Kids With Perforated Appendix May Benefit From Early Surgery
MONDAY, Feb. 21 -- Early appendectomy is better for children with a perforated appendix than postponing the surgery, a new study finds.
The two commonly used surgical options for children with a perforated appendix are early appendectomy (surgical removal of the appendix within 24 hours of hospitalization) and what's known as "interval" appendectomy (surgery six to eight weeks after the initial diagnosis).
It had been assumed that postponing surgery would allow contamination in the abdominal cavity to resolve, reducing the likelihood of infection. But this study found that early appendectomy was linked to fewer adverse events, such as surgical site infection, intra-abdominal abscess, and unplanned readmission to hospital.
There could also be an added benefit for parents and kids from operating early.
"We found that those treated with early appendectomy return to normal activities an average of five days earlier. Because a child's time away from normal activities limits parents' abilities to work, we believe it is an important outcome from a patient and family perspective," Dr. Martin L. Blakely, of the University of Tennessee Health Science Center in Memphis, and colleagues wrote in a news release from the journal.
The team evaluated the outcomes of 131 patients younger than 18 who were diagnosed with appendicitis with a perforated appendix between October 2006 and August 2009. They randomly assigned early appendectomy to 64 patients, while another 67 youngsters were randomly assigned to undergo interval appendectomy.
The study found that the average time away from normal activities was just under 14 days for early appendectomy, compared to more than 19 days for interval appendectomy. The overall adverse event rate was 30 percent for early appendectomy and 55 percent for interval appendectomy.Finally, the average total length of hospital stay was more than two days shorter for patients in the early appendectomy group.
However, one expert believes that the findings may not be the final word on this issue.
"The child with a perforated appendix requires treatment with antibiotics," explained Dr. Steve Dolgin, chief of pediatric surgery at Cohen Children's Medical Center of New York, in New York City. "The timing of an appendectomy does not need to be immediate. Some children with advanced appendicitis do better if they are treated with antibiotics and no operation during the acute illness."
Dolgin added that "this new study does not answer this question [of when to operate] but adds to the debate." He said that, "the best way to help children with appendicitis is to make the diagnosis early, before the appendix perforates. That is not addressed by this study. Parents should know that persistent localized abdominal pain, especially on the lower right side, requires an emergency visit to the doctor for possible appendicitis. The appendix typically perforates two to three days after the onset of abdominal pain, which is often at first in the mid abdomen and then moves to the right lower quadrant."
The study was published online prior to publication in the June print issue of the Archives of Surgery.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about appendicitis.
Posted: February 2011
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