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

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

doi:10.1055/s-0038-1668139

Cited by 23 publications

(7 citation statements)

References 61 publications

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“…Conflicting results have also been reported after laparoscopic appendectomy for complicated appendicitis [ 10 , 11 ]. In these patients, the type of drain tube and distance from the abdominal wound to the most distal end of the tube play a role in the outcomes.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

et al. 2021

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Background This study examined whether drain placement or not is associated with the postoperative outcomes of pediatric patients following trans-umbilical single-port laparoscopic appendectomy (TUSPLA) for complicated appendicitis. Methods The medical records of pediatric patients undergoing TUSPLA for acute complicated appendicitis from January 2012 to September 2018 in Kaohsiung Chang Gung Memorial Hospital were reviewed retrospectively. They were classified according to whether they received passive drainage with a Penrose drain (Penrose group) (19), active drainage with a Jackson-Pratt drain with a vacuum bulb (JP group) (16), or no drain (non-drain group) (86). The postoperative outcomes of the three groups were compared. Results Postoperative visual analog scale pain score was significantly higher in the non-drain group than in either the JP group or Penrose group. Patients in the Penrose group had a significantly longer postoperative hospital stay than those in the non-drain group and a higher rate of intra-abdominal abscess, while patients in the JP group had a significantly shorter postoperative hospital stay; moreover, no patient in JP group developed a postoperative intra-abdominal abscess. Conclusions Compared to passive drainage with a Penrose drain or no drain, active drainage with a JP drain shorter the postoperative hospital stay and decreased the risk of postoperative intra-abdominal abscess.

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Section: Introductionmentioning

confidence: 99%

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

et al. 2021

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“…In 2018, in a wide-ranging study, Tom et al 19 found that of the 58511 appendectomies conducted in children’s hospitals in the USA between 2003 and 2012, 70% were done using laparoscopy, compared to 53% of the ∼1.2 million conducted at non-children’s hospitals. Zani et al 20 summarized the results of the European Pediatric Surgeons’ Association survey on the management of pediatric appendicitis, compiled from 169 respondents from 42 countries (24 European). For simple appendicitis, laparoscopy was the preferred method for 89%, while for perforated appendicitis, it remained the method of choice for 81%.…”

Section: Discussionmentioning

confidence: 99%

Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

Hannan¹,

Parveen

Nandy

2020

Preprint

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Background: Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. Objective: The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. Methods: This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital, Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. Results: The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). Conclusions: Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure.

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“…Тоді як у розвинутих країнах ЛА є стандартним методом лікування дітей з ГА [47,57,72], то у краї-нах, що розвиваються, цей метод лікування тільки набуває поширеності [3]. Це в першу чергу зумовлено тим, що значна частка пацієнтів госпіталізується з клінічною картиною ускладненого ГА, і хірурги не ризикують виконувати мініінвазивного втручання, а, крім того, зберігаються проблеми кривої навчання.…”

Section: результати дослідження та їх обговоренняunclassified

“…Незважаючи на недоведеність ефективності лаважа черевної порожнини, багато хірургів вважають за доцільне промивати черевну порожнину для «розведення» гнійного вмісту та «очищення» зони запалення, керуючись висловом «розведення є вирішенням проблеми забруднення -dilution is the solution to pollution» [16, 26,35]. За даними опитування Європейської асоціації дитячих хірургів, лише 29% хірургів завжди промивають черевну порожнину при ГА, 58%лише за наявності гнійного випоту, а 13% -переважно лаваж не використовують [72]. Серед наших пацієнтів лаваж проведений у 23,7% при ВА і у 32,9% при ЛА.…”

Section: результати дослідження та їх обговоренняunclassified

Modern principles of diagnostic and treatment of acute appendicitis in children

Pereyaslov¹,

Stenyk²,

Bobak³

et al. 2021

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Introduction. The typical clinical picture of acute appendicitis (AA) is absent in most of patients, that lead for the high frequency of misdiagnosis with the increase of complicated forms of AA. Due to that, it is necessary to establish the new available laboratory markers, which permitted with the high level of reliability distinguish children not only with AA, but also is appendix perforation. The question what method of appendectomy should be choose – the conventional or mini-invasive – are still under debate. Aim of the study was to summarize the results of diagnosis and treatment of AA in children with the applying of various laboratory markers, ultrasonography (US), and laparoscopy. Materials and methods. This study based on the results of surgical treatment of 3171 children with AA, which were operated during 2009–2018 years. Diagnosis was established on the data of anamnesis, results of objective and laboratory investigation. US was performed in 1183 (37.3%) of patients. Open appendectomy (OA) was performed in 2879 (90.8%) and laparoscopic (LA) – in 292 (9.2%) of patients. With the aim to evaluate the results the methods of variative statistic, determination of specificity, sensitivity, positive (PPV) and negative (NPV) predictive value, etc. were applied. Results. Among the laboratory markers, the best results for the diagnosis of AA showed the neutrophil to lymphocytes ratio (NLR) with the sensitivity – 84.9%, specificity – 67.1%, PPV – 17.8%, and NPV – 98.9%. NLR (sensitivity – 82.5%, specificity – 84%, PPV – 98.5%) and sodium blood level (sensitivity – 90.3%, specificity – 89.9%, PPV – 98.9%) had the best results for the diagnostic of perforated AA. US is the important compound of diagnostic of AA in children with the high level of sensitivity, specificity, PPV, and NPV – 93%, 85%, 86%, and 92%, correspondingly. By the frequency of complications in the early postoperative period, OA and LA had no statistically significant differences, but at follow-up after surgery, LA revealed the sufficient advantages over OA. Conclusions. Among the various laboratory markers, NLR had the better prognostic value for the diagnosis of AA and indices of plasma sodium concentration and NLR for the preoperative diagnosis of perforated appendicitis. US with the high degree of reliability allows to confirm or exclude the diagnosis of AA in children with acute abdominal syndrome. Laparoscopic appendectomy is the real alternative for conventional methods of AA treatment. Besides of the well-known advantages of mini-invasive surgery, the laparoscopic appendectomy had an advantage at the follow-up period. No conflicts of interest was declared by the authors. Key words: acute appendicitis, children, diagnostic, treatment, laparoscopy.

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

Abstract: 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.

Cited by 23 publications

References 61 publications

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

Inappropriate manipulation and drainage exacerbate post-operative pain and prolong the hospital stay after laparoscopic appendectomy for pediatric complicated appendicitis

Spinal Anesthesia is Safe and Cost-effective for Laparoscopic Appendectomy in Children: A Case-Control Study

Modern principles of diagnostic and treatment of acute appendicitis in children

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