Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
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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

Abstract

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

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