Current practice patterns for postoperative activity restrictions in children.

BACKGROUND: Postoperative activity restrictions are designed to prevent undue stress on a recent repair and minimize the risk of surgical complication, however, there is little evidence to support certain restrictions in clinical practice. For the pediatric population, there is a paucity of formal evaluations of postoperative activity restrictions, and little is known about current practice patterns among pediatric surgeons. This study aimed to describe national practice patterns of pediatric surgeons for postoperative activity recommendations following three common general surgical procedures. METHODS: A 7-item survey was sent to all American Pediatric Surgical Association (APSA) members regarding surgeon practice of recommended activity restrictions for school attendance, participation in playground or gym, participation in contact sports, and heavy lifting in children following 3 procedures: exploratory laparotomy, laparoscopic appendectomy, and inguinal hernia repair. Information on type and duration of clinical practice was also collected for each surgeon. Descriptive and bivariate analyses were performed. RESULTS: The survey was completed by 293 pediatric surgeons for a response rate of 28.9%. There was wide national variability in the recommended activity restrictions for children <12 years old among pediatric surgeons. Following laparoscopic appendectomy, 30.7%, 51.9% and 47.8% of surgeons recommends restriction of gym, contact sports, and heavy lifting for 2-3 weeks respectively, but 26.7%, 19.8%, and 22.2% do not recommend any restriction whatsoever of these three activities. Following inguinal hernia repair, 31.7%, 49.1% and 44.4% of surgeons recommend restriction of gym, contact sports, and heavy lifting for 2-3 weeks, but 30.8%, 30.8%, and 29.2% do not recommend any restriction of these three activities. Only 22% of surgeons change their activity restriction recommendations for children ≥12 years old, this decision was not associated with surgeon years in practice or type of practice. CONCLUSIONS: There is considerable variability in surgeon recommendations for activity restrictions following three general surgery procedures in children. While activity restrictions are rooted in the physiology of wound healing, there is little evidence to support the benefit of these restrictions in clinical practice. In addition, activity restriction may have unintended deleterious effects on a child's psychosocial well-being and quality of life. Further investigation should be pursued to understand the utility of activity restrictions in children and their impact on clinical outcomes and patient quality of life. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level V, expert opinion.

[Comparison of standard and fast track rehabilitation in patients with acute appendicitis. Intermediate results of multicenter prospective randomized trial]. / Sravnitel'naia otsenka metodov standartnoi i uskorennoi reabilitatsii bol'nykh s ostrym appenditsitom. Promezhutochnye rezul'taty mnogotsentrovogo prospektivnogo randomizirovannogo issledovaniia.

AIM: To analyze outcomes of fast track rehabilitation in patients with acute appendicitis. MATERIAL AND METHODS: Prospective, randomized multi-center trial including 86 patients was conducted. There were 38 patients in the main group and 48 in the control group. All patients underwent laparoscopic appendectomy under endotracheal anesthesia. Protocol included informing, no premedication, glucose infusion prior to surgery, antibiotics administration, mesoappendix excision, limited deployment of drainage tubes, intraabdominal prolonged anesthesia, minimal pneumoperitoneum, limited irrigation, minimum power monopolar electrocautery, antiemetics, early activation and eating (2 and 6 hours after surgery). Pain was evaluated by visual-analogue scale. Auscultative peristalsis was considered every 2 hours after surgery. Cortisol level was assessed preoperatively, in 6 and 12-24 hours after surgery in 11 (29%) and 15 (31%) patients of the main and control groups respectively. Discharge criteria: no leukocytosis, fever and pain syndrome requiring anesthesia, no signs of complications and patient's consent. RESULTS: Terms of disease, gender, age and comorbidities were similar in all patients. Duration of surgery under minimal pneumoperitoneum and standard pressure was also similar: 69.2±3.98 and 70.9±3.89 min (p=0.762). Pain syndrome grade and need for analgesics were significantly lower in the main group within entire follow-up. Pain syndrome was absent at the 1st postoperative day in 16 (42%) and 2 (4.1%) patients of both groups, respectively (score 0-1). Phrenic nerve syndrome was observed in 36.8% of the main group and 60.4% of the control group (p=0.05). Incidence of dyspepsia and terms of peristalsis onset were similar. Length of hospital-stay was 1.45 days in the main group and 3.15 days in the control group (p=0.002). In the main group 18 (47%) patients were discharged on the first day after surgery. There were only 4 (8.3%) patients with similar hospital-stay in the control group (p<0.001). There were no repeated hospitalizations. Postoperative cortisol concentration was similar in both groups as well as in complicated and uneventful postoperative period. In the main group postoperative intestinal paresis (Clavien-Dindo grade 2) occurred in 1 patient. In the control group 7 patients had postoperative infiltrate and 1 patient - intestinal paresis (Clavien-Dindo grade 2). Postoperative drainage tube was deployed in 3 out of 7 patients with postoperative infiltrates and 6 of them received antibiotic therapy. Medication was successfully applied in all patients with complications. CONCLUSION: There are some advantages of FTR for AA including reduced pain syndrome, morbidity and less length of hospital-stay. Issue of cortisol concentration requires further trials.

