Interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates?
BACKGROUND: The need for interval appendectomy after nonoperative management of a perforated appendicitis is being questioned owing to recent studies that estimated recurrence rates as low as 5% because of obliteration of the appendiceal lumen. We review our experience with interval appendectomy in this subset of patients to determine the postoperative outcomes and luminal patency rates.
METHODS: A retrospective review was conducted of all children treated nonoperatively for a perforated appendicitis followed by elective interval appendectomy during the past 10 years. The data collected included initial hospitalization, convalescence period, perioperative course, and luminal patency rates.
RESULTS: A total of 128 patients were identified, of whom 55% were male. Their mean ± SD age was 9.1 ± 4.2 years. The mean interval from the initial presentation to appendectomy was 65.9 ± 20.3 d. All but 2 of the patients underwent laparoscopic appendectomy with 3 conversions to open surgery. The mean operative time was 43.6 ± 19.2 min. The complication rate was 9%, including 1 postoperative abscess, 1 reoperation for bleeding, and 1 readmission for Clostridium difficile infection. Six patients had a superficial wound infection, and 2 patients underwent outpatient procedures for suture granuloma. No risk factors for complications were identified. Of the specimens, 16% had obliterated lumens.
CONCLUSIONS: Major postoperative morbidity for interval appendectomy after a perforated appendicitis is low and should not be a deterrent in offering interval appendectomy to this subset of patients.
The Journal of surgical research
Adolescent; Appendectomy; Appendicitis; Appendix; Child; Child, Preschool; Contraindications; Female; Humans; Male; Missouri; Postoperative Complications; Retrospective Studies
Iqbal, C. W., Knott, E. M., Mortellaro, V. E., Fitzgerald, K. M., Sharp, S. W., St Peter, S. D. Interval appendectomy after perforated appendicitis: what are the operative risks and luminal patency rates? The Journal of surgical research 177, 127-130 (2012).