A history of the treatment of appendicitis in children: lessons learned

Abstract

During the latter half of the 19th century, surgeons increasingly reported performing appendicectomies. Fitz from Harvard, Groves from Canada and Tait from Britain all recorded successful removal of the appendix. McBurney described the point of maximal tenderness in classic appendicitis and also the muscle-splitting incision centred on this point. Priority is given to McArthur in describing the lateral muscle-splitting incision. The direction of the cutaneous incision was later modified by Elliott and Lanz. Incisions that healed well were essential to recovery. Appendicectomy became a 'fashionable' operation after the London surgeon, Treves, removed the appendix of King Edward VII. Through the 20th century, the mortality from appendicitis fell notably with the advent of sulphonamide and penicillin, improvements in fluid therapy and safer anaesthesia. By 1990, diagnostic delay was the main cause of death. Semm performed the first laparoscopic appendicectomy in 1990, roundly criticized at the time for what is now a routine procedure. We view contemporary debates on the indications for appendicectomy, the best approach and how to optimize recovery in the light of the history of this intriguing disease.

Appendicectomy mortality: an Australian national audit

“…Since the first appendicectomy was performed in Australia in 1893, advancements in surgical diagnostic and operative techniques particularly in the last 30 years, such as increased computed tomography (CT) diagnostic accuracy, and refinement of laparoscopic surgery, has presumably led to better surgical outcomes. The current perception is that appendicectomy is a safe surgical procedure with minimal risks.…”

Incidence of complicated acute appendicitis: a single-centre retrospective study

“…However, it was not until the end of the nineteenth century that a more detailed description of the pathophysiology of appendicitis was presented [1,2]. The awareness of its high mortality rate encouraged doctors to undertake active measures to develop methods for the management and treatment of the disease.…”

Refining the management of acute appendicitis: towards improving cost efficiencies

“…In the current issue of the ANZ Journal of Surgery, there are five high-quality reports from New Zealand that provide an insightful perspective into the current state of surgical practice in that country. [1][2][3][4][5] This collection of manuscripts includes two articles from the North Shore Hospital in Auckland assessing outcomes from pancreatic surgery 1 and an audit of oesophageal resections for adenocarcinoma, 2 a review of surgical treatment of early stage breast cancer in the Auckland and Waikato regions, 3 a review of appendicectomies performed at Wellington Hospital 4 and an exploration of attitudes to bariatric surgery amongst the New Zealand population from the University of Auckland. 5 New Zealand has a population of approximately 4.5 million, and the country is governed by 16 local government regions and serviced by 20 independent District Health Boards (DHBs).…”

“…[1][2][3][4][5] This collection of manuscripts includes two articles from the North Shore Hospital in Auckland assessing outcomes from pancreatic surgery 1 and an audit of oesophageal resections for adenocarcinoma, 2 a review of surgical treatment of early stage breast cancer in the Auckland and Waikato regions, 3 a review of appendicectomies performed at Wellington Hospital 4 and an exploration of attitudes to bariatric surgery amongst the New Zealand population from the University of Auckland. 5 New Zealand has a population of approximately 4.5 million, and the country is governed by 16 local government regions and serviced by 20 independent District Health Boards (DHBs). Interestingly, almost half of the population of New Zealand, 1.9 million, live in the Auckland and Waikato regions, and it is perhaps not surprising that four of the five studies originate from the Auckland Province.…”

“…4 By the mid-20th century, the mortality from appendicitis plummeted considerably with the advent and widespread use of antibiotic therapy, intravenous fluids and safer anaesthesia, and the operative approach was even further refined when Semm performed the first laparoscopic appendicectomy in 1990 which has now become the routine procedure. 5 Indeed, in first world countries, mortality has become so low that appendicectomy has been relegated to a trainee surgeon's operation.…”