Early appendectomy is the best treatment for perforated appendicitis in children.
Performing an early appendectomy in children with a diagnosis of "perforated appendicitis" can significantly reduce the time it takes for the patient to resume daily activities and is accompanied by fewer adverse events.
Despite the fact that perforated appendicitis in children is quite common, a unified approach to its treatment has not yet been developed. Only a small number of studies have compared the most common treatment approaches. Currently, early appendectomy is a recognized treatment for acute perforated appendicitis. At the same time, the question of surgical tactics in the case of a patient with perforated appendicitis remains unresolved due to the large number of conflicting opinions. Most often, an early and delayed appendectomy is used to treat perforated appendicitis in children.
Unfortunately, in the literature, there are no published results from a large randomized study in which a detailed comparison of the presented treatment approaches was performed. An early appendectomy involves performing an operation during the first 24 hours after hospitalization, delayed 6 to 8 weeks after diagnosis, when the patient resumes their usual lifestyle.
Regardless of the time of operation, in both cases it is mandatory to carry out an infusion and antibacterial treatment with the inclusion of broad-spectrum drugs.
Theoretically, in the case of a delayed appendectomy, the probability of developing intra and postoperative complications is much lower, because it is only carried out if the peritoneal contamination is completely resolved.
To compare these methods of surgical treatment, a study at the University of Memphis Research Center (Tennessee, USA) included patients under 18 diagnosed with perforated appendicitis (n = 131), who were randomly allocated for emergency surgery (n = 64) or delayed appendectomy (n = 67).
Compared to a delayed appendectomy, an early appendectomy was accompanied by a significant reduction in the time required to resume normal life on average by 5 days (13.8 days vs 19.4 days, p less than 0.001). Adverse events (AEs) were observed in 30% of patients who underwent early appendectomy; in the case of delayed surgery, AEs were recorded in 55% of patients (relative risk 1.86; 95% confidence interval, 1.21-2.87; p = 0.003).
Of the patients who planned a delayed appendectomy, 23 children (34%) had to undergo surgery earlier than expected because of a lack of positive dynamics in the condition (n = 17), a relapse of the appendicitis (n = 5) or for some other reason (n = 1).
Thus, an early appendectomy greatly reduces the time required to restore normal activity. In addition, the incidence of adverse events was significantly lower when using early appendectomy.
With only a small amount of information, the research team suggested that early appendectomy is more preferable, although surgery during the acute phase of the disease is associated with certain difficulties. However, the duration of the operation in the event of an early and delayed appendectomy was practically the same (113 minutes and 112 minutes respectively). Intraoperative complications were also rare.
The limitations of this study were the characteristics of its design (the study was carried out in a single center) and the absence of a standardized method to determine the period of time necessary to bring the patient back to daily life.