# Perforated Appendicitis — GCMD Library living collection

Updated: n/a · 3 episodes · 21 cited statements

## Episodes
### Resources
- [Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462) — video · 1:21 · [machine version](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462.md)
- [Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819) — video · 27:50 · [machine version](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819.md)
- [Quick Literature Updates Episode 11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954.md)

## Chapters
- [0:04](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=4) Non-Operative Management of Appendicitis as 2018 Practice Gap #2 (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=0) Introduction and Antibiotic Selection for Perforated Appendicitis (Ep 2)
- [6:37](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=397) Discussion of Appendicitis Antibiotic Trial Results (Ep 2)
- [9:08](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=548) Surgical Management of Necrotizing Enterocolitis (Ep 2)
- [14:56](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=896) Gastrostomy Tube Placement Technique Selection (Ep 2)
- [21:13](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1273) Bariatric Surgery in Adolescents and Thyroid Cancer Management (Ep 2)
- [25:49](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1549) Closing Remarks and APSA Announcement (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=0) Introduction and Episode Overview (Ep 3)
- [0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46) Firearm vs Automobile Fatalities in Children (Ep 3)
- [2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131) Gabapentin for Pain Control After Appendectomy (Ep 3)
- [3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187) Periumbilical Hernia Risk After Gastroschisis Closure (Ep 3)
- [4:16](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=256) Closing Remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Non-operative management of perforated appendicitis has been known for a long time. (clinical) [Ep 1 · 0:19](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management. (clinical) [Ep 1 · 0:19](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management. (clinical) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management resulted in decreased hospital stays compared to operative management. (clinical) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management resulted in decreased days of disability compared to operative management. (clinical) [Ep 1 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account. (guideline) [Ep 1 · 0:52](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=52)
- APSA was not making a flat out recommendation to start doing non-operative appendicitis. — Gibbons (opinion) [Ep 1 · 1:08](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=68)
- The data on non-operative appendicitis management is becoming more clear. — Gibbons (opinion) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=74)
- The choice between operative and non-operative appendicitis management remains dealer's choice. — Gibbons (opinion) [Ep 1 · 1:06](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=66)
- The Chilean Society of Pediatric Surgery screens approximately 1,200 articles each month from non-pediatric surgical journals to identify the 3% relevant to pediatric surgery. — Jose Campos (clinical) [Ep 2 · 1:38](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=98)
- One participating hospital in the appendicitis antibiotic trial did not see a difference in abscess rates between the two antibiotic regimens in their cohort, while the overall study results were driven entirely by Phoenix Children's Hospital's experience. — Shawn St. Peter (clinical) [Ep 2 · 7:04](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=424)
- NSQIP-P national data shows no difference in abscess rates between ceftriaxone-metronidazole and piperacillin-tazobactam across much larger patient numbers. — Shawn St. Peter (epidemiological) [Ep 2 · 7:45](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=465)
- In the NEC trial, there was significant surgeon intention to treat, with most patients who received initial peritoneal drainage going to laparotomy shortly after drain placement. — Shawn St. Peter (clinical) [Ep 2 · 12:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=760)
- Peritoneal drainage for NEC often serves as a temporizing measure to stabilize septic patients before laparotomy rather than as definitive therapy. — Shawn St. Peter (opinion) [Ep 2 · 13:42](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=822)
- Peritoneal drainage started as a temporizing measure for NEC but morphed into a definitive management strategy in approximately 40-50% of surgeons' minds. (opinion) [Ep 2 · 14:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=850)
- The original description of percutaneous endoscopic gastrostomy (PEG) was done by Todd Ponsky Sr. — Jose Campos (clinical) [Ep 2 · 15:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=950)
- PEG tubes are difficult to change to button tubes, often requiring a second anesthetic with GI specialists to remove the PEG endoscopically before placing a button. — Meera Kotagal (clinical) [Ep 2 · 20:29](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1229)
- The article by Todd Ponsky Sr. and Mike Goddard on PEG tube placement remains the most cited article in the history of the Journal of Pediatric Surgery, with approximately three times the citations of the number two article. — Todd Ponsky (clinical) [Ep 2 · 17:36](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1056)
- The Teen Labs Consortium has been conducting NIH-funded prospective trials on bariatric surgery in adolescents since 2007. (clinical) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1450)
- Sleeve gastrectomy is a very safe operation in adolescents with good long-term data showing resolution of comorbidities, especially in pre-diabetic and diabetic patients. (clinical) [Ep 2 · 23:14](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1394)
- The average time pediatric patients spend in bariatric surgery programs before proceeding to surgery is approximately nine months. (clinical) [Ep 2 · 25:11](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1511)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A multi-institutional prospective randomized trial comparing piperacillin-tazobactam to ceftriaxone-metronidazole for perforated appendicitis was stopped at 75% enrollment when interim analysis favored the piperacillin-tazobactam group. — Jose Campos summarizing the discussion [Ep 2 · 4:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=280)
