Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform?

Abstract

Background. Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection.Materials and methods. A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed.Results. A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not. Conclusions.Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.

Pediatric obesity and perioperative medicine

“…Furthermore, any excess risk of SSI is often associated with an extended hospital stay, thus imposing a severe financial pecuniary burden on the health-care system [39,40]. Among a cohort of children undergoing surgery for acute appendicitis, Delgado-Miguel et al found that obesity conferred almost two times higher risk for SSI [12 ▪ ]. Similar findings have been reported by other researchers analyzing children undergoing similar surgical procedures [41,42].…”

“…It is therefore essential that clinicians who endeavor to address these surgical needs be equipped with the most up-to-date empirical data on the opportunity to improve the care for the subset of children who are obese. Obese children are at an increased risk for chronic health conditions and several complications specific to the perioperative period, including respiratory adverse events, infections, bleeding events [9–11,12 ▪ ,13]. This excess risk of perioperative morbidity makes it imperative that childhood obesity be adequately screened during the preoperative assessment [14].…”