Treating Acute Appendicitis

Acute appendicitis - one of the most common consults you'll get as a general surgeon!
In this video I build on the information we learned in the first two videos so if you haven't checked those out definitely do that!
We're going to take a deep dive into the treatment and management of appendicitis as well as a review of the literature.
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HOW ABOUT THE TREATMENT OF APPENDICITIS?
Remember that the treatment of appendicitis doesn't just start in the operating room, put your knives away for just a moment.
The treatment of appendicitis starts immediately in the emergency room with fluid resuscitation, IV antibiotics and then a decision of where the patient needs to go...the OR, the floor or the ICU.
After that you now need to make a decision, are you going to manage this nonoepratively or take the patient to surgery.
There is strong literature to support a nonoperative approach in both adults and children but it's important to understand the inclusion and exclusion criteria for nonoperative management.
If you decide to go to the operating room now you have some new decisions to make...
An open appendectomy?
A laparoscopic appendectomy?
A robotic appendectomy?
Each of these options is safe and you need to decide as a surgeon how you want to solve the appendicitis problem.
After your appendectomy it's time to decide on antibiotics or not and to make that decision you need to know...was this simple or complicated appendicitis.
In many cases of simple appendicitis an operation is enough and no antibiotics are indicted. In complicated appendicitis postoperative antibiotics are indicated for 3-7 days following the operation.
Lastly we're going to discuss the interval appendectomy.
I will counsel families on the value of interval appendectomy in patients who have an obstructing fecalith or mass or those who do not want to risk an episode of recurrent appendicitis.
In adults, patients with an age greater than 45 year have an increased risk of a underlying malignancy so interval appendectomy is indicated.
I will usually perform this interval appendectomy at 12 weeks after diagnosis.
Check out these AMAZING timestamps and fast forward if you need to:
Start 00:00
Initial Management of Appendicitis 02:09
Nonoperative Management of Appendicitis 04:51
Surgery for Acute Appendicitis 09:35
Postoperative Antibiotics for Appendicitis 13:06
Interval Appendectomy 16:42
REFERENCES
Nonoperative Management of Appendicitis
CODA Trial citizensurgeon...
APPAC Trial citizensurgeon...
Children-Gonzalez citizensurgeon...
Children-Pearson citizensurgeon...
Children-Minneci JAMA citizensurgeon...
Chapter 42 Holcomb and Ashcraft's Pediatric Surgery citizensurgeon...
Laparoscopic Versus Open Appendectomy
citizensurgeon...
Complicated Appendicitis
citizensurgeon...
Interval Appendectomy
citizensurgeon...
WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!
DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. If you have medical questions definitely consult a medical professional. Good luck and enjoy!
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