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Appendicitis
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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
Quality Improvement Campaign Improved Utilization of Rapid Sequence MRI for Diagnosis of Pediatric Appendicitis
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New article you should know from Journal of Pediatric Surgery by Cecilia Gigena
"Quality Improvement Campaign Improved Utilization of Rapid Sequence MRI for Diagnosis of Pediatric Appendicitis"
Authors: Bailey D. Lyttle, Marina L. Rep
video · Mar 2024
Pain assessment should be integrated as a mandatory vital sign at triage, similar to temperature, heart rate, and blood pressure — Patricia, Evaluación y Tratamiento del Dolor en Urgencias · 17:10
Evaluación y Tratamiento del Dolor en Urgencias
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video47:38 · Jun 2022
The best quality study on irrigation showed no difference in outcomes, while a more recent but less well-designed study showed a difference favoring standardized large-volume irrigation. — Whit Holcomb, Update Course Rewind: Perforated Appendicitis 2019 · 10:51
Appendicitis Irrigation Technique with ZERO Abscesses!
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Check out this article by Melanie LaPlant and Dr. Donavon Hess from the University of Minnesota! They describe a unique method of irrigation that resulted in ZERO post-operative abscesses in appendicitis patients. http://ow.ly/VXPC30lGpbS D
video · Sep 2018
Peritoneal Access
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At the 7th Annual Pediatric Surgery Update Course, Dr. Carroll "Mac" Harmon reviews rapid fire cases with a focus on peritoneal access.
video · Mar 2020
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
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
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
Dr. Krysta Sutyak - Best of the Best in Pediatric Surgery 2025
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Watch PAPS' Dr. Krysta Sutyak’s presentation on “Safety Evaluation of the Use of Povidone-Iodine Irrigation for Perforated Appendicitis” at the 2025 Best of the Best in Pediatric Surgery event!
Moderators: Drs. Todd Ponsky, Dan von Allme
video7:55 · Mar 2025
Narrated Dipes appy
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Surgical content by Dr. Steve Rothenberg — Abdominal Surgery
video3:23 · May 2026
In pediatric trauma, the cutoff of approximately 12 years or puberty is used as the breaking point for when to think about VTE prophylaxis — Katie Rossel, 2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals · 11:04
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
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 2021: DEI – CONCORDANCE AND POST OP COMPLICATION STUDIES
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In this session from the 2021 Update Course, Dr. Meera Kotagal, MD discussed the effects of racial concordance on perioperative outcomes and why it is critical for pediatric surgeons to focus onDiversity, Equity, and Inclusion (DEI).
Art
video · May 2022
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
Journal of Pediatric Surgery Article Review: November 2023
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 3 articles from November 2023 issue, with editor Dr. Mikko Pakarinen and authors Dr. Bailey Lyttle
Hosts: Cecilia
podcast12:26 · May 2024
2025 Pediatric Surgery Update Course - Updates in Pediatric Surgery feat. non-JPS Journals
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On August 26th, the largest Pediatric Surgery course in the world each year was held, where top hospital experts from around the US will discuss this year’s changes in practices and innovation. Learn more about the future of pediatric surge
video22:32 · Aug 2025
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
Surgeons who report lower abscess rates for perforation may be including gangrenous or necrotic appendicitis (not truly perforated) in their perforated group, which lowers the abscess rate — Whit Holcomb, Appendicitis with Dr. Whit Holcomb · 34:42
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 Rewind: Management of Appendicitis 2022
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Appendicitis is one of the most common conditions seen by pediatric surgeons but still has many controversies in management.
This topic was discussed in the 10th annual Update Course in Pediatric Surgery 2022, with Drs. Meera Kotagal, To
video · May 2023
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
AI models help increase efficiency but humans must always be in the equation for medical and scientific work — Rami, Top 10 AI Websites and Tools for Medical Research and Education · 7:12
Top 10 AI Websites and Tools for Medical Research and Education
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This year was the 12th Annual Pediatric Surgery Update Course, where top hospital experts from around the world discussed this yearâs changes in practices and i
podcast23:58 · Jul 2026
Practical applications of generative AI in medical research and education
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This year was the 12th Annual Pediatric Surgery Update Course, where top hospital experts from around the world discussed this yearâs changes in practices and i
podcast23:58 · Jul 2026
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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.
clinical0:19 ↗
Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management.
clinical0:19 ↗
There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management.
clinical0:35 ↗
Non-operative management resulted in decreased hospital stays compared to operative management.
clinical0:35 ↗
Non-operative management resulted in decreased days of disability compared to operative management.
clinical0:35 ↗
Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account.
guideline0:52 ↗
APSA was not making a flat out recommendation to start doing non-operative appendicitis.
opinionGibbons1:08 ↗
The data on non-operative appendicitis management is becoming more clear.
opinionGibbons1:14 ↗
The choice between operative and non-operative appendicitis management remains dealer's choice.
opinionGibbons1:06 ↗
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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
opinionMarc Levitt25:34 ↗
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.
clinicalMarc 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.
clinicalMarc 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.
opinionMarc Levitt28:50 ↗
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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc 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.
clinicalMarc Levitt36:39 ↗
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