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Outcome of initially nonoperative treatment for acute simple appendicitis in children

Ramon R Gorter1, Johanna H van der Lee2, Florence A C J Heijsters3

  • 1Paediatric Surgical Centre of Amsterdam. Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, the Netherlands; Department of Surgery, Red Cross Hospital. Beverwijk, the Netherlands.

Journal of Pediatric Surgery
|February 4, 2018
PubMed

Insights

Initially nonoperative treatment for simple appendicitis in children yields outcomes similar to immediate appendectomy. This approach successfully avoids appendectomy in most children, with comparable complication rates and health-related quality of life.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Appendicitis is a common surgical emergency in children.
  • Traditional management involves immediate appendectomy.
  • Nonoperative strategies are emerging as an alternative for simple appendicitis.

Purpose of the Study:

  • To compare outcomes of initial nonoperative treatment versus immediate appendectomy for pediatric simple appendicitis.
  • To assess complication rates, subsequent appendectomy rates, and health-related quality of life (HRQOL).

Main Methods:

  • Multicenter prospective cohort study involving children aged 7-17 with radiologically confirmed simple appendicitis.
  • Patients were assigned to either an initial nonoperative treatment strategy or immediate appendectomy.
  • Follow-up assessments included complications, subsequent appendectomies, and HRQOL.

Main Results:

  • Complication rates were similar between the nonoperative (12%) and immediate appendectomy (11%) groups.
  • 24% of children in the nonoperative group eventually required an appendectomy, with no subsequent complications.
  • Health-related quality of life in the nonoperative group was comparable to healthy peers.

Conclusions:

  • Initial nonoperative management for simple appendicitis in children demonstrates similar outcomes to immediate appendectomy.
  • Nonoperative management can successfully avert appendectomy in approximately 75% of pediatric cases.
  • This approach offers a viable alternative with comparable safety and quality of life.
Abstract

Keywords:
AppendectomyAppendicitisNonoperative treatmentQuality of life

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