Treatment of appendicitis in pediatric patients – Status quo 2017
Authors:
V. Dotlačil 1; B. Frýbová 1; O. Petrů 1; O. Hradský 2; L. Plánka 3; K. Harvánek 4; R. Hanák 5; R. Štichhauer 6; T. Příplatová 7; L. Janeček 8; P. Havránek 9; K. Kocmanová 10; T. Malý 11; I. Slívová 12; Z. Horák 13; J. Bierhanzlová 14; P. Polák 15; M. Rygl 1
Authors place of work:
Klinika dětské chirurgie 2. LF UK a FN Motol, Praha
1; Pediatrická klinika 2. LF UK a FN Motol, Praha
2; Klinika dětské chirurgie, ortopedie a traumatologie, FN Brno
3; Oddělení dětské chirurgie a traumatologie, Nemocnice Na Bulovce, Praha
4; Chirurgické oddělení, Nemocnice České Budějovice
5; Oddělení dětské chirurgie a traumatologie, FN Hradec Králové
6; Oddělení dětské chirurgie, ON Kladno
7; Oddělení dětské chirurgie, ON Kolín
8; Klinika dětské chirurgie a traumatologie 3. LF UK a TN, Praha
9; Všeobecná chirurgie, Krajská nemocnice Liberec
10; I. chirurgická klinika, FN Olomouc
11; Chirurgická klinika, FN Ostrava
12; Chirurgická klinika – Oddělení dětské chirurgie, Pardubická nemocnice
13; Chirurgická klinika, FN Plzeň a LF UK v Plzni
14; Oddělení dětské chirurgie – dětské úrazové centrum, Masarykova nemocnice, Ústí nad Labem
15
Published in the journal:
Čes-slov Pediat 2019; 74 (8): 443-448.
Category:
Original Papers
Summary
Introduction: Appendicitis is one of the most common diagnoses in pediatric surgery and its therapy involves a combination of surgical and antibiotic (ATB) treatment. Based on evidence-based medicine, new recommendations for its treatment have been published. The aim of this work was to evaluate current practice in the Czech Republic from the perspective of pediatric surgeons.
Methods: In a multicentre retrospective online questionnaire, 15 pediatric-surgical departments in the Czech Republic (university clinics, independent departments, pediatric surgery ordinariates at general surgery departments) were addressed. The questionnaire contained 10 questions. The monitored parameters were the number of operations, surgical approach, ATB prophylaxis and therapy, postoperative complications at individual departments in 2017. SurveyMonkey Inc. questionnaire was used for anonymous data collection.
Results: Fourteen of the fifteen surveyed departments completed the questionnaire (93%). In 2017, 1,379 appendectomies were performed, of which 456 (33%) were laparoscopically. The necessity of conversion was 2%. 1/4 of the patients had complicated appendicitis (gangrene, perforation) and were operated in 70% classically. ATB prophylaxis was always given in 4 (29%) departments, in 4 departments according to the surgeon's decision, in 4 departments it was not administered and in 2 departments ATB was administered only during laparoscopy. Five types of antibiotics were used for ATB prophylaxis at all departments. In cases of phlegmonous appendicitis, ATB was administered therapeutically in 2 departments (14%), in 8 departments (57%) as decided by the surgeon and in 4 departments it was not administered. In complicated appendicitis, ATB was therapeutically administered in 100% of cases. There were 6.7% (93/1379) complications overall - after classical appendectomy, they occurred in 6.9% (64/923), after laparoscopic appendectomy in 6.4% (29/456).
Conclusion: In 2017, two-thirds of appendectomies were operated classically in the questioned departments. The prophylaxis and therapy of ATB vary from department to department and even varies inside one department. The percentages of complications and inconsistency in ATB use are comparable to those reported in the literature, however, we differ in the number of appendectomies performed laparoscopically.
Keywords:
antibiotics – laparoscopy – appendectomy – pediatric surgery – postoperative complications
Zdroje
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Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
2019 Číslo 8
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