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Nonoperative Management of Appendicitis
Andrew Scott1, Steven L Lee1,2, Daniel A DeUgarte1,2
11 University of California at Los Angeles, CA, USA.
Clinical Pediatrics
|September 28, 2017
Summary
Nonoperative management (NOM) is a feasible approach for pediatric nonperforated appendicitis, with 68% of patients avoiding surgery. While appendicoliths increase failure risk, they are not absolute contraindications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Appendicitis is common in children.
- Surgical appendectomy is the traditional treatment.
- Nonoperative management (NOM) is an emerging alternative.
Purpose of the Study:
- To evaluate the outcomes of NOM for pediatric nonperforated appendicitis.
- To compare NOM success and recurrence rates with laparoscopic appendectomy.
- To assess the impact of appendicoliths on NOM outcomes.
Main Methods:
- Prospective evaluation of 50 children with suspected nonperforated appendicitis offered NOM.
- NOM involved intravenous antibiotics and hospital admission.
- Laparoscopic appendectomy was performed for lack of improvement within 24 hours.
Main Results:
- The initial success rate for NOM was 80% (34/50 patients avoided appendectomy).
- The recurrence rate was 13%.
- Patients with an appendicolith had a higher initial failure rate (37%) compared to those without (10%; P < .05).
Conclusions:
- Nonoperative management is feasible and effective for pediatric nonperforated appendicitis.
- Appendicoliths are associated with a higher failure rate in NOM but do not preclude its use.
- A significant majority of children can successfully avoid surgery with NOM.
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