hello. i am jeffrey lukish, one of the pediatricsurgeons at johns hopkins university now practicing here at howard countygeneral hospital. so, appendicitis occurs in 6.9 percentof girls and 7.3 percent of boys. the appendix isa small vestigial organ...that means it is anorgan that was more important many, many years ago when we ate more vegetable fiber than meat fiber where things needed to stay in ourintestine longer to be absorbed and to dissolve and absorb.
the appendix now really does not serve asignificant functional purpose. there are some theoretical reasons why we have an appendix. unfortunately, it canbecome inflamed. surgery is always indicated in children.there are some studies in adults with other complicating issues thatperhaps antibiotics alone in adults but in children the risk ofperforation and then risks of significantcomplications that can potentially be life-threatening can occur. if the childis healthy and presents with appendicitis the standard of care inthis country and in most industrialized
countries is that the child undergoes anoperation. so, the surgery for appendicitis, likemany of the things that we do now, can be carried out telescopically...againthrough a small incision at the belly button and two other little keyhole smallincisions below the belly button. we can go in...we get a great view of the appendix, it's swollen... we have a fancy machine that staples offthe base and puts it in a bag and then we remove it. the area...that bit of where the appendixwas
because we can see it on a big digitalscreen in our operating room... we can wash it out, we can clean thechild up. many times these children undergo the operation andit takes about 30 minutes to 45 minutes. they usually are in the hospital for about aday or two for straightforward acute appendicitis because they do have some bacteria that's in theirblood and they do need some antibiotics post-operatively for about 24 hours. when a child with appendicitis presents andthey've been complaining for pain for two or three or four days..thiscommonly happens in a toddler,
for a three-year-old child it's sometimesdifficult for the folks to tell whether the child has pain or isuncomfortable. they think it's the flu and they watch it and then the child gets very, very sick...that is a child, a toddler, a 3- 6 year old thatpresents with now what's called complicated or perforated appendicitis. we have really moved to telescopic surgeryfor a perforated appendicitis as well. it's probably been five or six yearssince i've done an open appendectomy because going in with the telescope, evenwhen there's gross contamination,
and the appendix is perforated we findthat with the telescope we can more thoroughly clean out theirabdomen and get rid of as much of the infection as possible with the fancy telescopic suction device.in the old days...when i say old days, but five or six years ago we would do that through a little incision in the right lower quadrant. we were always hesitant to make a bigincision and as a result with a little tiny littleincision through the muscle walls in the right lower quadrant we weren'treally able to see
exactly what we were clearing out. nowwith the telescope which is a much smaller incision than theincision in the right lower quadrant certainly from a cosmetic standpoint, it's a great incision. we can more thoroughly cleanclean them out. so, i really think of appendicitis,both complicated and straightforward appendicitis, as atelescopic operation that is really carried out veryefficiently. we've done that operation many times here at howard county overthe last year and these kids have all done very well.
the short answer is acute appendicitis: the length of hospitalization is a day,complicated perforated appendicitis: the average length of stay is seven days. wehere at howard county have done, i think our average is probablysomewhere between three and four days.