Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
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Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 6, June, p. 745–750

doi: 10.17219/acem/122176

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Current management of pediatric appendicitis: A Central European survey

Vojtech Dotlacil1,A,B,C,D,F, Barbora Frybova1,B,E, Natalie Polívka1,B, Daniel Kardos2,B,D,E, Peter Vajda2,D,E, Krystian Toczewski3,B,C, Rebeka Pechanová4,B,C, Jozef Babala4,D,E, Michal Rygl1,C,D,E,F, Dariusz Patkowski3,D,E

1 Department of Pediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic

2 Department of Pediatrics, Surgical Division, University of Pecs, Hungary

3 Department of Pediatric Surgery and Urology, Wroclaw Medical University, Poland

4 Department of Pediatric Surgery, Comenius University in Bratislava, National Institute of Children’s Diseases, Slovakia


Background. Appendicitis is one of the most common diagnoses in pediatric populations. Although new recommendations for the treatment of pediatric appendicitis were published, management varies among different institutions.
Objectives. To determine current practices in 4 (n = 4) representative pediatric surgical departments in Central Europe.
Material and Methods. One department from each of the 4 countries was surveyed using an online questionnaire. Questions focused on preoperative, operative and postoperative practices in 2018, particularly those related to antibiotic (ATB) therapy and laparoscopy.
Results. A total of 519 appendectomies were performed, among which 413 (79.6%) were laparoscopic appendectomies (LAs), with a conversion rate of 5.1%. Appendectomy, as an elective procedure, was performed in 43 (8.3%) patients. One-quarter (129 patients) had complex appendicitis and 72.3% of these were operated laparoscopically. In 3 departments, ATB prophylaxis was administered, based on the decisions of the operating surgeon. One department used standard ATB prophylaxis (metronidazole). Whenever phlegmonous appendicitis was detected, ATB were administered therapeutically in 2 departments. Two other departments administered ATB based on surgeon decision. The choice of ATB was not standardized. If complex appendicitis was detected, all sites administered ATB therapeutically. The type of ATB treatment was standardized in complex cases in 2 departments. Thirty-four complications (6.6%) at surgical sites were recorded – 4.1% (16/390) after uncomplicated and 14% (18/129) after complex appendicitis. Thirty-two occurred after acute surgeries and 26 of these followed laparoscopic procedures. Postoperatively, intra-abdominal abscesses occurred in 3.5% of laparoscopic and in 2.9% of open appendectomy (OA) cases.
Conclusion. This questionnaire study showed that treatment outcomes for appendicitis in children in Central Europe are comparable with data reported in the literature. Laparoscopic appendectomy is the predominant surgical method, but there is a little consensus for ATB treatment in the management of appendicitis at our 4 pediatric surgical departments.

Key words

pediatric surgery, antibiotics, laparoscopy, appendectomy, postoperative complications

References (23)

