What's New in Appendicitis

Management of appendicitis in children has changed over the last 10 to 15 years. Prior to that time, a right lower quadrant incision was the usual approach for appendectomy and surgeons usually based the need for operation on clinical grounds and physical examination. A negative appendectomy rate of 10 to 15% was felt reasonable due to the fact that it was believed to be important to operate prior to perforation.

Over the last 10 to 15 years, imaging studies have been utilized in most children, especially in the United States and other countries. The laparoscopic approach is now favored by many pediatric surgeons, primarily because of a marked reduction in wound infections with the small incisions. Even patients with perforated appendicitis and patients presenting with a well-formed abscess can be managed with the laparoscopic approach. The use of a scoring system to help determine the need for operation or further imaging studies has also been developed over the past 10 years. Some surgeons find these scoring systems useful, whereas others do not.

In this issue, these changes in management of appendicitis in children are discussed. The use of laparoscopy, whether through a traditional 3-port technique or a single-incision umbilical approach, is described. The optimal management for patients with perforated appendicitis as well as patients presenting with a well-defined abscess are also discussed. The use of imaging studies and the use of scoring systems are also reviewed. Finally, an article is devoted to whether or not we actually need to remove the appendix and whether appendicitis be managed nonoperatively.

I am very hopeful that our readers will find these articles interesting and informative for their practice. Please do not hesitate to contact the authors if questions arise.

Editor's Note

Dear readers, dear colleagues,

During recent years the number of review articles published in the European Journal of Pediatric Surgery was limited. These articles were appreciated very much by our readers and there have been numerous requests to increase their number in our journal.

Therefore, the Editors together with Thieme publishers decided to publish blocks of reviews on specific clinical aspects of pediatric surgery in up to 3 issues per year. There will be a Guest Editor for these reviews that will deal with new aspects published during the recent 2 to 3 years on the specific topics.

We are very glad to have Dr. George W. Holcomb from Kansas City, USA as the first Guest Editor on the topic “What's new in appendictis.” We hope that this is a successful start of a new focus of the journal.

Best regards,

Benno Ure

Editor-in-Chief