Study Supports Immediate Surgery for Kids With a Ruptured Appendix

About 80,000 children in the U.S. undergo appendectomies each year, making the procedure the most common emergency operation in kids. Still, in the 100 or so years the surgery has been performed, there has been little rigorous scientific research to guide its use, The Wall Street Journal reported Tuesday.

Now, a new study looks at two competing surgical approaches to treating the most dangerous form of appendicitis, when a child arrives at the emergency room with an appendix that has already ruptured, which happens about 30 percent of the time. When the appendix bursts, it spills its contents, loaded with toxic bacteria, into the abdominal cavity, potentially leading to systemic infections such as sepsis and to the failure of kidneys and other organs.

For these patients, surgeons have been sharply divided for years on what course to take. Some doctors administer an antibiotic infusion followed by immediate surgery to remove the appendix. Others prefer initially to give antibiotics alone, and then wait six or more weeks to perform the appendectomy.

In the study, the immediate-surgery approach, which is the more traditional treatment, won out. Although both surgical approaches are effective, an immediate appendectomy was better for kids and their families, the researchers said. The approach allowed the child to return to routine activities, such as school and sports, nearly six days sooner, according to the study, published in the Archives of Surgery.

When the appendix ruptures and contaminates the surrounding area, abscesses can form nearby. Hefty doses of intravenous antibiotics are required to neutralize the bacteria while catheters and suction devices are used to drain the abscesses and remove toxic matter. A hospital stay typically lasts seven to 10 days. Some kids end up in the intensive-care unit.

But other doctors say that immediate surgery for a ruptured appendix could spread bacteria and other toxins around the abdomen and increase the risk of surgical-wound and other infections.

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