title: Interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates?
abstract: BACKGROUND
  The need for interval appendectomy after nonoperative management of a perforated appendicitis is being questioned owing to recent studies that estimated recurrence rates as low as 5% because of obliteration of the appendiceal lumen. We review our experience with interval appendectomy in this subset of patients to determine the postoperative outcomes and luminal patency rates.
  
  
  METHODS
  A retrospective review was conducted of all children treated nonoperatively for a perforated appendicitis followed by elective interval appendectomy during the past 10 years. The data collected included initial hospitalization, convalescence period, perioperative course, and luminal patency rates.
  
  
  RESULTS
  A total of 128 patients were identified, of whom 55% were male. Their mean ± SD age was 9.1 ± 4.2 years. The mean interval from the initial presentation to appendectomy was 65.9 ± 20.3 d. All but 2 of the patients underwent laparoscopic appendectomy with 3 conversions to open surgery. The mean operative time was 43.6 ± 19.2 min. The complication rate was 9%, including 1 postoperative abscess, 1 reoperation for bleeding, and 1 readmission for Clostridium difficile infection. Six patients had a superficial wound infection, and 2 patients underwent outpatient procedures for suture granuloma. No risk factors for complications were identified. Of the specimens, 16% had obliterated lumens.
  
  
  CONCLUSIONS
  Major postoperative morbidity for interval appendectomy after a perforated appendicitis is low and should not be a deterrent in offering interval appendectomy to this subset of patients.
authors.affiliation: Department of Surgery, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
authors.forename: Corey W
authors.initials: CW
authors.lastname: Iqbal
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Vincent E
authors.initials: VE
authors.lastname: Mortellaro
authors.forename: Keely M
authors.initials: KM
authors.lastname: Fitzgerald
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000473:pathology / Q000601:surgery*; D001065:Appendix / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008923:Missouri / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies