Treatment of appendicitis in pediatric patients – Status quo 2017
Authors:
V. Dotlačil 1; B. Frýbová 1; O. Petrů 1; O. Hradský 2; L. Plánka 3; K. Harvánek 4; R. Hanák 5; R. Štichhauer 6; T. Příplatová 7; L. Janeček 8; P. Havránek 9; K. Kocmanová 10; T. Malý 11; I. Slívová 12; Z. Horák 13; J. Bierhanzlová 14; P. Polák 15; M. Rygl 1
Authors‘ workplace:
Klinika dětské chirurgie 2. LF UK a FN Motol, Praha
1; Pediatrická klinika 2. LF UK a FN Motol, Praha
2; Klinika dětské chirurgie, ortopedie a traumatologie, FN Brno
3; Oddělení dětské chirurgie a traumatologie, Nemocnice Na Bulovce, Praha
4; Chirurgické oddělení, Nemocnice České Budějovice
5; Oddělení dětské chirurgie a traumatologie, FN Hradec Králové
6; Oddělení dětské chirurgie, ON Kladno
7; Oddělení dětské chirurgie, ON Kolín
8; Klinika dětské chirurgie a traumatologie 3. LF UK a TN, Praha
9; Všeobecná chirurgie, Krajská nemocnice Liberec
10; I. chirurgická klinika, FN Olomouc
11; Chirurgická klinika, FN Ostrava
12; Chirurgická klinika – Oddělení dětské chirurgie, Pardubická nemocnice
13; Chirurgická klinika, FN Plzeň a LF UK v Plzni
14; Oddělení dětské chirurgie – dětské úrazové centrum, Masarykova nemocnice, Ústí nad Labem
15
Published in:
Čes-slov Pediat 2019; 74 (8): 443-448.
Category:
Original Papers
Overview
Introduction: Appendicitis is one of the most common diagnoses in pediatric surgery and its therapy involves a combination of surgical and antibiotic (ATB) treatment. Based on evidence-based medicine, new recommendations for its treatment have been published. The aim of this work was to evaluate current practice in the Czech Republic from the perspective of pediatric surgeons.
Methods: In a multicentre retrospective online questionnaire, 15 pediatric-surgical departments in the Czech Republic (university clinics, independent departments, pediatric surgery ordinariates at general surgery departments) were addressed. The questionnaire contained 10 questions. The monitored parameters were the number of operations, surgical approach, ATB prophylaxis and therapy, postoperative complications at individual departments in 2017. SurveyMonkey Inc. questionnaire was used for anonymous data collection.
Results: Fourteen of the fifteen surveyed departments completed the questionnaire (93%). In 2017, 1,379 appendectomies were performed, of which 456 (33%) were laparoscopically. The necessity of conversion was 2%. 1/4 of the patients had complicated appendicitis (gangrene, perforation) and were operated in 70% classically. ATB prophylaxis was always given in 4 (29%) departments, in 4 departments according to the surgeon's decision, in 4 departments it was not administered and in 2 departments ATB was administered only during laparoscopy. Five types of antibiotics were used for ATB prophylaxis at all departments. In cases of phlegmonous appendicitis, ATB was administered therapeutically in 2 departments (14%), in 8 departments (57%) as decided by the surgeon and in 4 departments it was not administered. In complicated appendicitis, ATB was therapeutically administered in 100% of cases. There were 6.7% (93/1379) complications overall - after classical appendectomy, they occurred in 6.9% (64/923), after laparoscopic appendectomy in 6.4% (29/456).
Conclusion: In 2017, two-thirds of appendectomies were operated classically in the questioned departments. The prophylaxis and therapy of ATB vary from department to department and even varies inside one department. The percentages of complications and inconsistency in ATB use are comparable to those reported in the literature, however, we differ in the number of appendectomies performed laparoscopically.
Keywords:
antibiotics – laparoscopy – appendectomy – pediatric surgery – postoperative complications
Sources
1. Wan MJ, Murray K, Ungar WJ, et al. Acute appendicitis in young child-ren: Cost-effectiveness of US versus CT in diagnosis – a Markov decision analytic model. Radiology 2009; 250 (2): 378–386. doi: 10.1148/radiol.2502080100. ISSN 0033-8419.
2. Buckius MT, Mcgrath B, Monk J, et al. Changing epidemiology of acute appendicitis in the United States: Study period 1993–2008. J Surg Res 2012; 175 (2): 185–190. doi: 10.1016/j.jss.2011.07.017. ISSN 00224804.
3. Mcburney Ch. The incision made in the abdominal wall in cases of appendicitis, with a description of new method of operating. Ann Surg 1894; 20, 38–43. doi: 10.1097/00000658-189407000-00004. ISSN 0003-4932.
4. Shawyer AC, Hatchell AC, Pemberton J, et al. Compliance with published recommendations for postoperative antibiotic management of children with appendicitis: A chart audit. J Pediatr Surg 2015; 50 (5): 783–785. doi: 10.1016/j.jpedsurg.2015.02.040. ISSN 00223468.
5. Fraser JD, Aguayo P, Leys ChM, et al. A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg 2010; 45 (6): 1198–1202. doi: 10.1016/j.jpedsurg.2010.02.090. ISSN 00223468.
6. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: an American pediatric surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg 2010; 45 (11): 2181–2185. doi: 10.1016/j.jpedsurg.2010.06.038. ISSN 00223468.
7. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane database of systematic reviews [online]. doi: 10.1002/14651858.CD001439.pub2. ISSN 14651858.
8. Newman K, Ponsky T, Kittle K, et al. Appendicitis 2000: Variability in practice, outcomes, and resource utilization at thirty pediatric hospitals. J Pediatr Surg 2003; 38 (3): 372–379. doi: 10.1053/jpsu.2003.50111. ISSN 00223468.
9. Zani A, Hall N, Rahman A, et al. European Paediatric Surgeons‘ Association Survey on the management of pediatric appendicitis. Eur J Pediatr Surg 2019; 29 (01): 053–061. doi: 10.1055/s-0038-1668139. ISSN 0939-7248.
10. Semm K. Endoscopic Appendectomy. Endoscopy 1983; 15 (02): 59–64. doi: 10.1055/s-2007-1021466. ISSN 0013-726X.
11. Chandler NM, Ghazarian SR, King TM, et al. Cosmetic outcomes following appendectomy in children: A comparison of surgical techniques. J Laparoendosc Adv Surg Tech 2014; 24 (8): 584–588.
12. Masoomi H, Mills S, Dolich MO, et al. Comparison of outcomes of laparoscopic versus open appendectomy in children: Data from The Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg 2012; 36 (3): 573–578.
13. Jaschinski T, Mosch ChG, Eikermann M, et al. Laparoscopic versus open surgery for suspected appendicitis. Cochrane database of systematic reviews [online]. doi: 10.1002/14651858.CD001546.pub4. ISSN 14651858.
14. Esposito C, Calvo AI, Castagnetti M, et al. Open versus laparoscopic appendectomy in the pediatric population: A literature review and analysis of complications. J Laparoendosc Adv Surg Tech 2012; 22 (8): 834–839.
15. Štichhauer R, Koudelka J. Otevřená versus laparoskopická operace akutní apendicitidy u dětí. Rozhl Chir 2018; 97 (1): 17–121.
16. Perez EA, Piper H, Burkhalter LS, et al. Single-incision laparoscopic surgery in children: a randomized control trial of acute appendicitis. Surg Endosc 2013; 27 (4): 1367–1371. doi: 10.1007/s00464-012-2617-5. ISSN 0930-2794.
17. Ameer A, Dhillon S, Peters M, et al. Systematic literature review of hospital medication administration errors in children. Integrated Pharmacy Research and Practice [online]. doi: 10.2147/IPRP.S54998. ISSN 2230-5254.
18. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: an American pediatric surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg 2010; 45 (11): 2181–2185. doi: 10.1016/j.jpedsurg.2010.06.038. ISSN 00223468.
19. Peter ST, Shawn D., Kuojen T, et al. Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: a prospective randomized trial. J Pediatr Surg 2008; 43 (6): 981–985. doi: 10.1016/j.jpedsurg.2008.02.018. ISSN 00223468.
20. Dreznik Y, Feigin E, Samuk I, et al. Dual versus triple antibiotics regimen in children with perforated acute appendicitis. Eur J Pediatr Surg 2018; 28 (06): 491–494. doi: 10.1055/s-0037-1606847. ISSN 0939-7248.
21. Markar SR, Blackburn S, Cobb R, et al. Laparoscopic versus open appe-dectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg 2012; 16 (10): 1993–2004. doi: 10.1007/s11605-012--1962-y. ISSN 1091-255X.
22. Nataraja RM, Teague WJ, Galea J, et al. Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg 2012; 47 (2): 317–321. doi: 10.1016/j.jped-surg.2011.11.023. ISSN 00223468.
23. Vahdad MR, Troebs RB, Nissen M, et al. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg 2013; 48 (3): 555–561. doi: 10.1016/j.jpedsurg.2012.07.066. ISSN 00223468.
24. Chang HK, Han SJ, Choi SH, et al. Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J 2013; 54 (6): 1478–1483. doi: 10.3349/ymj.2013.54.6.1478. ISSN 0513-5796.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2019 Issue 8
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