Appropriate use of total parenteral nutrition in children with perforated appendicitis.

BACKGROUND: Total parenteral nutrition (TPN) is often used in children with perforated appendicitis, despite the absence of clear indications. We assessed the validity of specific clinical indications for initiation of TPN in this patient cohort. METHODS: Data were gathered prospectively on duration of nil per os (NPO) status and TPN use in a cohort of children treated under a perforated appendicitis protocol during a 19-month period. TPN was started in the immediate postoperative period in patients who had generalized peritonitis and severe intestinal dilatation at operation, or later per the discretion of the attending surgeon. At discharge, TPN was considered to have been used appropriately, according to consensus guidelines, if the patient was NPO≥7days or received TPN≥5days. RESULTS: During the study period, TPN was initiated in 31 (25.4%) of 122 patients operated for perforated appendicitis. Sixteen (51.6%) received TPN per operative finding indications and 15 (48.4%) for prolonged ileus. The operative indications demonstrated 47% sensitivity, 86% specificity, a positive predictive value (PPV) of 35%, and a negative predictive value (NPV) of 91%, when adherence to TPN consensus guidelines was considered the gold standard. CONCLUSION: Patients without severe intestinal dilatation and generalized peritonitis at operation should not be placed on TPN in the immediate postoperative period. Refinement of selection criteria is necessary to further decrease inappropriate TPN use in children with perforated appendicitis. TYPE OF STUDY: Diagnostic Test. LEVEL OF STUDY: II.

[Novelties in surgery in 2016]. / Quoi de neuf en chirurgie?

The year 2016 allowed further implementation of previous years innovations with the PIPAC treatment for peritoneal carcinomatosis, the development of new surgical technologies and procedures and challenging general principles in general and digestive surgery, including cholecystectomy and appendectomy. Prevention, improved general and perioperative care (ERAS program) become an integral part of our standard surgical activity.

L'année 2016 a permis le développement des innovations des années précédentes avec le traitement PIPAC pour la carcinose péritonéale, le déploiement de nouvelles technologies et procédures chirurgicales et la remise en cause de principes généraux en chirurgie générale et digestive, notamment pour la cholécystectomie et l'appendicectomie. La prévention, l'amélioration des soins et de la prise en charge périopératoire (programme ERAS) deviennent une part intégrante de notre activité chirurgicale.

Recovery and convalescence after laparoscopic surgery for appendicitis: A longitudinal cohort study.

BACKGROUND: Information about predictors for the duration of convalescence and the overall general wellbeing after laparoscopic surgery for suspected appendicitis is missing in the scientific literature. We aimed to describe and identify predictors for the duration of convalescence and the quality of recovery for patients undergoing laparoscopic surgery for suspected appendicitis. METHODS: A prospective cohort of adult patients undergoing laparoscopic surgery for suspected appendicitis was performed between July 2014 and December 2014. Patients completed a QoR-15 questionnaire six times during the 30-d postoperative period. Time until resumption of recreational and occupational activities was recorded. Potential predictors for the duration of convalescence and the quality of recovery measured by the QoR-15 score were identified. RESULTS: A total of 108 patients were included, and 95 patients were eligible for analysis. The median duration of convalescence was 13 d. Disease, depressive mood, level of recreational activities, age, and pain at rest on the first postoperative day were significant predictors of the duration of convalescence. Gender, postoperative complications, disease, and anxiety were significant predictors of the quality of recovery during the 30-d postoperative period. A 10% increase in the QoR-15 score increased the hazard ratio of 1.24 (95% confidence interval, 1.08-1.43, P = 0.002) for ending the period of convalescence. CONCLUSIONS: Duration of convalescence after laparoscopic surgery for appendicitis seems long. Psychological factors, demographical factors, and perioperative outcomes were important predictors for the quality of recovery and the duration of convalescence. Increased quality of recovery is associated with a shorter period of convalescence.

Meta-analysis of the results of randomized controlled trials that compared laparoscopic and open surgery for acute appendicitis.

PURPOSE: We conducted a meta-analysis to evaluate and compare the outcomes of laparoscopic and open surgery for the treatment of patients with acute appendicitis. METHODS: We searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant papers published between January 1990 and February 2012. We analyzed 22 outcomes of laparoscopic and open surgery for acute appendicitis. RESULTS: We identified 39 papers reporting results from randomized controlled trials that compared laparoscopic surgery with open surgery for acute appendicitis. Our meta-analysis included 5,896 patients with acute appendicitis; 2,847 had undergone laparoscopic surgery, and 3,049 had undergone open surgery. Compared with open surgery, laparoscopic surgery was associated with longer operative time (by 13.12 min). However, compared with open surgery, laparoscopic surgery for acute appendicitis was associated with earlier resumption of liquid and solid intake; shorter duration of postoperative hospital stay; a reduction in dose numbers of parenteral and oral analgesics; earlier return to normal activity, work, and normal life; decreased occurrence of wound infection; a better cosmesis; and similar hospital charges. CONCLUSIONS: Laparoscopic surgery may now be the standard treatment for acute appendicitis.

Early discharge following laparoscopic appendectomy in children utilizing an evidence-based clinical pathway.

BACKGROUND: The utility of laparoscopic appendectomy (LA) in children remains controversial. The determination of the efficacy of LA in children is complicated by variable postoperative management, duration of antibiotics,and criteria for discharge. The aim of this study was to examine the results of a commitment to LA and the concurrent implementation of an evidence-based clinical pathway (CP) for management appendicitis in a children's hospital. METHODS: With institutional review board approval, all children presenting with appendicitis (n = 72; age =10.6 +/- 0.1 years) were offered LA and management directed by CP. Data were accrued prospectively for 12 consecutive months (May 2006 to April 2007) and analysis performed at 15 months. Data are reported as the mean +/- standard error of the mean. RESULTS: Children were stratified based on the operative findings: group one - acute 41; group two-suppurative=11; and group 3-gangrenous or perforated 20. Duration of hospital stay differed between the groups:group one= 26 +/- 0.3 hours; group 2 =48 +/- 3 hours; group 3= 127 +/- 6 hours (P <0.05). No patients in groups one or two suffered a complication or were readmitted following discharge. Two patients in group 3 (10%)were readmitted and treated with antibiotic therapy alone. Overall, 66% of the children with acute appendicitis(27/41) and 27% with suppurative appendicitis (3/11) were discharged within 24 hours of admission. Discharge by 24 hours in groups 1 and 2 was not influenced by age, gender, or time of operation (before or after 7 PM). CONCLUSIONS: The commitment to LA and use of CP resulted in discharge within 24 hours in 2 of 3 of children with acute appendicitis without readmission or complications being observed. Early discharge was not influenced by age, gender, or time of admission. For advanced appendicitis, length of hospital stay, determined by clinical parameters, resulted in a low rate of complication or readmission.

