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Noh, Chung, and Choi: Optimal Time for Appendectomy in Perforated Appendicitis of Children
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 78(4): 242-248.

Published online: 13 April 2010

DOI: https://doi.org/10.4174/jkss.2010.78.4.242

Optimal Time for Appendectomy in Perforated Appendicitis of Children

Kyoung Tae Noh, M.D., Soon Seop Chung, M.D., Kum-Ja Choi, M.D.

Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author (kumchoi@ewha.ac.kr)

Received 14 October 2009       Accepted 14 December 2009

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients.

Methods

Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay.

Results

During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5℃ at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course.

Conclusion

For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.

Keywords: Perforated appendicitis, Children, Optimal time for operation

Figures and Tables

Table 1
Age distribution
jkss-78-242-i001

*Mean±SD = 7 yrs 9 month±3 yrs 2 month.

Table 2
Symptom duration
jkss-78-242-i002

*Mean±SD = 47.4±38.4 hr.

Table 3
Diagnostic methods
jkss-78-242-i003

*P/Ex. = physical examination; †US = ultrasonography; ‡CT = computed tomography.

Table 4
Postoperative days of beginning diet
jkss-78-242-i004

*Mean±SD = 2.8±1.4 day; †Longest NPO time = 9 days.

Table 5
Postoperative complic
jkss-78-242-i005

*NPO more than 5 days postoperatively.

Table 6
Length of Hospital stay
jkss-78-242-i006

*Mean±SD = 9.0±2.6 days; †Longest hospitalization = 19 days.

Table 7
Factors affecting postoperative course
jkss-78-242-i007

*Sx. = symptom; †BT = body temperature when the patient visited hospital.

Table 8
Preoperative antibiotics administration and hospital course in high-risk patients
jkss-78-242-i008

*BT = body temperature when the patient visited hospital.

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