European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis

Augusto Zani, Nigel J Hall, Abidur Rahman, Francesco Morini, Alessio Pini Prato, Florian Friedmacher, Antti Koivusalo, Ernest van Heurn, Agostino Pierro

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalEuropean Journal of Pediatric Surgery
DOIs
Publication statusE-pub ahead of print - Aug 15 2018

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Appendicitis
Appendectomy
Pediatrics
Abscess
Anti-Bacterial Agents
Cellulitis
Suppuration
Abdominal Cavity
Microbiology
Sodium Chloride
C-Reactive Protein
Laparoscopy
Surgeons
Surveys and Questionnaires
Drainage
Ultrasonography
Histology
Tomography
Magnetic Resonance Imaging
Guidelines

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European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis. / Zani, Augusto; Hall, Nigel J; Rahman, Abidur; Morini, Francesco; Pini Prato, Alessio; Friedmacher, Florian; Koivusalo, Antti; van Heurn, Ernest; Pierro, Agostino.

In: European Journal of Pediatric Surgery, 15.08.2018.

Research output: Contribution to journalArticle

Zani, Augusto ; Hall, Nigel J ; Rahman, Abidur ; Morini, Francesco ; Pini Prato, Alessio ; Friedmacher, Florian ; Koivusalo, Antti ; van Heurn, Ernest ; Pierro, Agostino. / European Paediatric Surgeons' Association Survey on the Management of Pediatric Appendicitis. In: European Journal of Pediatric Surgery. 2018.
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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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AU - Zani, Augusto

AU - Hall, Nigel J

AU - Rahman, Abidur

AU - Morini, Francesco

AU - Pini Prato, Alessio

AU - Friedmacher, Florian

AU - Koivusalo, Antti

AU - van Heurn, Ernest

AU - Pierro, Agostino

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