Interval appendectomy in perforated appendicitis

Abstract

The treatment of the perforated appendix remains controversial, with the optimal timing of surgical intervention unclear. Previous studies have documented an increase in both minor and major complication rates in patients undergoing appendectomy for perforated appendicitis. We sought to evaluate the nonoperative therapy of perforated appendicitis followed by interval appendectomy. The charts of all children undergoing admission for appendicitis during a 10-year period (n = 480) were reviewed. Data were abstracted regarding patient presentation, laboratory and radiologic findings, operative and pathology reports, and postoperative course in those patients with perforated appendicitis (n = 104). Comparisons were made between patients undergoing primary appendectomy for perforated appendicitis (n = 87) and those treated with IV antibiotics and hydration and then scheduled for interval appendectomy 4 to 6 weeks following the acute event (n = 17). Treatment assignment was determined by the attending pediatric surgeon in a non-randomized fashion. No significant differences were seen between these two groups in days of antibiotic treatment, nasogastric decompression, and IV hydration. Additionally, total hospital days and cost did not differ significantly between the two groups (primary = 10.3 days and $10,550; interval = 13.3 days and $13,221, P = 0.11 and 0.21, respectively). The overall complication rates, 12.6% in the primary group and 5.9% in the interval group, also did not differ significantly, while the major complication rate (wound dehiscence, abscess, and small-bowel obstruction), 10% versus 0%, was significantly higher in the primary group as compared with the interval group. Our data demonstrate no significant disadvantage, and possibly an improvement in the major complication rate, with nonoperative treatment of perforated appendicitis followed by interval appendectomy. We suggest that this treatment modality should be considered when evaluating the child with perforated appendicitis.