Proper Pre-Operative Observation Time reduces the Incidence of Unnecessary Appendectomy in Managing Suspected Acute Appendicitis in Children
Osama Ismail Al-Mashhadany,, Al_Ani, Muataz; Alikhan Safira,, Qassid Layth ; Al-Kzayer Lika’a
1029
ABSTRACT
Aim: To evaluate the
effectiveness of routine preoperative medical management in patients with
suspected appendicitis in our institution.
Methods: A Descriptive study
design; a prospective study was performed during the period from June 2016 to
June 2018, at the Pediatric Surgery Center in City of Mosul, Iraq. 160 patients
admitted at the pediatric surgery center in Al-Khansaa teaching hospital with
initial diagnoses of acute appendicitis. In this descriptive study, patient
age, gender, chief complaint and duration, signs, and symptoms recorded. White
blood cell counts and U/S tests are done. All patients observed for 16-24
hours. Then, those patients diagnosed with appendicitis requiring surgery were
managed by either open or laparoscopic operation. Post-operative complications
were recorded.
Results: After 16-24 hours of observation with
antibiotic cover and IV fluid use, 49 patients were excluded due to improvement
of abdominal pain, discharged home within 48 hours on oral antibiotics for 7-10
days, and followed for 6-12 months three of the 49(6%) excluded patients who
underwent appendectomy within the follow-up period. Furthermore, 30% of
included patients improved on conservative measures, and 111 underwent surgery.
In (65 percent) patients without treatment failure or recurrence throughout the
follow-up period of 6 months, conservative treatment has been successful.
Conclusions: The current study concluded that the use of
antibiotics in the treatment of acute appendicitis without complications could
reduce the financial costs and human resources needed for surgical
intervention.
Keywords: Acute appendicitis,
laparoscopic appendectomy, pre-operative observation
ABSTRACT
Aim: To evaluate the
effectiveness of routine preoperative medical management in patients with
suspected appendicitis in our institution.
Methods: A Descriptive study
design; a prospective study was performed during the period from June 2016 to
June 2018, at the Pediatric Surgery Center in City of Mosul, Iraq. 160 patients
admitted at the pediatric surgery center in Al-Khansaa teaching hospital with
initial diagnoses of acute appendicitis. In this descriptive study, patient
age, gender, chief complaint and duration, signs, and symptoms recorded. White
blood cell counts and U/S tests are done. All patients observed for 16-24
hours. Then, those patients diagnosed with appendicitis requiring surgery were
managed by either open or laparoscopic operation. Post-operative complications
were recorded.
Results: After 16-24 hours of observation with
antibiotic cover and IV fluid use, 49 patients were excluded due to improvement
of abdominal pain, discharged home within 48 hours on oral antibiotics for 7-10
days, and followed for 6-12 months three of the 49(6%) excluded patients who
underwent appendectomy within the follow-up period. Furthermore, 30% of
included patients improved on conservative measures, and 111 underwent surgery.
In (65 percent) patients without treatment failure or recurrence throughout the
follow-up period of 6 months, conservative treatment has been successful.
Conclusions: The current study concluded that the use of
antibiotics in the treatment of acute appendicitis without complications could
reduce the financial costs and human resources needed for surgical
intervention.