Parecoxib frente a ketorolaco en el control del dolor agudo postoperatorio moderado / Parecoxib versus ketorolac for the management of moderate postoperative acute pain

Introducción y objetivos: El parecoxib es un profármaco que tras ser administrado se convierte con rapidez en valdecoxib, un inhibidor selectivo de la cicloooxigenasa 2 (COX-2) y que se administra vía parenteral. Intentamos valorar su eficacia en el tratamiento del dolor postoperatorio de intensidad moderada. Material y métodos: Es un estudio prospectivo, randomizado sobre un total de 96 pacientes intervenidos de: apendicectomías, ooforectomías, hernioplastias y fracturas de cadera entre enero y febrero de 2004. Un grupo recibió parecoxib 40 mg i.v. cada 12 horas (grupo P) y otro ketorolaco 30 mg i.v. cada 8 horas (grupo K). El analgésico de rescate fue paracetamol 1 g i.v. cada 6 horas. Se realizó la escala visual analógica tras 30 minutos de su ingreso en la unidad de recuperación postoperatoria, a las 2, 24 y 48 horas. Resultados: La valoración del dolor a través de la EVA no presentó diferencias entre grupos. La necesidad de analgesia de rescate en el primer día fue del 83,3% (40/48) en el grupo K, frente a un 66,7% (32/48) en el grupo P (p = 0,059). En el segundo día las demandas de analgesia adicional decrecieron. La necesidad de analgesia de rescate fue mayor en los pacientes sometidos a cirugía traumatológica. Los pacientes que recibieron parecoxib mostraron mayor porcentaje de satisfacción de forma significativa. Conclusiones: El control del dolor fue similar para ambos grupos, sin embargo, las pautas analgésicas mostraron limitaciones en el control del dolor, ya que el EVA en las primeras horas y el grado de satisfacción de los pacientes pueden mejorarse. A la vista de los buenos resultados del rescate con paracetamol, la combinación de parecoxib con paracetamol puede ser una mezcla importante en el control analgésico postquirúrgico (AU)

Introduction and objectives: Parecoxib is a pro-drug that after being injected into the body, it is rapidly converted into the active drug valdecoxib, an injectable selective inhibitor of cyclooxygenase 2 (COX-2). Our aim was to determine its effectiveness for the management of moderate postoperative pain. Material and methods: A prospective randomized study was conducted on a total of 96 patients undergoing: appendectomies, oophorectomies, hernioplasties and hip fractures between January and February 2004. One group received parecoxib 40 mg IV each 12 hours (group P) and the other one received ketorolac 30 mg IV each 8 hours (group K). Rescue analgesia was paracetamol 1 g IV each 6 hours. An analogical visual scale was used 30 minutes after admittance to the postoperative recovery unit, and after 2, 24 and 48 hours. Results: Pain was assessed through the VAS scale, with no differences found between groups. The need of rescue analgesia on the first day was 83.3% (40/48) in group K, versus 66.7% (32/48) in group P; (p = 0.059). On the second day, the demand of additional analgesia decreased. The need of rescue analgesia was greater among patients undergoing traumatological surgery. Patients that received parecoxib showed a greater percentage of satisfaction, this difference being significant. Conclusions: Pain management was similar in both groups. However, the analgesic patterns showed limitations in the management of pain, since the VAS score and the degree of satisfaction during the first hours can be improved. Considering the effectiveness of rescue therapy with paracetamol, parecoxib combined with paracetamol may be an useful combination for postoperative analgesic management (AU)

Analgesia multimodal preventiva: estudio comparativo / Preventive multimodal analgesia: a comparative study

