Completed Prospective Studies Early vs. Delayed Operation for Perforated Appendicitis with Abscess

St. Peter, Shawn D.; Aguayo, Pablo; Fraser, Jason D.; Keckler, Scott J.; Sharp, Susan W.; Leys, Charles M.; Murphy, Patrick; Snyder, Charles L.; Sharp, Ronald J.; Andrews, Walter S.; Holcomb III, George W.; Ostlie, Daniel J."Initial Laparoscopic Appendectomy vs. Initial Nonoperative Management and Interval Appendectomy for Perforated Appendicitis with Abscess: A Prospective, Randomized Trial." Journal of Pediatric Surgery. 45, (2010): 236-240.

Appendicitis is the most common surgical condition in children. Presentation varies widely. 

Some patients present after one-to-two weeks of perforation at which time a well-defined abscess is seen on the CT scan. These patients were historically treated with an immediate operation.

With the developing skill of interventional radiology, many institutions have been successfully treating this patient population with percutaneous drainage, intravenous antibiotics and interval appendectomy two months later. The proponents of delayed operation cite the ease of appendectomy with a very low complication rate.

Proponents of early operation argue that patients can be treated immediately, albeit with more operative difficulty and the patients completing therapy in five-to-seven days.

We are therefore comparing these two management strategies to determine which has more clinical advantages. Additionally, we are carefully measuring quality of life for the children and their parents during the three-month period of the study. Thirty patients will be enrolled in this pilot study.

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