Bobak A. The diagnosis and treatment of acute appendicitis in children with the applying of modern technologies

This work based on the results of the treatment of 3171 children with acute appendicitis that were operated at the Lviv Regional Children's Clinical Hospital "OHMATDYT" for 10 years. Ultrasonography with the aim to confirm/exclude diagnosis of acute appendicitis was applied in 37.3% of patients. According the results of ultrasonography the primary and the second (indirect) signs of acute appendicitis were established. The prognostic value of ultrasonography for the diagnosis of acute appendicitis was rather high - specificity 93%, sensitivity 85%, positive prognostic value 86%, and negative predictive value 92%. It was established, that for the diagnostic of acute appendicitis, the best prognostic value has the total neutrophils count, neutrophils to lymphocytes ratio, and Samuel criteria. While leukocytes count, C-reactive protein level, and Anderson criteria has low prognostic value. For the preoperative diagnostic of perforated appendicitis, best results demonstrated the potassium level, neutrophils to lymphocytes ratio, and Anderson criteria, but other markers have low prognostic value. Among all patients, the open appendectomy was applied in 2879 (90.8%) and laparoscopic - in 292 (9.2%) children. Results of the open and laparoscopic appendectomy with the intraoperative lavage and drainage of the abdomen were analyzed. The results of open and laparoscopic appendectomy do not differ significantly in the frequency of complications in the early postoperative period, while at the remote terms after operation, the number of negative consequences is much lower by laparoscopic appendectomy.