Primary appendectomy in appendicular masses of children: an institutional experience

Abstract

Background: Early appendectomy (EA) for appendicular mass (AM) has been found to be a safer alternative in various studies in adults, while very few studies report such advantages in pediatric population. The purpose of this study was to assess the safety, efficacy and practical implications of EA in pediatric patients with AM.Methods: All patients with acute appendicitis or its complications that underwent EA between January 2016 and December 2018 were retrospectively reviewed. AM was defined if any or combination of the following criteria were satisfied with other signs of appendicitis: palpable mass in right iliac fossa (RIF), sonologically identified mass in RIF, per-operatively confirmed as a mass by surgeon.Results: 37 patients (among a total of 642 patients) were determined to have AM per-operatively and were included in the analysis. 29.7% (n=11) had a contained appendicular abscess. Age group ranged from 4-12 years (mean 7.8 years). The key per-operative findings were fecolith (21.6%), gangrenous appendix (56.8%), difficult adhesiolysis (48.6%), and full thickness bowel injury (2.7%). Postoperatively, wound infection in 9 (24.3%), intra-abdominal abscess in 1 (2.7%), prolonged ileus in 2 (5.4%) and sepsis in 2 (5.4%) were managed medically.Conclusions: EA approach in AM is a safe option in children as it avoids misdiagnosis, treats complicated appendicitis early, avoids second admission, and has shorter hospital stay with better compliance. Failures of non-operative management and potentially lethal complications of complicated appendicitis are also eliminated.

Factors associated with early inhospital adverse outcome following surgery for acute appendicitis in Uganda: A multicenter cohort

“…The complication rate in this study was lower than that reported by Knaapen et al (16) in the Netherlands (25.0%), Monrabal Lezama et al (17) in Argentina among patients converted from laparoscopic to open (48.0%), Salminen et al (18) in Finland (24.4%) and Puthenvariath et al (19) in India 24%, but higher than that reported by Becker et al (20) in the USA (10.6%), Tankel et al (21) in Israel (0.5%), Minutolo et al (22) in Italy (13.2%), Mönttinen et al (23) in Finland (4.8%), Talan & Di Saverio (5) in Canada (3%) and Ayele (24) in Ethiopia (12%).…”

Factors associated with early inhospital adverse outcome following surgery for acute appendicitis in Uganda: a multicenter cohort

“…The complication rate in this study was lower than that reported in the Netherlands (25.0%) (16), Argentina among patients converted from laparoscopic to open (48.0%) (Monrabal Lezama et al 2193), in Finland (24.4%) (Salminen et al 2018) and in India 24% (Puthenvariath et al 2020), but higher than that reported in the USA (10.6%) (Becker et al 2019), in Israel (0.5%) (Tankel et al 2020), in Italy (13.2%) (Minutolo et al 2014), in Finland (4.8%) (Mönttinen et al 2021), in Canada (3%) (Talan and Saverio 2021) and in Ethiopia (12%) (Ayele 2021).…”

Complicated Appendicitis-Shifting towards Early Appendectomy-A Comprehensive Review

“…The mean blood loss was also reduced in patients who undergo laparoscopic appendectomy for complicated appendicitis. [35][36][37][38][39] The drawback observed in these studies was that they were retrospective in nature and sample size were small. [40][41][42] A systemic review and meta-analysis on the feasibility of laparoscopic appendectomy for complicated appendicitis.…”