Management of post appendicectomy intra-abdominal collections: A volumetric cut off for drainage?
| Autor: | Georgina M. Bough, Ashwini Joshi, Bethan Johnson, Rashmi R. Singh, Mathanki Soorasangaram, Shazia P. Sharif, Krishnaa T. Mahbubani |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Adolescent business.industry General surgery Patient demographics General Medicine Prolate spheroid Dimension measurement Appendicitis Maximum diameter Pediatrics Perinatology and Child Health medicine Appendectomy Drainage Humans Surgery Cut-off Outcome data business Complication Child Abdominal Muscles Retrospective Studies |
| Zdroj: | Journal of pediatric surgery. 57(2) |
| ISSN: | 1531-5037 |
| Popis: | Background Intra-abdominal collections (IAC) are a common complication following appendicectomy, one of the most commonly performed emergency abdominal procedures in childhood. The option to drain a collection is frequently available but not always required. Aim The aim of this study was to compare the outcomes of medically and procedurally-managed post appendicectomy IACs and suggest a method of standardising the need for intervention. Methods A single centre, retrospective review of children aged ≤16 years presenting between 2014 and 2019 was performed. Patient demographics, management, and outcome data were collected. IAC volume and surface area were calculated assuming a prolate spheroid or true ellipsoid depending on the number of dimensions reported. Results 60 patients (18%) of patients developed an IAC post appendicectomy. Medical management was undertaken in 44 (73%), drainage in 12 (20%), and surgical washout in 4 (7%). Collection size was associated with failure of medical management: maximum diameter (p=0.028), volume (p=0.002), and surface area (p=0.001). Collections with a volume of 2ml/kg were significantly less likely to fail medical management than larger collections (0/33 vs 6/11; p Discussion Not all post appendicectomy IACs require drainage. The relationship between collection volume and need for drainage is more closely assessed using a volume calculation than a single dimension measurement, particularly when adjusted for weight of the child. A cut off of 2ml/kg appears to be a good objective measure for intervention and provides a communication tool for discussion among the multidisciplinary team. Prospectively collected multicentre data on this subject would be timely. |
| Databáze: | OpenAIRE |
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