Role of interval appendectomy in the management of complicated appendicitis in children.
BACKGROUND
The aim of this study was to ascertain the optimal treatment for children with complicated appendicitis. We reviewed an inception cohort of children with documented complicated appendicitis to develop criteria for interval appendectomy. We compared the outcomes of two treatments: immediate operation and interval appendectomy.


METHODS
Children with complicated appendicitis were separated into two groups. Group 1 patients had had symptoms of complicated appendicitis for less than 72 hours or appeared toxic. Group 2 patients had had symptoms of complicated appendicitis for longer than 72 hours and did not appear toxic. Group 1 underwent immediate operation treated by criteria previously published. Group 2 patients were treated in hospital with triple antibiotics until they were afebrile, had normal white blood cell counts, tolerated an oral diet, and had adequate pain control. They were discharged on oral metronidazole or metronidazole plus Bactrim for 6 weeks and then underwent interval appendectomy.


RESULTS
A total of 86 children had complicated appendicitis; 59 were operated on immediately, and 27 underwent an interval appendectomy. Complications included one wound infection and two intraabdominal abscesses (all in group 1). There was one death (group 1). The length of stay for the immediate operation group was 4.9 +/- 1.7 days; the initial-admission length of stay for the interval appendectomy group was 4.1 +/- 1.0 days with a subsequent postoperative stay of 0.9 +/- 0.8 days. One patient in the interval appendectomy group was treated off protocol.


CONCLUSIONS
Treating selected children with interval appendectomy led to a decrease in complications and a shorter length of stay in this limited population. Interval appendectomy is a safe, cost-effective, useful adjunct treatment for children with complicated appendicitis.
Vane
Dennis W
DW
Department of Surgery, University of Vermont College of Medicine, 111 Colchester Avenue, Fletcher 460, Burlington, Vermont 05401, USA. Dennis.Vane@vtmednet.org
Fernandez
Nathanial
N
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008795:Metronidazole / Q000627:therapeutic use; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination