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):
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
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.