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Appendicitis
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
If after 10 minutes of attempting SILS there is no significant forward progress, conversion to traditional multi-port technique with two additional trocars should be performed. — Nelson Rosen, SILS Appendectomy by Dr. Nelson Rosen · 9:00
Perforated Appendicitis
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At the 7th Annual Pediatric Surgery Update Course, Dr. George "Whit" Holcomb discusses management of perforated appendicitis.
video18:22 · Mar 2020
SILS Appendectomy by Dr. Nelson Rosen
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In this video Dr. Nelson Rosen shows an appendectomy by a single umbilical incision.
video10:57 · Jan 2024
Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account. Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2 · 0:52
Standardization of Care for Pediatric Perforated Appendicitis
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Dr. Todd Ponsky reviews the article "Standardization of Care for Pediatric Perforated Appendicitis Improves Outcomes," by Dr. Yousef, Dr. Sherif Emil and colleagues from Hopital de Montreal pour enfants.DOI:https://doi.org/10.1016/j.jpedsur
video2:20 · Sep 2018
Appendicitis Management & APPY Trial: Update Course 2016
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Dr. Shawn St. Peter gives an update on appendicitis management techniques. His presentation includes topics of appendectomy vs. antibiotics for non-perforated appendicitis, the APPY trial, acute appendicitis in adults, and non-operative man
video31:55 · Oct 2018
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about usingCorticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb aboutsurgical site infections (SSI) are an important source of morbidity and mortality.andfeasibility and safety o
podcast44:19 · Jan 2019
Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2
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Drs. Todd Ponsky, Alex Casar, Alex Gibbons, and Rae Hanke review 2018 Practice Gap #2: Wilms Tumor Protocol Violations, as identified by the APSA Professional Development Committee.
video1:21 · Jun 2019
Biliary Atresia, Appendicitis, Intestinal Failure, and Anesthetic...
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Audio Journal with Dr. Von Allmen about using Corticosteroids After Hepatoportoenterostomy for Bile Drainage, Dr. Whit Holcomb about surgical site infections (SSI) are an important source of morbidity and mortality. and feasibility and safe
podcast44:19 · Dec 2020
Update Course Rewind: Perforated Appendicitis 2019
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Did you miss our annual Update Course? Don't worry, we are summarizing our favorite sessions from years past. In this episode, Dr. Whit Holcomb talks us through the diagnosis and management of perforated appendicitis. Mark your calendars fo
podcast12:08 · Apr 2021
Journal Club: Appendicitis in 2021
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We all know how commonly pediatric surgeons see patients with appendicitis and how frequently new literature is published on its management. Dr. Jose Campos helped us find some of the latest publications on appendicitis management and we di
podcast15:06 · Aug 2021
Update Course 2022 - TOP PUBLICATIONS IN NON- PED SURG JOURNALS - Jose Campos
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In this session, Dr. Jose Campos leads us through the top publications that are not in the Journal of Pediatric Surgery.
Articles referenced:
1. IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children T
video27:50 · Sep 2022
Quick Literature Updates Episode 11
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We’re back with eleventh episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. This episode, we will review three articles covering the mo
video · Jul 2023
Quick Literature Updates Ep 24
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We’re back with 24th episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesti
video4:42 · Nov 2025
Symptom duration of 3-4 days warrants immediate operation; 6-7 days suggests well-defined abscess suitable for non-operative management; 5 days is transition zone — Whit Holcomb, Appendicitis with Dr. Whit Holcomb · 50:00
Hirschsprung Disease Part I with Marc Levitt
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Podcast discussion with Dr. Marc Levitt on Hirschsprung disease management, preceded by clinical updates on appendicitis treatment including same-day discharge protocols and antibiotic regimens. Features listener Q&A addressing negative app
podcast59:20 · Jan 2019
Appendicitis with Dr. Whit Holcomb
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Dr. Whit Holcomb discusses current concepts and controversies of appendicitis.
podcast58:22 · Jan 2019
Hirschsprung Disease Part I with Marc Levitt
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Dr. Marc Levitt and Dr. Todd Ponsky discuss Hirschsprung disease.Dr. Ponsky: Welcome to "Stay Current” in pediatric surgery, I’m Todd Ponsky, a pediatric surgeon at Akron Children’s Hospital and today we’re going to be focusing on Hirschspr
podcast59:20 · Dec 2020
Evidence-based diagnosis and management of pediatric appendicitis with Dr. Whit Holcomb
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Dr. Whit Holcomb discusses current concepts and controversies of appendicitis.Dr. Ponsky: Perfect. I know today we’re going to be talking about appendicitis, and I know that you’ve built a pretty robust research center there and I think tha
podcast58:22 · Dec 2020
Update Course 2023 - Update Course 2022 and Best of the Best Recap
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This session is a recap on Update Course 2022 and Best of the Best with Dr. Cecilia Gigena.
The 11th Annual Pediatric Surgery Update Course was held on August 29, 2023 in Cleveland, Ohio and was livestreamed to a global audience. The fu
video17:24 · Oct 2023
Expert statements from the recordings in this collection.
Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2
Non-operative management of perforated appendicitis has been known for a long time.
Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management.
There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management.
