Loret-de-Mola-Pino ER, Castelló-González M, Hernández-Moore E, Aguilar-Atanay D

Language: Spanish
References: 31
Page: 435-4444
PDF size: 619.48 Kb.

ABSTRACT

Background: complicated acute appendicitis is the first cause of secondary peritonitis in the pediatric age.
Objective: to characterize patients treated for complicated acute appendicitis.
Methods: a descriptive, cross-sectional study was performed in patients treated for complicated acute appendicitis. The universe consisted of 166 patients and all were included in the study. The variables used were: age, sex, surgical access route (open or laparoscopic), intraoperative findings, including the stage of the disease and the position of the cecal appendix; used antimicrobial agents, hospital stay and complications.
Results: most of the patients were between 10 to 14 years old, and more than a half were male. Most of appendectomies were performed by an open technique. The most frequent position of the cecal appendix was posterior mesoceliac, and in more than a half of the patients the organ was perforated. The most used antimicrobial therapy included ceftriaxone, amikacin and metronidazole. The hospital stay rated from 4 to 6 days in most of the cases. The most frequent postoperative complication was surgical wound infection.
Conclusions: male patients, between 10 and 14 years old were more frequent. The cecal appendix was mainly found perforated and in posterior mesoceliac position. With the surgical and antimicrobial treatment used, the hospital stay was short, with few complications, among which the surgical wound infection was the most frequent. The results in the few patients treated by minimal access surgery suggest that this approach may be extended in children with complicated appendicitis.

REFERENCES

1. Serres SK, Cameron DB, Glass CC, Graham DA, Zurakowski D, Anandalwar SP, et al. Time to appendectomy and risk of complicated appendicitis and adverse outcomes in children. JAMA Pediatr. 2017 Ago;171(8):740-6.

2. Rentea RM, St Peter SD, Snyder CL. Pediatric appendicitis: state of the art review. Pediatr Surg Int. 2017 Mar;33(3):269-83.

3. Vialat Soto V, Mena Miranda VR, Labrada Arjona E, Manresa Gómez D. Guías de Buenas Prácticas Clínicas. Peritonitis en el niño. Medisur. 2005;3(5):87-91.

4. Bhangu A, Soreide K, Saverio S, Assarsson J, Drake F. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015 Sep;386(10000):1278-87.

5. Ali R, Anwar M, Akhtar J. Laparoscopic versus open appendectomy in children: a randomized control trial from a developing country. J Pediatr Surg. 2018 Feb;53(2):247-9.

6. St Peter SD, Sharp SW, Holcomb GW, Ostlie DJ. An evidence based definition for perforated appendicitis derived from a prospective randomized trial. J Pediatr Surg. 2008 Dic;43(12):2242-5.

7. Emil S, Gaied F, Lo A, Laberge JM, Puligandla P, Shaw K, et al. Gangrenous appendicitis in children: a prospective evaluation of definition, bacteriology, histopathology and outcomes. J Surg Res. 2012 Sep;177(1):123-6.

8. Bueno Rodríguez JC, Hernández Moore E, Aguilar Atanay D, Castelló González M, Castro Guevara JE, Piovet Dorta Y. Tratamiento antimicrobiano secuencial en la apendicitis aguda complicada. Cir Cir. 2012 May-Jun;80(3):233-8.

9. Bonadio W, Peloquin P, Brazg J, Scheinbach I, Saunders J, Okpalaji C, et al. Appendicitis in preschool aged children: Regression analysis of factors associated with perforation outcome. J Pediatr Surg. 2015 Sep;50(9):1569-73.

10. Sullins VF, Lee SL. Appendicitis. En: Holcomb GW, Murphy JP, Ostlie DJ, editors. Ashcraft’s Pediatric Surgery. 6th ed. Londres: Saunders; 2014.p.568-79.

11. Van der Boom AL, Gorter RR, van Haard PM, Doornebosch PG, Heij HA, Dawson I. The impact of disease severity, age and surgical approach on the outcome of acute appendicitis in children. Pediatr Surg Int. 2015 Abr;31(4):339-45.

12. Salö M, Ohlsson B, Arnbjörnsson E, Stenström A. Appendicitis in children from a gender perspec-tive. Pediatr Surg Int. 2015 Sep;31(9):845-53.

