Reoperations in the treatment of acute appendicitis in children

Abstract

Aim – to assess the experience in the treatment for children with postoperative abdominal complications after acute appendicitis, to determine their incidence rates and types, to analyze reasons of their occurrence with the view of effective prevention. Material and methods. Treatment results of 8832 various aged children, who underwent urgent surgery for acute appendicitis in 2009–2018, were analyzed. Results of surgical treatment in 204 (2.31 %) children with postoperative abdominal complications, who had to be reoperated, were presented. In total, 216 reinterventions were performed. Complete examination of the patients included clinical, laboratory and instrumental methods. Results. Continuing peritonitis in 94 patients (46.07 % of cases) and peritonitis with secondary purulent-septic complications (intraabdominal abscesses, intestinal perforations, purulent omentitis, intestinal suture failure, complications of Meckel’s diverticulum) in 58 patients (28.43 % cases) were the main reasons of relaprotomies. Early adhesive bowel obstruction was a reason for relaparotomies in 52 patients (25.49 % cases). 167 relaparotomies were performed on-demand, including 101 open relaparotomies and 66 laparoscopic. 49 of relaparotomies were programmed and performed in 37 children: 36 open programmed laparotomies and 13 programmed laparoscopeis. One child died postoperatively of severe sepsis with polyorganic dysfunction. Conclusions. Patient’s age, general condition, premorbid state and duration of the disease should be taken into account in urgent appendectomies that significantly influence the surgical results and allow predicting treatment outcomes. Children under the age of 3 years are included in the risk group of possible postoperative complications. There were 22.06 % of complications in this patient group. More than 2/3 of patients were admitted late to the surgical department – more than 24 hours after the onset of the disease. Postoperative complications in children occur most frequently in destructive types of appendicitis and late hospitalization. Continuing peritonitis (46.08 %), abscesses of abdominal cavity (15.20 %), intestinal obstruction (25.49 %) were the main surgical indications for relaparotomy. Laparoscopic relaparotomy (in total, 79 operations, including 66 (83.54 %) on-demand and 13 (16.46 %) programmed) is an adequate method for postoperative abdominal complications allowing to achieve positive treatment results in overwhelming majority of patients. Integrated treatment for children with severe generalized peritonitis postoperative peritonitis can benefit from programmed therapeutic relaparotomy.

Keywords

• appendicitis
• postoperative complications
• relaparotomy