A. N. Munoz1, R. Hazboun1, I. Vannix1, V. Pepper1, T. Crane1, E. P. Tagge1, D. C. Moores1, J. E. Baerg1 1Loma Linda University School Of Medicine,Division Of Pediatric Surgery,Loma LInda, CA, USA
Introduction:
To prospectively document the impact of early vs. late operation on intestinal function in children undergoing planned appendectomy at initial presentation of perforated appendicitis.
Methods:
After IRB approval, between September 2016 and August 2017, complete data were prospectively collected for children undergoing planned appendectomy for perforated appendicitis. Pathologist-confirmed transmural perforations were included. Antibiotics and intra-operative irrigation were standardized. The median time to operation after first abdominal pain was 3 days (range: 1-9 days). Operation at day 2 or before (early) was compared to day 3 or after (late). Vomiting, nasogastric tubes (NGs) placed for vomiting, and time to tolerate diet evaluated intestinal function. Categorical and continuous variables were analyzed by chi-square and t-tests. A p<0.05 achieved significance. Data were reported as mean and standard deviation, median and range.
Results:
125 children with abdominal pain and suspected perforated appendicitis underwent appendectomy (99% laparoscopic), 101 had a confirmed perforation and were included. They were 67% male, 80% Hispanic and none were Asian.
There were 45 in the early and 56 in the late group, with 22/56(39 %) operated on day 3 (range: 3-9 days). Follow-up evaluation was documented in 44/101 (41%), median: 41.5 days (5-81 days)
Children with early appendectomy were significantly younger (p=0.02), 7.8(3.5) vs. 9.5(3.8) years.
Pre-appendectomy, over 80% of each group were vomiting (p=0.84). There were no significant differences in NGs (p= 0.07), WBC (p=0.62), fever (p=0.29), diarrhea (p=0.17) or imaged-abscesses (p=0.97) reported. The maximum imaged-abscess diameter was significantly greater in the late group (p=0.02), none were drained.
At appendectomy, reported purulent fluid (p=0.41), fecaliths (p=0.48) and operation time (p=0.07) did not differ significantly.
Post-appendectomy, 5(5%) developed abscesses (p=0.38) treated with drainage and antibiotics; 4 recovered. One in the late group had persistent obstruction and required laparotomy 12 days after appendectomy. The late group had a significantly longer hospital stay 3.5 (2.2) vs 5.6 (4.3) days (p=0.01). All 44 with documented follow-up evaluation recovered completely
Conclusion:
A cohort of younger children with rapid progression of perforated appendicitis that recover after appendectomy was prospectively identified. Over 80% vomited before operation, but by the second post-operative day, only 18% persisted in vomiting. If appendectomy is performed on the third day of pain or later, significantly more NGs are placed and the time to tolerate diet is significantly prolonged. Early operation for perforated appendicitis is beneficial in children.