Objetivos: Evaluar la eficacia de la analgesia multimodal preventiva para producir analgesia postoperatoria. Material y método: Estudio prospectivo y comparativo en 120 pacientes intervenidos de apendicectomía y distribuidos aleatoriamente en cuatro grupos: grupo I (grupo control), grupo II (metamizol magnésico), grupo III (diclofenaco + metamizol magnésico) y grupo IV (bupivacaína + diclofenaco + metamizol magnésico). Se estudiaron las siguientes variables de respuesta: intensidad del dolor postoperatorio medido mediante escala analógica visual (EAV). Con los resultados que se obtuvieron en cada grupo y en cada momento de la evaluación se crearon tablas de contingencia para su análisis ulterior por la prueba de Chi cuadrado. Se calcularon las medias para cada hora en los 4 grupos y se realizaron tests de comparación de medias dos a dos con una confianza del 95 por ciento (=0,05). Los 4 grupos se compararon estadísticamente dos a dos en cada tiempo de medición, para comparar diferencias de valores estadísticos. Resultados: Se logró mejor analgesia postoperatoria en los grupos II, III y IV comparados con el I; en el III los resultados fueron más positivos que en el II; y en el IV aún más satisfactorios que en el II y en el III. Conclusiones: Se obtuvieron resultados satisfactorios, estadísticamente significativos, con el uso de la analgesia preventiva multimodal. Los mejores resultados se obtuvieron al asociar metamizol magnésico y diclofenaco por vía intravenosa con bupivacaína al 0,25 por ciento infiltrada en la zona quirúrgica (AU)

Factors determining the return to normal activity after appendicectomy.

BACKGROUND: The ability of a patient to return to their normal activities is an important outcome of an operation. The present study was designed to identify and rank factors that are important in determining this return to normal activity (RTNA) after appendicectomy. METHODS: Consecutive patients were identified prospectively following appendicectomy at North Shore Hospital between February and April 2000. Data regarding 25 different factors were obtained by a structured patient interview before and after discharge from hospital and by review of the medical records. Statistical analysis involved analysis of variance and logistic regression analysis. RESULTS: There were 98 patients (median age 28, range 15-69 years, male : female ratio 48:50) who had an appendicectomy. An open appendicectomy was performed in 74 patients, a laparoscopic appendicectomy in 22 patients and a laparotomy in two patients. This includes the 16 patients who were converted from laparoscopic to open appendicectomy (conversion rate 42% 16/38). Acute appendicitis was confirmed by histology in 67 (68%) patients. The significant independent variables identified by anova were ranked by logistic regression analysis. The most important determinant for the time to RTNA was what the doctor advised (chi-squared 43.7, P < 0.0001). The other determinants were the physical activity of their primary occupation (chi-squared 21.5, P < 0.017), the need for strong postdischarge analgesia (chi-squared 21.1, P < 0.13), the American Society of Anesthesiologists (ASA) category (chi-squared 13.6, P < 0.018) and the total sick leave obtained (chi-squared 9.6, P < 0.08). CONCLUSION: It has been shown that the most significant factor in determining the RTNA after appendicectomy was the advice given by the doctor, and that this was more important than the surgical approach, pathology, complications, age or occupation of the patient.

[Recovery and duration of work disability after laparoscopic and conventional appendectomy. A prospective randomized study]. / Rekonvaleszenz und Arbeitsunfähigkeitsdauer nach laparoskopischer und konventioneller Appendektomie. Eine prospektiv-randomisierte Studie.

