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Management of Perforated Appendicitis: Study Update | Cincinnati Children's
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Management of Perforated Appendicitis: Study Update | Cincinnati Children's

https://www.cincinnatichildrens.org Beth Rymeski, DO, Pediatric Surgeon: Hi, I’m Beth Rymeski one of the pediatric surgeons at Cincinnati Children’s. The topic of this video today is the management of perforated appendicitis. You may have noticed that there seems to be a practice change over the years. With historically patients being treated with prolonged antibiotics and delayed surgery. Whereas now the pendulum has swung almost completely in the other direction with most patients receiving immediate surgery. We’re going to review the data that led to that practice change and give you a quick update on how we treat this at Cincinnati Children’s. The two studies that really looked at this were both published in 2010 from the pediatric surgeons in Kansas City. The first study really was to demonstrate safety of early surgery and perforated appendicitis. Previously, early surgery was not offered to patients with perforation and abscess because surgeons felt that the patient would be at a higher risk for complications. Complications like fistula formation and unnecessary colectomies. What the group in Kansas city found was that there actually was no difference in the patients and that It was safe and effective to provide early appendectomy. The second study also published in the same year by the same group looked at prolonged IV antibiotics versus early conversion to oral antibiotics in patients with perforated appendicitis. They took about 100 patients and randomized them into two different arms. The IV antibiotics group had a mandated 5 day in patient hospital stay for IV antibiotics. At the end of that 5 days they had a clinical revaluation including labs to determine if further antibiotics were needed. In the early oral antibiotics group they switched to oral antibiotics as soon as they were able to tolerate a diet. So no surprise there they found that the patients who took oral antibiotics earlier, went home earlier. Probably the most important thing that came out of this study though, is that the abscess rate in these patients was exactly the same. So it was about 19-20 percent and it didn’t matter if you were on prolonged or if you were on the oral conversion early. Here at Cincinnati Children’s, we use that data to guide our management of perforated appendicitis. Almost all patients with perforated appendicitis will be taken immediately to the operating room for an appendectomy. A small number of patients who present with a well-formed abscess in certain situations may be offered drainage with the late appendectomy however that number is a handful a year. All patients after surgery for perforated appendicitis will be placed on IV antibiotics. We then use completely clinical criteria to determine the length and need of those antibiotics. For some patients, it’s 24 hours and other patients it can be 7 days. So we look at things like fever, abdominal pain, tolerance of diet to determine when a patient is well enough to go home. When we feel they’re well enough to go home we reassess with lab work to determine if more antibiotics are needed or if they’re done and can just leave. For more information please contact the Department of General and Thoracic Surgery at Cincinnati Children’s.

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