Appendicitis
Everything in the library about appendicitis — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
5 items
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
Listen →
Audio Journal with Dr. Von Allmen about usingCorticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb aboutsurgical site infections (SSI) are an important source of morbidity and mortality.andfeasibility and safety o
podcast44:19 · Jan 2019
Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2
Watch →
Drs. Todd Ponsky, Alex Casar, Alex Gibbons, and Rae Hanke review 2018 Practice Gap #2: Wilms Tumor Protocol Violations, as identified by the APSA Professional Development Committee.
video1:21 · Jun 2019
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
Listen →
Audio Journal with Dr. Von Allmen about using Corticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb about surgical site infections (SSI) are an important source of morbidity and mortality. and feasibility and safe
podcast44:19 · Dec 2020
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
Watch →
In this session, Dr. Jose Campos leads us through the top publications that are not in the Journal of Pediatric Surgery.
Articles referenced:
1. IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children T
video27:50 · Sep 2022
Quick Literature Updates Episode 11
Watch →
We’re back with eleventh episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. This episode, we will review three articles covering the mo
video · Jul 2023
In-Depth Reviews
2 items
Hirschsprung Disease Part I with Marc Levitt
Listen →
Podcast discussion with Dr. Marc Levitt on Hirschsprung disease management, preceded by clinical updates on appendicitis treatment including same-day discharge protocols and antibiotic regimens. Features listener Q&A addressing negative app
podcast59:20 · Jan 2019
Hirschsprung Disease Part I with Marc Levitt
Listen →
Dr. Marc Levitt and Dr. Todd Ponsky discuss Hirschsprung disease.Dr. Ponsky: Welcome to "Stay Current” in pediatric surgery, I’m Todd Ponsky, a pediatric surgeon at Akron Children’s Hospital and today we’re going to be focusing on Hirschspr
podcast59:20 · Dec 2020
Summaries and takeaways+ Show
The doctors in this collection+ Show
All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2
Non-operative management of perforated appendicitis has been known for a long time.
clinical0:19 ↗
Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management.
clinical0:19 ↗
There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management.
clinical0:35 ↗
Non-operative management resulted in decreased hospital stays compared to operative management.
clinical0:35 ↗
Non-operative management resulted in decreased days of disability compared to operative management.
clinical0:35 ↗
Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account.
guideline0:52 ↗
APSA was not making a flat out recommendation to start doing non-operative appendicitis.
opinionGibbons1:08 ↗
The data on non-operative appendicitis management is becoming more clear.
opinionGibbons1:14 ↗
The choice between operative and non-operative appendicitis management remains dealer's choice.
opinionGibbons1:06 ↗
Hirschsprung Disease Part I with Marc Levitt
The best treatment for Hirschsprung disease is irrigations using a large bore tube (20 French Foley) with warm saline, instilling 10-20 cc aliquots at a time and allowing fluid mixed with stool to drain back.
clinicalMarc Levitt8:43 ↗
It is very rare that Hirschsprung disease is a surgical emergency, but if you don't irrigate and overcome the distal obstruction, it will become an emergency.
clinicalMarc Levitt8:55 ↗
For rectal biopsy in suspected Hirschsprung disease, you must be at least 1 centimeter in from the dentate line. If you biopsy too close to the dentate line, everyone has an aganglionic segment there and you could get the wrong answer.
clinicalMarc Levitt12:38 ↗
The pathologist must report both the absence of ganglion cells AND the presence of hypertrophic nerves. The absence of ganglion cells alone is not Hirschsprung disease - that could be a biopsy taken too low.
clinicalMarc Levitt13:23 ↗
Hirschsprung disease has an immune component and the lining of the bowel (mucosa) is much more susceptible to bacterial translocation. Stasis in a Hirschsprung patient leads to bacterial translocation and a very sick baby from bacteremia.
clinicalMarc Levitt14:59 ↗
If irrigations are not working and the baby is ill, you need to divert. The recommendation is to divert in the ileum rather than doing a leveling colostomy, because frozen section can be inaccurate, particularly as you move higher in the colon.
