Patient-Family and Provider Partnerships in the Management of Pediatric Uncomplicated Appendicitis

Abstract

In recent years, studies have demonstrated non-operative management with antibiotics alone to be a safe and effective treatment option for children with uncomplicated acute appendicitis. Shared decision-making is critical in the treatment of uncomplicated appendicitis due to the markedly different risks and benefits associated with surgery and non-operative management. In this report, we discuss the importance of shared decision-making in surgery using a case of uncomplicated appendicitis as an example. We present both the patient-family and provider perspectives on evaluating and deciding between operative and non-operative management and discuss the value of shared decision-making in the unique setting of an acute pathologic process with surgical and medical treatment options.

Moving Toward Minimally Invasive Treatments and Better Risk Characterization for Pilonidal Disease

“…3 The flap procedures (Karydakis flap, Limberg flap, Bascom cleft lift, etc) flatten the contour of the buttocks and neutralize the impact of these 2 factors. 1 However, the buttock-contour flattening is cosmetically inferior, irreversible, and not preferred by patients. 5 In LOCULA, these 2 modifiable factors are not neutralized, and it is pertinent to instruct patients to take care of these 2 risk factors postoperatively to avoid recurrence (by regularly cleaning hairs and neutralizing effect of sweating by applying talcum powder to the gluteal cleft to keep it dry).…”

“…2020;90(10):2146-2148. doi:10.1111 To the Editor I read with interest the Review on pilonidal disease by Gil et al 1 I wish to highlight the significant overlap between pilonidal disease and hidradenitis suppurativa that was not reviewed. The epidemiology of hidradenitis suppurativa has similarities to pilonidal disease: most patients report disease onset at puberty and prevalence peaks in early adulthood.…”

“…Garg and Hemrajani importantly bring up the laying open with curettage under local anesthesia (LOCULA) treatment method, which we did not include in our Review. 1 The treatment method involves unroofing of the pilonidal sinus and curettage of the tract with partial trimming of the skin edges. 2 This technique is a viable alternative treatment strategy as it is not as invasive as traditional excisional procedures.…”