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Eur J Pediatr Surg 2019; 29(01): 053-061
DOI: 10.1055/s-0038-1668139
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

Augusto Zani
1   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
,
Nigel J. Hall
3   Faculty of Medicine, University of Southampton, Southampton, United Kingdom
,
Abidur Rahman
1   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
,
Francesco Morini
4   Department of Medical and Surgical Neonatology, Ospedale Pediatrico Bambino Gesu, IRCCS, Rome, Italy
,
Alessio Pini Prato
5   Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
,
Florian Friedmacher
6   Department of Pediatric Surgery, The Royal London Hospital, London, United Kingdom
,
Antti Koivusalo
7   Section of Pediatric Surgery, Children‧s Hospital, Helsinki, Finland
,
Ernest van Heurn
8   Emma Children‧s Hospital AMC and VU University Medical Center, Paediatric Surgical Center of Amsterdam, Amsterdam, The Netherlands
,
Agostino Pierro
1   Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
2   Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Publikationsverlauf

15. Mai 2018

04. Juli 2018

Publikationsdatum:
15. August 2018 (online)

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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.

Keywords

appendectomy - perforated - antibiotics - children - pediatric