperatively (64%), but only 15% offer antibiotic therapy alone (no appendectomy). In suspected perforated appendicitis, 96% start antibiotic preoperatively, and 92% perform an appendectomy. Presence of phlegmon/abscess is the main contraindication to immediate surgery. In case of appendix mass, most responders (75%) favor a conservative approach and perform interval appendectomy always (56%) or in selected cases (38%) between 2 and 6 months from the first episode (81%). Children with large intraperitoneal abscesses are managed by percutaneous drainage (59% responders) and by surgery (37% responders). Laparoscopy is the preferred surgical approach for both simple (89%) and perforated appendicitis (81%). Most surgeons send the appendix for histology (96%) and pus for microbiology, if present (78%). At the end of the operation, 58% irrigate the abdominal cavity only if contaminated using saline solution (93%). In selected cases, 52% leave a drain in situ. Conclusion Some aspects of appendicitis management lack consensus, particularly appendix mass and intraperitoneal abscess. Evidence-based guidelines should be developed, which may help standardize care and improve clinical outcomes.
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Accepted/In Press date: 4 July 2018
e-pub ahead of print date: 15 August 2018
Published date: 2019
Keywords:
antibiotics, appendectomy, children, pediatric, perforated
Identifiers
Local EPrints ID: 428187
URI: http://eprints.soton.ac.uk/id/eprint/428187
ISSN: 0939-7248
PURE UUID: a8483b45-6694-491d-bea9-81698c3e2a58
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Date deposited: 14 Feb 2019 17:30
Last modified: 16 Mar 2024 07:34
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Contributors
Author:
Augusto Zani
Author:
Abidur Rahman
Author:
Francesco Morini
Author:
Alessio Pini Prato
Author:
Florian Friedmacher
Author:
Antti Koivusalo
Author:
Ernest Van Heurn
Author:
Agostino Pierro
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