To evaluate whether laparoscopic appendectomy shortens the convalescence and the postoperative period until return to work when compared to conventional appendectomy, a prospective randomized trial was performed. The major endpoint of the study was the time until return to work; minor endpoints were postoperative pain, fatigue, operative time and postoperative morbidity. In all, 54 patients with a mean age of 29.5 +/- 10.1 years were randomized to open (n = 28) or laparoscopic appendectomy (n = 26). Age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) rating, job status as well as histologic degree of inflammation of the appendix were comparable in the two groups. Operative time was 59.2 +/- 15.8 min for laparoscopic and 59.8 +/- 24.4 min for conventional appendectomy (P = 0.9). Some 16 laparoscopic appendectomies (62%) were performed by board-certified surgeons, while 23 conventional appendectomies (82%) were performed by residents (P = 0.003). Postoperative morbidity was comparable between the two groups. After laparoscopic appendectomy, pain was rated significantly lower on the first, second and fourth postoperative day when compared to the conventional group. There were no difference in postoperative fatigue between the groups. Time to return to work was 17.0 +/- 6.2 days in the laparoscopic group and 18.2 +/- 6.0 days in the conventional group (p = 0.5). Laparoscopic appendectomy has no advantages in terms of convalescence and time to return to work when compared to open appendectomy and should therefore be limited to selected cases.

Laparoscopic versus open appendectomy.

This prospective clinical study was done because our initial retrospective review suggested that laparoscopic appendectomy (LA) offers no significant advantages over open appendectomy (OA) yet is significantly more expensive. From July 1992 to August 1993, 57 patients were approached preoperatively for randomization to either LA (n = 19) or OA (n = 18). There were no statistically significant differences between the LA and OA groups in operative risk: mean age, 28 +/- 2 vs 26 +/- 2 years; percent female, 26% vs 22%; body mass index, 24 +/- 0.8 vs 26 +/- 1.2 kg/m2. All patients were either ASA class I or class II, 78% in each group being class II. The differences between the LA and OA groups in mean operating time required (93 +/- 12 vs 87 +/- 8 minutes), postoperative intramuscular narcotic analgesic usage (24 +/- 6 vs 26 +/- 6 hours), postoperative hospital stay (57 +/- 12 vs 66 +/- 10 hours), and return to normal activity (20 +/- 6 vs 14 +/- 3 days) were also not significant. However, LA was much more expensive because of higher operating room charges. The mean total hospital bill was $4,600 +/- $160 for the LA group and $1,700 +/- $70 for the OA group. This prospective study corroborated our previous analysis. Laparoscopic appendectomy is safe, effective, and expensive and overall has no greatly significant advantages over open appendectomy.

Infección de heridas post-apendicectomia en el Hospital Pablo Arturo Suarez 1990-1995

El presente es un estudio descriptivo retrospectivo, que determina la incidencia de heridas quirurgicas infectadas post-apendicectomia, en el período comprendido entre, enero de 1990 a diciembre de 1995. Se encontró un número total de 55 pacientes diagnosticados de herida infectada post-apendicectomia y que fueron sometidos a intervención quirurgica de emergencia (apendicectomia) para la resolución satisfatoria de su patología de base (apendicectomía) para la resolución satisfactoria de su patología de base (apendicitis aguda), y en los cuales se encontraron los siguientes resultados. La incidencia de infecciones quirurgicas post-apendicectomía es del 10.35 por ciento (n=55), de acuerdo al sexo masculino es del 54.55 por ciento (n=30) y al femenino 45.45 por ciento(n=25), el promedio de edad de presentación es de 29.6 años (R= 11-62 años), el tipo de incisión que presentó mayores casos de infección fue la infraumbilical media 60 por ciento(n=33), la apendicitis aguda perforada purulenta se asocio con mayor frecuencia a infección de la herida quirurgica en 70.9 por ciento (n=39), el tiempo quirurgico en promedio fue de 1.83 hs (R=30 min - 4 hs). El promedio de días para el diagnostico fue de 4.23 días, (R= 2-7 días). El tratamiento para resolver esta complicación se basó en curación de la herida en forma exclusiva 54.5 por ciento (n=30) y en curación más antibióticoterapia 45.5 por ciento (n=25).

Functional limitations and recovery in children with severe trauma: a one-year follow-up.

