Early Versus Delayed Operation for Perforated Appendicitis
Early Versus Delayed Operation for Perforated Appendicitis
The objective of this study is to scientifically evaluate two different operative strategies
 for perforated appendicitis with abscess.

 The hypothesis is that the increased difficulty of early operation is balanced by the immense
 patient investment with delayed operation.
This will be a single institution, prospective, randomized clinical trial involving patients
 who present to the hospital with perforated appendicitis with abscess. This will be a pilot
 study.

 Power calculations are not used for a pilot study. One group will undergo a primary
 laparoscopic appendectomy. The other group will receive intravenous antibiotics with drainage
 if possible and a laparoscopic appendectomy 10 weeks after initiation of treatment at
 presentation. All 7 general pediatric surgeons will be involved with the operations, who are
 all comfortable with these management arms. The surgeon will not induce a significant
 confounding variable into this study. The laparoscopic appendectomy is approached in the same
 manner by all members of our group. Those named on the form are qualified by the IRB to
 obtain consent and/or will be accountable for overseeing the study.

 Both groups will have the same antibiotic regiment. All data will be analyzed on
 intention-to-treat basis.
Inclusion Criteria:

 -  Patients with perforated appendicitis and an abdominal abscess diagnosed on CT scan.

 -  Children of any age will be included.

 Exclusion Criteria:

 -  Patients with immune deficiency

 -  Another condition affecting surgical decision making or recovery (e.g. hemophilia,
 severe cardiac or respiratory co-morbidities).

 -  Acute sepsis or severe pain from perforation not allowing for delayed management.