13. Hamill JK, Hill AG. A history of the treatment of appendicitis in children: lessons learned. ANZ J Surg. 2016 Oct;86(10):762-7.

14. Canavosso L, Carena P, Carbonell J, Monjo L, Zuñiga C, Sánchez M, et al. Dolor en fosa ilíaca derecha y Score de Alvarado. Cir Esp. 2008 May;83(5):243-7.

15. Antoniou SA, Antoniou GA, Antoniou AI, Granderath FA. Past, present and future of minimally invasive abdominal surgery. JSLS [Internet]. 2015 Jul-Sep [citado 31 Mar 2018]; 19(3): [aprox. 5 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589904/pdf/e2015.00052.pdf

16. Svensson JF, Patkova B, Almströmab M, Eaton S, Westerab T. Outcome after introduction of laparoscopic appendectomy in children: A cohort study. J Pediatr Surg. 2016 Mar;51(3):449-53.

17. Tashiro J, Einstein SA, Perez EA, Bronson SN, Lasko DS, Sola SE. Hospital preference of laparoscopic versus open appendectomy: Effects on outcomes in simple and complicated appendici-tis. J Pediatr Surg. 2016 May;51(5):804-9.

18. Cheong L, Emil S. Pediatric laparoscopic appendectomy: a population-based study of trends, as-sociations, and outcomes. J Pediatr Surg. 2014 Dic;49:1714–8.

19. Shun Z, Tao D, Xiaohua J, Chun S. Laparoscopic appendectomy in children with perforated ap-pendicitis: A meta-analysis. Surg Laparosc Endosc Percutan Tech. 2017 Ago;27(4):262-6.

20. Shen GK, Wong R, Daller J, Melcer S, Tsen A, Awtrey S, et al. Does the retrocecal position of the vermiform appendix alter the clinical course of acute appendicitis? A prospective analysis. Arch Surg. 1991 May;126(5):569-70.

21. ChanW, Cheng N, Cheng K, Cheung K, Cheung M, Huen K. Does appendix position affect the clinical outcome of acute appendicitis? Sur Pract. 2002 Nov;6(4):109-12.

22. Fallon S, Kim M, Hallmark CH, Carpenter J, Eldin K, Lopeza M, et al. Correlating surgical and pathological diagnoses in pediatric appendicitis. J Pediatr Surg. 2015 Abr;50(4):638-41.

23. Lee SL, Islam S, Cassidy LD, Abdullah F, Arca MJ. Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee Systematic Review. J Pediatr Surg. 2010 Nov;45(11):2181-5.

24. Obinna OA, Barnaby K, Dobies J, Comerford M, Drill A, Walker N, et al. Postoperative antibiotic therapy for children with perforated appendicitis: long course of intravenous antibiotics versus early conversion to an oral regimen. Am J Surg. 2008 Feb;195(2):141-3.

25. Holcomb GW, St Peter SD. Current management of complicated appendicitis in children. Eur J Pediatr Surg. 2012 Jun;22(3):207–12.

26. Fraser JD, Aguayo P, Leys CM, Keckler SJ, Newland JG, Sharp SW, et al. A complete course of intravenous antibiotics versus a combination of intravenous and oral antibiotic for perforated appen-dicitis in children: a prospective randomized trial. J Pediatr Surg. 2010 Jun;45(6):1198-1202.

27. Whisker L, Luke D, Hendrickse CH, Bowley D, Lander A. Appendicitis in children: a comparative study between a specialist paediatric centre and a district general hospital. J Pediatr Surg. 2009 Feb;44(2):362–7.

28. Svensson JF, Patkova B, Almström M, Eaton S, Wester T. Outcome after introduction of laparo-scopic appendectomy in children: A cohort study. J Pediatr Surg. 2016 Mar;51(3):449–53.

29. Lin YM, Hsieh CH, Cheng CI, Tan BL, Liu HT. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications. Asian J Surg. 2012 Jul;35(3):113-6.

30. Shimizu T, Ishizuka M, Kubota K. A lower neutrophil to lymphocyte ratio is closely associated with catarrhal appendicitis versus severe appendicitis. Surg Today. 2016 Jan;46(1):84-9.

31. Boomer L, Cooper J, Deans K, Minneci K, Leonhart K, Diefenbach K, et al. Does delay in appen-dectomy affect surgical site infection in children with appendicitis? J Pediatr Surg. 2014 Jun;49(6):1026-9.