To examine functional limitations, recovery rates, and association with Injury Severity Scores (ISSs), we followed 92 children with severe trauma and 59 control subjects with appendicitis at 6 months and 1 year after discharge. Physical health status was assessed by the Rand Health Insurance Study instrument. Overall, 73% and 55% of trauma patients had one or more functional limitations at 6 months and 1 year, respectively, in contrast to 14% and 9% of the controls. Overall functional status of the trauma patients improved by 22% in the first 6 months and 24% in the second. Much higher recovery rates (73% and 46%) were noted for self care. Although ISS did not correlate with overall functional status, higher ISSs were related to impairment in patients whose principal injury was to the head or the face-chest-abdomen but not in those whose principal injury was to an extremity. This study shows that many children with severe trauma are left with disabilities. Recovery rates are not uniform but depend on type of limitation. Functional impairment and recovery are related more to the body parts involved than to ISS.

Hemograma; seu valor na apendicite aguda; estudo de 130 casos / The hemograml his value in acute appendicitis; a study of 130 cases

O autor faz uma recordaçäo do quadro clínico, fisiopatologia, cirurgia, tratamento e complicaçöes da apendicite aguda. Pöe em evidência o hemograma-leucograma como exame complementar fiel e que deve ser sempre solicitado

La hidratación oral inmediatamente después de la apendicectomía / Early oral hidration after appendicectomy

Se llevó a cabo un estudio experimental en 20 pacientes consecutivos para saber si inmediatamente después de apendicectomía toleran la hidratación con soluciones de sales de rehidratación por vía oral en reemplazo de la hidratación endovenosa. La hidratación oral fue indicada en todos los casos inmediatamente despues de la operación y solo hubo un fracaso (5 por ciento). En el 95 por ciento restante la hidratación oral fue tolerada, 45 por ciento de ellos sin síntomas digestivos, 35 por ciento con síntomas digestivos leves y en el restante 15 por ciento con síntomas digestivos moderados. La asociación Gentamicina-Metronidazol administrado por vía intramuscular y oral respectivamente se usó en el 100 por ciento de los pacientes, en el 80 por ciento como profilaxis y en el 20 por ciento como tratamiento. Dos casos se complicaron con sepsis de herida, uno del grupo de profilaxis (5.9 por ciento) y otro del grupo de tratamiento. Se concluye que la hidratación oral con sales de rehidratación son tolerados por los pacientes inmediatamente después de la apendicectomía

Estudio y tratamiento de la apendicitis aguda en el Hospital Juárez / Study and treatment of the appendicitis at the Hospital Juarez

Se hace un análisis sobre el estudio clínico del paciente con apendicitis, así como el tratamiento aplicado y el post-operatorio que presentan estos casos en el Hospital Juárez de la Secretaría de Salud. Este padecimiento es el componente de las lesiones inflamatorias que ausan abdomen agudo y que en este hospital predominan en un 41.2 por ciento en relación a otras causas de abdomen agudo. La apendicitis es un poco más frecuente en el sexo masculino apreciándose en porcentajes: 54.2 para el masculino y 45.7 para el femenino. En especial afecta en la segunda y tercera década de la vida. En un análisis de la ocupación de los pacientes, se halló predominio en el estudiante. Los síntomas y signos más frecuentes fueron: dolor abdominal, náuseas y vómitos, así como el signo de Von Blumerg. Llama la atención el tratamiento preoperatorio que reciben los pacientes con apendicitis, encontrando que el 22.85 por ciento reciben antibióticos previos y el 62.85 por ciento, analgésicos. El laboratorio informó de leucocitosis en el 65.7 por ciento y los rayos X muestran el íleo en el 44.28 por ciento y borramiento del psoas en el 34.28 por ciento. El diagnóstico pre-operatorio de apendicitis aguda se pudo establecer en el 67.14 por ciento y con el absceso apendicular en el 17.14 por ciento. El procedimiento de apendicectomía más empleado fué el de Oscher en el 95.7 por ciento. Las complicaciones se presentaron en el 33 por ciento, siendo la infección de la herida la más común. El 61.4 por ciento recibió antibióticos y el 38.5 por ciento no lo recibió en el post-operatorio. Ninguna defunción hubo en los pacientes estudiados