- Intra-abdominal abscess formation was significantly lower in the piperacillin-tazobactam group with an odds ratio of 4.8. — Jose Campos summarizing the discussion [Ep 2 · 5:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=330)
- The number needed to treat with piperacillin-tazobactam to prevent one intra-abdominal abscess was 5.7. — Jose Campos summarizing the discussion [Ep 2 · 5:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=350)
- Necrotizing enterocolitis treated surgically is associated with high mortality rates and poor neurodevelopmental outcomes. — Jose Campos summarizing the discussion [Ep 2 · 10:30](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=630)
- Two previous randomized controlled trials comparing surgical techniques for NEC both failed to enroll enough patients to answer the clinical question. — Jose Campos summarizing the discussion [Ep 2 · 10:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=650)
- A 20-center randomized controlled trial by Marty Blakely comparing initial laparotomy versus peritoneal drainage for NEC randomized 310 premature newborns. — Jose Campos summarizing the discussion [Ep 2 · 11:05](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=665)
- At 18 to 22 months of corrected age, the composite outcome of death and neurodevelopmental impairment was similar in both the laparotomy and peritoneal drainage groups in frequentist analysis. — Jose Campos summarizing the discussion [Ep 2 · 11:25](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=685)
- Bayesian analysis of the NEC trial showed a high probability of laparotomy being superior to peritoneal drainage. — Jose Campos summarizing the discussion [Ep 2 · 11:40](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=700)
- In the original papers by Ziggy Hein on peritoneal drainage for NEC, approximately one-third of patients died, one-third received laparotomy, and one-third were managed with drainage alone. — The host summarizing the discussion [Ep 2 · 13:51](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=831)
- A systematic review examining gastrostomy insertion techniques reviewed 900 publications, with 58 being used for final recommendations. — Jose Campos summarizing the discussion [Ep 2 · 18:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1100)
- Twelve studies directly compared outcomes between laparoscopic and percutaneous endoscopic gastrostomy, showing major complication rates were significantly less common with laparoscopic placement. — Jose Campos summarizing the discussion [Ep 2 · 18:50](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1130)
- The number needed to treat to prevent one major complication from PEG (by using laparoscopic approach instead) is 24. — Jose Campos summarizing the discussion [Ep 2 · 19:20](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1160)
- A database comparison of 3,000 patients with differentiated papillary thyroid cancer found no survival difference between total thyroidectomy and thyroid lobectomy. — Jose Campos summarizing the discussion [Ep 2 · 25:49](https://library.globalcastmd.com/watch/update-course-2022-top-publications-in-non-ped-surg-journals-jose-campos-5819?t=1549)
- Stevens et al. examined CDC Wonder database data between 1999 and 2020 for pediatric firearm and automobile fatalities. — Ellen Encisco summarizing a resource [Ep 3 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- Stevens et al. used the Gifford's Law Center annual gun law scorecard between 2014 and 2020 to assess state gun law scores. — Ellen Encisco summarizing a resource [Ep 3 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- In recent years, the fatality rate for firearms has surpassed the fatality rate for automobiles in children. — Ellen Encisco summarizing a resource [Ep 3 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- Stronger gun laws were associated with decreased fatality rates, with a 55% lower firearm fatality rate for states with the strongest gun laws compared to those with the weakest gun laws. — Ellen Encisco summarizing a resource [Ep 3 · 0:46](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=46)
- Gabapentin is an anticonvulsant often used off-label as part of multimodal pain control after major surgery. — Alex Halpern summarizing a resource [Ep 3 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- Lascano et al. performed a retrospective cohort study at Children's Hospital of LA looking at kids age 2 to 18 who underwent appendectomy for perforated appendicitis between 2014 and 2019. — Alex Halpern summarizing a resource [Ep 3 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- In the Lascano et al. study, kids who received gabapentin had decreased postoperative opioid use. — Alex Halpern summarizing a resource [Ep 3 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- In the Lascano et al. study, kids who received gabapentin had decreased postoperative length of stay. — Alex Halpern summarizing a resource [Ep 3 · 2:11](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=131)
- Frazier et al. conducted a retrospective study from the Midwest Pediatric Surgery Consortium following 375 patients with gastroschisis who underwent closure between 2013 and 2016. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- The overall rate for periumbilical hernias after gastroschisis closure was 22.7%. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Periumbilical hernia rate was significantly higher in patients who underwent primary closure versus those who needed silo placement. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Patients who underwent sutureless gastroschisis closures had 50% rates of persistent hernia. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Only 16.4% of patients who underwent sutured gastroschisis closure had a persistent hernia. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Spontaneous closure of periumbilical hernias after gastroschisis was seen in 38.8% of cases. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Only 31.8% of patients with periumbilical hernias after gastroschisis needed surgery. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)
- Sutureless gastroschisis closures lead to more periumbilical hernias, but they can be managed as any other congenital umbilical hernia and have no additional risk. — Cecilia Gigena summarizing a resource [Ep 3 · 3:07](https://library.globalcastmd.com/watch/quick-literature-updates-episode-11-6954?t=187)

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