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Children with appendix benefit from early surgery

Early appendectomy is better for children with a perforated appendix than postponing the surgery.

Children with appendix benefit from early surgery

Early appendectomy is better for children with a perforated appendix than postponing the surgery.

Persistent localised abdominal pain, especially on the lower right side, requires an emergency visit to the doctor for possible appendicitis. The appendix typically perforates two to three days after the onset of abdominal pain, which is often at first in the mid abdomen and then moves to the right lower quadrant. The two commonly used surgical options for children with a perforated appendix are early appendectomy (surgical removal of the appendix within 24 hours of hospitalisation) and what's known as interval appendectomy (surgery done six to eight weeks after the initial diagnosis).

Researchers evaluated the outcomes of 131 patients younger than 18 years in America who were diagnosed with appendicitis with a perforated appendix between October 2006 and August 2009. They randomly assigned early appendectomy to 64 patients, while another 67 youngsters were randomly assigned to undergo interval appendectomy.

It was found that the average time away from normal activities was just under 14 days for early appendectomy, compared to more than 19 days for interval appendectomy. The overall adverse event rate was 30 percent for early appendectomy and 55 percent for interval appendectomy. Finally, the average total length of hospital stay was more than two days shorter for patients in the early appendectomy group.

It has been assumed that postponing surgery would allow contamination in the abdominal cavity to resolve, reducing the likelihood of infection. But the study found that early appendectomy was linked to fewer adverse events, such as surgical site infection, intra-abdominal abscess, and unplanned readmission to hospital. There could also be an added benefit for parents and children from an early surgery. Also, those treated with early appendectomy return to normal activities an average of five days earlier. Because a child's time away from normal activities limits parents' abilities to work, it is an important outcome from a patient as well as the family's perspective.
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