Pathology findings following interval appendectomy: Should it stay or go?
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Read the article on jpedsurg.org ↗Article · May 2019 · 1 min read
In brief
In brief
This retrospective study of 149 pediatric patients found that all children who underwent interval appendectomy after nonoperative management of complicated appendicitis showed persistent inflammation on pathology, with 17% having appendicoliths and no neoplasms identified. The findings support interval appendectomy as appropriate treatment, with low complication rates (6%) and most procedures performed around 7-8 weeks after initial presentation.
Written by the GCMD Library team from the article.
Purpose
Interval appendectomy following nonoperative management of complicated appendicitis remains controversial. The aim of this study was to evaluate surgical pathology and clinical outcomes after pediatric interval appendectomy.
Methods
Pathology results from children with complicated appendicitis who underwent interval appendectomy at a single children's hospital from 2010 to 2017 were reviewed. The primary outcome was pathology results. Secondary outcomes included complications and readmission following initial treatment and after interval appendectomy.
Results
Among 149 patients (median age 11 years; range, 1–18), all had evidence of persistent inflammation on surgical pathology, 25 (17%) had an appendicolith, and no neoplasms were identified. Median duration of the initial admission was 8 days (range, 2–28) and 70% received a percutaneous drain prior to appendectomy. Interval appendectomy was performed at a median of 7.5 weeks (range, 2.9–29.1). Thirty-six (24%) returned to the hospital prior to their scheduled appendectomy and 6 (4%) required appendectomy earlier than planned. Nine patients (6%) experienced a complication following interval appendectomy, of which superficial surgical site infection was the most common (n = 4).
Conclusion
All children had evidence of ongoing inflammation on surgical pathology. While the clinical implications of persistent inflammation remain uncertain, these findings suggest that interval appendectomy is an appropriate treatment following medical management of complicated appendicitis in children.
Level of Evidence section
IV, Case series with no comparison groups.