  1. Wan MJ, Murray K, Ungar WJ, et al. Acute appendicitis in young children: Cost-effectiveness of US versus CT in diagnosis. A Markov decision analytic model. Radiology. 2009;250(2):378–386. doi:10.1148/radiol. 2502080100
  2. Buckius MT, McGrath B, Monk J, et al. Changing epidemiology of acute appendicitis in the United States: Study period 1993–2008. J Surg Res. 2012;175(2):185–190. doi:10.1016/j.jss.2011.07.017
  3. McBurney C. The incision made in the abdominal wall in cases of appendicitis, with a description of new method of operating. Ann Surg. 1894;20:38–43. doi:10.1097/00000658-189407000-00004
  4. Shawyer AC, Hatchell AC, Pemberton J, et al. Compliance with published recommendations for postoperative antibiotic management of children with appendicitis: A chart audit. J Pediatr Surg. 2015;50(5);783–785. doi:10.1016/j.jpedsurg.2015.02.040
  5. Fraser JD, Aguayo P, Leys CM, et al. A complete course of intravenous antibiotics vs a combination of intravenous and oral antibiotics for perforated appendicitis in children: A prospective, randomized trial. J Pediatr Surg. 2010;45(6):1198–1202. doi:10.1016/j.jpedsurg.2010.02.090
  6. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: An American pediatric surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg. 2010;45(11):2181–2185. doi:10.1016/j.jpedsurg.2010.06.038
  7. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001439.pub2
  8. Zani A, Hall N, Rahman A, et al. European Paediatric Surgeons’ Association Survey on the management of pediatric appendicitis. Eur J Pediatr Surg. 2019;29(01):53–61. doi:10.1055/s-0038-1668139
  9. OECD/EU (2018), Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris.
  10. Ure BM, Spangenberger W, Hebebrand D, et al. Laparoscopic surgery in children and adolescents with suspected appendicitis: Results of medical technology assessment. Eur J Pediatr Surg. 1992;2(6):336–340.
  11. Masoomi H, Mills S, Dolich MO, et al. Comparison of outcomes of laparoscopic versus open appendectomy in children: Data from the Nationwide Inpatient Sample (NIS), 2006–2008. World J Surg. 2012;36(3):573–578.
  12. Jaschinski T, Mosch ChG, Eikermann M, et al. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001546.pub4
  13. Esposito C, Calvo AI, Castagnetti M, et al. Open versus laparoscopic appendectomy in the pediatric population: A literature review and analysis of complications. J Laparoendosc Adv Surg Tech A. 2012;22(8):834–839.
  14. Chandler NM, Ghazarian SR, King TM, et al. Cosmetic outcomes following appendectomy in children: A comparison of surgical techniques. J Laparoendosc Adv Surg Tech A. 2014;24(8):584–588.
  15. Ameer A, Dhillon S, Peters M, et al. Systematic literature review of hospital medication administration errors in children. Integr Pharm Res Pract. doi:10.2147/IPRP.S54998
  16. Lee SL, Islam S, Cassidy LD, et al. Antibiotics and appendicitis in the pediatric population: An American Pediatric Surgical Association outcomes and clinical trials committee systematic review. J Pediatr Surg. 2010;45(11):2181–2185. doi:10.1016/j.jpedsurg.2010.06.038
  17. Peter ST, Shawn D, Kuojen T, et al. Single daily dosing ceftriaxone and metronidazole vs standard triple antibiotic regimen for perforated appendicitis in children: A prospective randomized trial. J Pediatr Surg. 2008;43(6):981–985. doi:10.1016/j.jpedsurg.2008.02.018
  18. Dreznik Y, Feigin E, Samuk I, et al. Dual versus triple antibiotics regimen in children with perforated acute appendicitis. Eur J Pediatr Surg. 2018;28(06):491–494. doi:10.1055/s-0037-1606847
  19. Dai L, Shuai J. Laparoscopic versus open appendectomy in adults and children: A meta-analysis of randomized controlled trials. United European Gastroenterol J. 2016;5(4):542–553. doi:10.1177/2050640616661931
  20. Markar SR, Blackburn S, Cobb R, et al. Laparoscopic versus open appendectomy for complicated and uncomplicated appendicitis in children. J Gastrointest Surg. 2012;16(10):1993–2004. doi:10.1007/s11605-012-1962-y
  21. Nataraja RM, Teague WJ, Galea J, et al. Comparison of intraabdominal abscess formation after laparoscopic and open appendicectomies in children. J Pediatr Surg. 2012;47(2):317–321. doi:10.1016/j.jpedsurg.2011.11.023
  22. Vahdad MR, Troebs RB, Nissen M, et al. Laparoscopic appendectomy for perforated appendicitis in children has complication rates comparable with those of open appendectomy. J Pediatr Surg. 2013;48(3):555–561. doi:10.1016/j.jpedsurg.2012.07.066
  23. Chang HK, Han SJ, Choi SH, et al. Feasibility of a laparoscopic approach for generalized peritonitis from perforated appendicitis in children. Yonsei Med J. 2013;54(6):1478–1483. doi:10.3349/ymj.2013.54.6.14