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Nonoperative management in children with early acute appendicitis: A systematic review

Jane Xu1, Susan Adams2, Yingrui Cyril Liu3

  • 1The School of Women's and Children's Health, The University of New South Wales, New South Wales, Australia.

Journal of Pediatric Surgery
|May 25, 2017
PubMed

Insights

Nonoperative management (NOM) shows promise for uncomplicated appendicitis in children, with initial success rates from 58-100%. Further high-quality studies are needed to confirm its long-term effectiveness compared to surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Evidence-Based Medicine

Background:

  • Appendectomy is the traditional treatment for acute appendicitis.
  • Nonoperative management (NOM) is an emerging alternative for uncomplicated cases in adults.
  • Evidence comparing NOM and operative management (OM) in children is limited.

Purpose of the Study:

  • To systematically review existing evidence on nonoperative management (NOM) versus operative management (OM) for acute uncomplicated appendicitis in children.
  • To assess the feasibility and outcomes of NOM in pediatric appendicitis.

Main Methods:

  • Systematic literature searches of MedLine, Embase, and clinicaltrials.gov were conducted in March 2016.
  • Included studies focused on NOM for uncomplicated appendicitis in pediatric populations.
  • Study quality was assessed using the Oxford Centre for Evidence-Based Medicine criteria; the review is Level IV evidence.

Main Results:

  • Fifteen articles were included: 4 retrospective analyses, 4 prospective cohort studies, 4 prospective nonrandomized comparative trials, and 1 RCT.
  • Initial success rates for NOM ranged from 58% to 100%.
  • Recurrence rates within one year for NOM varied from 0.1% to 31.8%.

Conclusions:

  • Current literature suggests NOM is a feasible approach for acute uncomplicated appendicitis in children.
  • Higher quality prospective randomized controlled trials (RCTs) with larger sample sizes are necessary.
  • Future research should focus on comparing the noninferiority of NOM with antibiotics to OM.
Abstract

Keywords:
Antibiotic managementAppendicitisNonoperative management

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