- Risks and Complications
What is pediatric appendectomy?
Pediatric appendectomy is the surgical removal of the appendix in children. The vermiform appendix is a small sac in the lower right abdomen, attached to cecum, the beginning part of the colon. The appendix produces a protein that helps fight infection, however, its presence is not essential for survival.
Why is a pediatric appendectomy performed?
- Emergency appendectomy: An immediate surgery for appendix removal upon diagnosis of appendicitis.
- Interval appendectomy: Appendectomy performed eight to 12 weeks after the initial episode of appendicitis, after treatment of the acute inflammation with medications. This method is followed if the perforation of the appendix is localized and the child is clinically well otherwise.
Emergency versus interval appendectomy
Studies indicate that emergency appendectomy reduces the:
- Incidence of post-procedural adverse events
- Recovery period before return to normal activities
- Hospital charges and costs
Some studies indicate that 80% of children with a mass in the appendix without a rupture may not need an interval appendectomy after medical treatment of appendicitis. The benefit of interval appendectomy over early appendectomy, however, remains controversial and requires further trials.
Is an appendectomy a major surgery?
Pediatric appendectomy is a routinely performed, relatively minor surgical procedure with minimal risks. The removal of appendix is a simple procedure unless extensive infection is present due to rupture of the appendix.
What are the types of pediatric appendectomy?
A pediatric appendectomy may be:
- Open appendectomy: The surgeon makes a single two- to three-inch incision to access and remove the appendix with standard surgical instruments.
- Laparoscopic appendectomy: The surgeon makes one to three tiny incisions and uses flexible tubes and inserts a tiny lighted camera (laparoscope) to visualize the appendix, and tiny instruments to perform the surgery.
Laparoscopic appendectomy is more favored over an open surgery because of its advantages which include:
- Reduced post-operative pain
- Lower risk for wound infection
- Shorter hospital stays
- Faster wound healing and return to normal activities
- Useful in obese patients and patients whose appendicitis diagnosis is in doubt
- Ability to evaluate the entire abdomen, which is useful in adolescent girls in whom gynecological conditions can imitate appendicitis.
How is a pediatric appendectomy performed?
A pediatric surgeon performs a pediatric appendectomy with the child under general anesthesia. The surgery typically takes about an hour.
- The child first undergoes tests and an ultrasonography or CT scan to decide between immediate surgery and interval surgery after non-operative treatment.
- Unless it is an emergency surgery, the child has to avoid eating and drinking for a few hours prior to the surgery.
- The surgeon administers fluids and antibiotics to treat and prevent infection.
- An anesthesiologist administers anesthesia and continuously monitors the child’s vital functions during the procedure.
- In an open surgery, the surgeon
- Makes a single incision in the abdominal skin and muscle over the appendix.
- Clamps the base of the appendix and excises it.
- Sutures the appendix stump.
- Identifies and removes all signs of infection, if the appendix is perforated, and irrigates the area with saline solution to clear all contamination.
- Closes the incision with sutures.
- In a laparoscopic surgery, the surgeon
- Decompresses the stomach and bladder.
- Blows gas into the abdominal cavity.
- Makes a single incision or three incisions in the abdomen, depending on the specific laparoscopic technique.
- Removes the appendix with laparoscopic instruments and sutures the stump close.
- Irrigates (rinses with sterile solution) the area if the appendix is perforated.
- Releases the gas, and closes the incisions with sutures or staples.
- Post-surgical care involves weaning the child off anesthesia, administration of painkillers and monitoring vital signs for a few hours.
How long does it take for a child to recover from an appendectomy?
Most children will be able to go home within a day after an appendectomy if the appendix is not ruptured. After appendectomies involving rupture and severe contamination, the child will require IV administration of antibiotics with hospital stay extended from five to seven days.
Post appendectomy, the children should return for a follow-up one to two weeks after discharge. Return to normal activity may take two to six weeks depending on the severity of appendicitis and the type of surgery.
What are the risks of a pediatric appendectomy?
Pediatric appendectomy is a low-risk procedure, but a few complications may arise, especially with a perforated appendix. The risks of pediatric appendectomy include:
- Side effects of general anesthesia such as:
- Abscess in the abdomen which can lead to:
- Pylephlebitis (block by blood clot in the liver’s portal vein due to infection) also known as septic portal vein thrombosis, which can lead to: