Analysis of intra-operative diagnosis and results of histological examination in children with acute appendicitis
DOI:
https://doi.org/10.15574/PS.2019.64.13Keywords:
acute appendicitis, children, intra-operative diagnosis, hystologyAbstract
Introduction. Acute appendicitis is the most often pathology that required surgical intervention. Prescription of antibacterial therapy and its duration at the post-operative period mainly depends of the severity of acute appendicitis, which primary established surgeon after removing of appendix.The aim of the study was to compare the intra-operative diagnosis with the results of histological examination and to analyze the factors of discrepancy in children with acute appendicitis.
Materials and methods. The study was based on the results of appendectomy and histological examination, which performed in 1624 children that treated in 1st surgical department of Lviv regional clinical hospital «OXMATDYT» during 2014-2018 years.
Results. According to the study results, in 60.6% of patients the intra-operative and histological diagnosis was coincide, whereas in 39.4% of children – the diagnosis was disagree. By that, in 87.7% children with the discrepancy of the diagnosis the hyperdiagnostic and in 12.3% – the underestimation of inflam matory changes in appendix was noted. The hyperdiagnostic most often was in children, which operated at the late evening and night (46.8%), and also at weekends (49.4%). Higher accuracy of diagnosis of acute appendicitis type was noted in cases of laparoscopic appendectomy compared with the conventional interventions (68.3% and 59.7%, respectively).
Conclusions. The surgery at the night and weekends accompanied by the higher rate of hyperdiagnostic of inflammatory changes in appendix. Applying in the clinical practice the methods of histological express diagnostic can optimize the antibacterial therapy during postoperative period in children with acute appendicitis.
No conflict of interest was declared by the authors.
References
Childers CP, Dworsky JQ, Massoumi RL et al. (2019, May). The contemporary appendectomy for acute uncomplicated appendicitis in children. Surgery. 165(5): 1027-1034. https://doi.org/10.1016/j.surg.2018.12.019; PMid:30905469.
Hamdy RF, Handy LK, Spyridakis E et al. (2019, Jul). Comparative effectiveness of ceftriaxone plus metronidazole versus anti-pseudomonal antibiotics for perforated appendicitis in children. Surg Infect (Larchmt). 20 (5): 399-405. https://doi.org/10.1089/sur.2018.234; PMid:30874482.
Kronman MP, Hersh AL, Gerber JS et al. (2015). Identifying antimicrobial stewardship targets for pediatric surgical patients. J Pediatr Infect Dis Soc. 4: e100-e108. https://doi.org/10.1093/jpids/piv022; PMid:26407258.
Kronman MP, Oron AP, Ross RK et al. (2016). Extended-versus narrower-spectrum antibiotics for appendicitis. Pediatrics. 138 (1): e20154547. https://doi.org/10.1542/peds.2015-4547; PMid:27354453.
Lane RS, Tashiro J, Burroway BW et al. (2018). Weekend vs. weekday appendectomy for complicated appendicitis, effects on outcomes and operative approach. Pediatr Surg Int. 34 (6): 621-628. https://doi.org/10.1007/s00383-018-4260-2; PMid:29626244.
Lee SL, Islam S, Cassidy LD et al.; 2010 American Pediatric Surgical Association Outcomes and Clinical Trials Committee (2010). Antibiotics and appendicitis in the pediatric population: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 45 (11): 2181-2185. https://doi.org/10.1016/j.jpedsurg.2010.06.038; PMid:21034941.
Podda M, Gerardi C, Cillara N et al. (2019, Jan 31) Antibiotic treatment and appendectomy for uncomplicated acute appendicitis in adults and children: a systematic review and meta-analysis. Ann Surg. https://doi.org/10.1097/SLA.0000000000003225; PMid:30720508. Epub ahead of print.
Roque FMCB, Melo Filho AA, Roque AJCB et al. (2019, Jul 4). Antibiotics for appendicectomy in children and adolescents during the perioperative period: an integrative review. Rev Paul Pediatr. https://doi.org/10.1590/1984-0462/;2019;37;4;00013; PMid:31291445 PMCid:PMC6821483. Epub ahead of print.
Yardeni D, Hirschl RB, Drongowski RA et al. (2004). Delayed versus immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg. 39 (3): 464-469. https://doi.org/10.1016/j.jpedsurg.2003.11.020; PMid:15017571.
Downloads
Issue
Section
License
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