clinicalMarc Levitt15:42 ↗
The Swenson operation involved full-thickness transabdominal dissection down below the peritoneal reflection. The operation was often done incorrectly with perirectal dissection done too wide, leading to fecal incontinence, urinary incontinence, sexual problems, and impotence.
clinicalMarc Levitt18:14 ↗
The Suave operation used a mucosal dissection to keep the outer rectal wall intact and avoid injury. The original Suave would leave the colon coming through the anus for a week before doing the coloanal anastomosis; Dr. Scott Boley modified it to do everything in one stage.
clinicalMarc Levitt19:28 ↗
The Duhamel operation leaves the original rectum in place, removes the aganglionic portion from the peritoneal reflection, and pulls ganglionic bowel in a retrorectal position, connecting the two lumens with a stapler.
clinicalMarc Levitt20:18 ↗
Of the four classic procedures (Swenson, Suave, Duhamel, Rabine), only the Swenson actually leaves behind virtually no Hirschsprung tissue. The others leave behind outer rectal wall or original rectum. Many patients did well despite this because ganglionic bowel, if it's good, can overcome a lot.
clinicalMarc Levitt21:18 ↗
Dr. Henrys in the Philippines pioneered primary pull-through operations (without initial colostomy) out of necessity because patients would never return to clinic due to social stigma against colostomies.
clinicalMarc Levitt22:19 ↗
Keith Jorgeson applied laparoscopic skills to Hirschsprung disease, doing the colonic work laparoscopically with a Suave dissection from above. Luis de la Torre and Jack Langer developed the transanal approach, starting the dissection from below.
clinicalMarc Levitt23:21 ↗
The current preferred approach is a transanal Swenson (full-thickness dissection). It is the purest operation, leaving behind no Hirschsprung except the very bottom just above the dentate line. If you find the right plane, it's elegant and bloodless.
opinionMarc Levitt25:34 ↗
Dr. Orvar Swenson, who recently died at age 105, maintained that the Swenson operation was good all along and people just weren't doing it right, which gave it a bad reputation.
clinicalMarc Levitt26:23 ↗
Even Suave enthusiasts are making shorter and shorter cuffs over time. Jorgeson's original laparoscopic Suave recommended a 5 cm cuff; nowadays Langer and de la Torre do 1-1.5 cm cuffs, essentially approaching a Swenson.
clinicalMarc Levitt27:06 ↗
Laparoscopy is appropriate for all cases to find the transition zone level. A transanal-only approach is only appropriate when you have a very reachable, obvious transition zone at mid-sigmoid that you can comfortably reach transanally.
opinionMarc Levitt28:50 ↗
There is significant morbidity from an overly aggressive transanal-only approach trying to reach the transition zone without going into the abdomen. If you're too aggressive transanally trying to visualize the dissection, you would have been better off with laparoscopic dissection.
clinicalMarc Levitt29:18 ↗
Total colonic Hirschsprung patients present differently: the diagnosis isn't made right away, the contrast study is not typical, and irrigations don't go well. These patients need laparoscopy first to find the biopsy location.
clinicalMarc Levitt31:18 ↗
The biggest technical problems are: (1) surgeons don't give themselves good exposure and start dissection too low, injuring or resecting the dentate line, or (2) they give very aggressive exposure and overstretch the sphincters.
clinicalMarc Levitt34:09 ↗
Proper technique requires marking 1 cm proximal to the dentate line with a purple mark and placing 5-0 silk stitches circumferentially at that level. This preserves the anal canal, dentate line, plus an additional 1 cm of columnar epithelium before starting dissection.
clinicalMarc Levitt35:30 ↗
By definition, you're leaving behind 1 cm of columnar epithelium that is Hirschsprung disease, plus the internal sphincter which has a problem with relaxation. However, good ganglionic bowel is able to overcome that, and the baby eventually learns to relax the sphincter.
clinicalMarc Levitt36:39 ↗
What's new+ Show