Our Summary

This research paper is a systematic review by the American Pediatric Surgical Association looking at the timing of appendectomy (surgery to remove the appendix) in children with acute appendicitis. The review was conducted to make recommendations to prevent any negative side effects, reduce costs, and improve patient and parent satisfaction. The researchers examined articles published between 1970 and 2016, and based their recommendations on the best available evidence. They found that performing an appendectomy within 24 hours of admission does not seem to increase the risk of appendix rupture or other negative outcomes. Similarly, performing the surgery within this time frame does not increase hospital costs or the length of stay. However, they found limited data to determine whether the timing of the surgery affects patient or parent satisfaction. As such, the researchers conclude that more high-quality research is needed to make strong recommendations about the timing of appendectomy for acute appendicitis in children.

FAQs

  1. What is the recommended timing for an appendectomy in children with acute appendicitis according to the American Pediatric Surgical Association?
  2. Does performing an appendectomy within 24 hours of admission increase the risk of appendix rupture or other negative outcomes?
  3. Is there any evidence to suggest that the timing of the surgery affects patient or parent satisfaction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric appendectomy is that it is generally safe to have the surgery within 24 hours of admission and that delaying the surgery beyond this timeframe may not be necessary. It is important to follow your doctor’s recommendations and not delay the surgery if it is recommended. It is also important to discuss any concerns or questions you may have with your healthcare provider.

Suitable For

Patients who are typically recommended for pediatric appendectomy are those with acute appendicitis, which is the most common surgical emergency in children. Symptoms of acute appendicitis include abdominal pain, fever, vomiting, and decreased appetite. Pediatric patients with these symptoms may undergo diagnostic tests such as blood tests, imaging studies (such as ultrasound or CT scan), and physical examination to confirm the diagnosis of appendicitis.

In general, pediatric patients with uncomplicated acute appendicitis are recommended for appendectomy. Uncomplicated appendicitis means that the appendix has not ruptured and there are no abscesses or other complications present. Patients with complicated appendicitis, such as those with a ruptured appendix or abscess formation, may require additional treatment before or after surgery.

It is important for pediatric patients with suspected acute appendicitis to be evaluated by a pediatric surgeon to determine the appropriate course of treatment. In some cases, antibiotics may be used as initial treatment to reduce inflammation and infection before surgery is performed. However, appendectomy is the definitive treatment for acute appendicitis and is typically recommended for pediatric patients to prevent potential complications such as perforation and peritonitis.

Timeline

Before pediatric appendectomy:

  1. Onset of symptoms such as abdominal pain, nausea, vomiting, and fever.
  2. Diagnosis of acute appendicitis through physical examination, blood tests, and imaging studies.
  3. Consultation with a pediatric surgeon to discuss treatment options.
  4. Preoperative preparation including fasting and administration of antibiotics.

After pediatric appendectomy:

  1. Surgery is performed to remove the inflamed appendix.
  2. Recovery in the hospital for monitoring and pain management.
  3. Postoperative care including wound care, pain management, and gradual resumption of normal activities.
  4. Follow-up appointments with the pediatric surgeon to monitor healing and address any complications.
  5. Return to normal activities and diet once fully recovered.

What to Ask Your Doctor

  1. What are the potential risks and benefits of delaying the appendectomy surgery for my child?
  2. How soon after diagnosis should my child undergo the appendectomy surgery?
  3. Will delaying the surgery increase the risk of complications, such as appendix rupture?
  4. What factors should be considered when determining the timing of the surgery for my child?
  5. What is the typical recovery time for a pediatric appendectomy?
  6. Are there any specific instructions or precautions my child should follow before or after the surgery?
  7. What are the potential long-term effects of having an appendectomy at a younger age?
  8. What alternative treatment options are available for pediatric appendicitis, and how do they compare to surgery in terms of effectiveness and safety?

Reference

Authors: Cameron DB, Williams R, Geng Y, Gosain A, Arnold MA, Guner YS, Blakely ML, Downard CD, Goldin AB, Grabowski J, Lal DR, Dasgupta R, Baird R, Gates RL, Shelton J, Jancelewicz T, Rangel SJ, Austin MT. Journal: J Pediatr Surg. 2018 Mar;53(3):396-405. doi: 10.1016/j.jpedsurg.2017.11.042. Epub 2017 Nov 20. PMID: 29241958