New England Surgical Society (NESS)
Search NESS
  Annual Meeting
  Annual Resident and Fellow Research Day
      Member Directory
      Members Only
  Scholars Foundation
  Job Board
  Journal of the American College of Surgeons
      Past Presidential Addresses
  Contact NESS


Interval Appendectomy Improves Outcomes in Children with Complicated Appendicitis

Dennis W Vane, Nathanial Fernandez
University of Vermont College of Medicine, Burlington, VT

Objective: Ascertain optimal treatment for children with complicated appendicitis(CA)
Design: An inception cohort of children with documented CA was reviewed and criteria for interval appendectomy(IA) developed. Outcomes comparing immediate operation (IO) or IA were reviewed.
Setting: University Hospital
Patients: Children(21 days-17 yrs) with documented CA by CTscan.
Interventions: Children with CA were separated into two groups. Those presenting with symptoms <72 hours of CA or who appeared toxic and those presenting >72 hours who were not toxic. Group 1 underwent IO treated by criteria previously published. Group 2 was treated in hospital with triple antibiotics until afebrile, normal WBC, tolerating diet and adequate pain control. They were discharged on oral Flagyl or Flagyl & Bactrim for 6 weeks and then underwent IA.
Main Outcome Measures: Length of stay(LOS), morbidity and mortality.
Results: 86 children had CA, 59 IO and 27 IA. There was one wound infection and two intra-abdominal abscess (all IO). Preadmission symptoms were present for 9 days +/- 5 days in the IA group and 3 days +/- 3 days in the IO group. There was one death (IO newborn). LOS for the IO group was 4.9+/- 1.7 days and 4.1 days + .9 +/- .8 days for the IA group. One patient was treated off protocol in the IA group.
Conclusions: Treating select children with IA led to a decrease in length of stay and complications in this limited population. IA is a safe, cost effective and useful adjunct for the pediatric surgeon treating children with CA.

Back to Final Program


Copyright © 2020 New England Surgical Society. All Rights Reserved.
Read Privacy Policy.