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Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis

Ramon R Gorter1, Sarah-May M L The2, Marguerite A W Gorter-Stam3

  • 1Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC & VU University Medical Center, Amsterdam, the Netherlands; Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.

Journal of Pediatric Surgery
|April 29, 2017
PubMed

Insights

Initial nonoperative treatment for uncomplicated appendicitis in children shows comparable complication rates to appendectomy. This approach may successfully avoid surgery in most children after one year.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Uncomplicated appendicitis is common in children.
  • Appendectomy is the standard treatment.
  • Nonoperative management is an alternative being explored.

Purpose of the Study:

  • To compare complication risks between nonoperative treatment and appendectomy for uncomplicated appendicitis in children.
  • To evaluate the efficacy of nonoperative management in avoiding appendectomy.

Main Methods:

  • Systematic review of randomized controlled trials and cohort studies.
  • Inclusion criteria: studies on children with uncomplicated appendicitis, minimum one-year follow-up.
  • Data extraction and quality assessment by two independent authors.

Main Results:

  • Five studies included 147 children (nonoperative) and 173 (appendectomy).
  • Complication rates were similar: 0-13% for nonoperative vs. 0-17% for appendectomy.
  • Nonoperative treatment avoided appendectomy in 62-81% of children after one year.

Conclusions:

  • Evidence for nonoperative treatment of uncomplicated appendicitis in children is insufficient.
  • Complication rates appear comparable between nonoperative and surgical groups.
  • Nonoperative management may avoid appendectomy in a majority of pediatric patients.
Abstract

Keywords:
AppendectomyAppendicitisNonoperative treatment

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