INTERVAL APPENDECTOMY IN PERFORATED APPENDICITIS

The treatment of the perforated appendix remains controversial, with t he optimal timing of surgical intervention unclear. Previous studies h ave documented an increase in both minor and major complication rates in patients undergoing appendectomy for perforated appendicitis. We so ught to evaluate the nonoperative therapy of perforated appendicitis f ollowed by interval appendectomy. The charts of all children undergoin g admission for appendicitis during a 10-year period (n = 480) were re viewed. Data were abstracted regarding patient presentation, laborator y and radiologic findings, operative and pathology reports, and postop erative course in those patients with perforated appendicitis (n = 104 ). Comparisons were made between patients undergoing primary appendect omy for perforated appendicitis (n = 87) and those treated with IV ant ibiotics and hydration and then scheduled for interval appendectomy 4 to 6 weeks following the acute event (n = 17). Treatment assignment wa s determined by the attending pediatric surgeon in a non-randomized fa shion. No significant differences were seen between these two groups i n days of antibiotic treatment, nasogastric decompression, and IV hydr ation. Additionally, total hospital days and cost did not differ signi ficantly between the two groups (primary = 10.3 days and $10,550; inte rval = 13.3 days and $13,221, P = 0.11 and 0.21, respectively). The ov erall complication rates, 12.6% in the primary group and 5.9% in the i nterval group, also did not differ significantly, while the major comp lication rate (wound dehiscence, abscess, and small-bowel obstruction) , 10% versus 0%, was significantly higher in the primary group as comp ared with the interval group. Our data demonstrate no significant disa dvantage, and possibly an improvement in the major complication rate, with nonoperative treatment of perforated appendicitis followed by int erval appendectomy. We suggest that this treatment modality should be considered when evaluating the child with perforated appendicitis.