[The management of pediatric appendicitis: an opinion survey of Israeli pediatric surgeons]

Abstract

Background: Appendicitis remains the most common acute surgical condition of the abdomen in children. However, considerable controversy still exists among surgeons as to the management of pediatric appendicitis. The goal of this study was to determine current practice patterns and provide a foundation for evidence-based outcome studies that would standardize patient care.

Methods: Members of the Israeli Pediatric Surgical Association were interviewed with respect to timing of operation, preoperative imaging, opinions on interval appendectomy, use of cultures, abdominal irrigation, transperitoneal drains, method of wound closure, spectrum and duration of post-operative antibiotic coverage and discharge criteria.

Results: A total of 14 of the 18 units or departments of Pediatric Surgery responded to our survey. Fifty percent of surgeons prefer to wait within 3-8 hours before the operation and wait until morning to operate on a stable child who presents in the middle of the night. A majority of respondents prefer abdominal ultrasound to CT when an imaging study is felt necessary. More than ninety percent of surgeons indicate that they routinely take intraperitoneal cultures, do not use intraperitoneal drains, use pure crystalloid to irrigate the abdominal cavity, and perform primary closure of the surgical wound, even in the presence of intraabdominal contamination. Laparoscopic versus open appendectomy as the procedure of choice is equally divided. Dissent exists in defining the importance of preoperative imaging, in the type and duration of antibiotic coverage, impact of clinical parameters on antibiotic use, and utility of discharge criteria.

Conclusions: There is an apparent consensus on the many aspects of perioperative and postoperative care of pediatric appendicitis among Israeli Pediatric Surgeons (IPS). This study consolidates current opinions on appropriate management of pediatric appendicitis, providing a foundation for evidence-based outcome studies.