Non-operative management resulted in decreased hospital stays compared to operative management.
Non-operative management resulted in decreased days of disability compared to operative management.
Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account.
Cites a guideline0:52
APSA was not making a flat out recommendation to start doing non-operative appendicitis.
The data on non-operative appendicitis management is becoming more clear.
The choice between operative and non-operative appendicitis management remains dealer's choice.
Hirschsprung Disease Part I with Marc Levitt
The best treatment for Hirschsprung disease is irrigations using a large bore tube (20 French Foley) with warm saline, instilling 10-20 cc aliquots at a time and allowing fluid mixed with stool to drain back.
Marc Levitt8:43
It is very rare that Hirschsprung disease is a surgical emergency, but if you don't irrigate and overcome the distal obstruction, it will become an emergency.
Marc Levitt8:55
For rectal biopsy in suspected Hirschsprung disease, you must be at least 1 centimeter in from the dentate line. If you biopsy too close to the dentate line, everyone has an aganglionic segment there and you could get the wrong answer.
Marc Levitt12:38
The pathologist must report both the absence of ganglion cells AND the presence of hypertrophic nerves. The absence of ganglion cells alone is not Hirschsprung disease - that could be a biopsy taken too low.
Marc Levitt13:23
Hirschsprung disease has an immune component and the lining of the bowel (mucosa) is much more susceptible to bacterial translocation. Stasis in a Hirschsprung patient leads to bacterial translocation and a very sick baby from bacteremia.
Marc Levitt14:59
If irrigations are not working and the baby is ill, you need to divert. The recommendation is to divert in the ileum rather than doing a leveling colostomy, because frozen section can be inaccurate, particularly as you move higher in the colon.
Marc Levitt15:42
The Swenson operation involved full-thickness transabdominal dissection down below the peritoneal reflection. The operation was often done incorrectly with perirectal dissection done too wide, leading to fecal incontinence, urinary incontinence, sexual problems, and impotence.
Marc Levitt18:14
The Suave operation used a mucosal dissection to keep the outer rectal wall intact and avoid injury. The original Suave would leave the colon coming through the anus for a week before doing the coloanal anastomosis; Dr. Scott Boley modified it to do everything in one stage.
Marc Levitt19:28
The Duhamel operation leaves the original rectum in place, removes the aganglionic portion from the peritoneal reflection, and pulls ganglionic bowel in a retrorectal position, connecting the two lumens with a stapler.
Marc Levitt20:18
Of the four classic procedures (Swenson, Suave, Duhamel, Rabine), only the Swenson actually leaves behind virtually no Hirschsprung tissue. The others leave behind outer rectal wall or original rectum. Many patients did well despite this because ganglionic bowel, if it's good, can overcome a lot.
Marc Levitt21:18
Dr. Henrys in the Philippines pioneered primary pull-through operations (without initial colostomy) out of necessity because patients would never return to clinic due to social stigma against colostomies.
Marc Levitt22:19
Keith Jorgeson applied laparoscopic skills to Hirschsprung disease, doing the colonic work laparoscopically with a Suave dissection from above. Luis de la Torre and Jack Langer developed the transanal approach, starting the dissection from below.
Marc Levitt23:21
The current preferred approach is a transanal Swenson (full-thickness dissection). It is the purest operation, leaving behind no Hirschsprung except the very bottom just above the dentate line. If you find the right plane, it's elegant and bloodless.
Dr. Orvar Swenson, who recently died at age 105, maintained that the Swenson operation was good all along and people just weren't doing it right, which gave it a bad reputation.
Marc Levitt26:23
Even Suave enthusiasts are making shorter and shorter cuffs over time. Jorgeson's original laparoscopic Suave recommended a 5 cm cuff; nowadays Langer and de la Torre do 1-1.5 cm cuffs, essentially approaching a Swenson.
Marc Levitt27:06
Laparoscopy is appropriate for all cases to find the transition zone level. A transanal-only approach is only appropriate when you have a very reachable, obvious transition zone at mid-sigmoid that you can comfortably reach transanally.
There is significant morbidity from an overly aggressive transanal-only approach trying to reach the transition zone without going into the abdomen. If you're too aggressive transanally trying to visualize the dissection, you would have been better off with laparoscopic dissection.
Marc Levitt29:18
Total colonic Hirschsprung patients present differently: the diagnosis isn't made right away, the contrast study is not typical, and irrigations don't go well. These patients need laparoscopy first to find the biopsy location.
Marc Levitt31:18
The biggest technical problems are: (1) surgeons don't give themselves good exposure and start dissection too low, injuring or resecting the dentate line, or (2) they give very aggressive exposure and overstretch the sphincters.
Marc Levitt34:09
Proper technique requires marking 1 cm proximal to the dentate line with a purple mark and placing 5-0 silk stitches circumferentially at that level. This preserves the anal canal, dentate line, plus an additional 1 cm of columnar epithelium before starting dissection.
Marc Levitt35:30
By definition, you're leaving behind 1 cm of columnar epithelium that is Hirschsprung disease, plus the internal sphincter which has a problem with relaxation. However, good ganglionic bowel is able to overcome that, and the baby eventually learns to relax the sphincter.
Marc Levitt36:39