Intermediate-term evaluation of interval appendectomy in the pediatric population

Area of Science:

• Pediatric Surgery
• Gastrointestinal Surgery
• Clinical Outcomes Research

Background:

• Complicated appendicitis management in children often involves initial non-operative therapy.
• Long-term effectiveness of interval appendectomy after non-operative management is not well-defined.
• This study evaluates long-term outcomes of interval appendectomy versus emergency appendectomy.

Purpose of the Study:

• To compare the long-term effectiveness of initial non-operative therapy with interval appendectomy versus emergency appendectomy in children with complicated appendicitis.
• To assess short- and long-term postoperative complications, including adhesive small bowel obstruction.
• To determine the optimal initial management strategy for pediatric complicated appendicitis.

Main Methods:

• Retrospective review of pediatric patients with complicated appendicitis (2010-2017).
• Comparison between initial non-operative therapy (n=471) and emergency appendectomy (n=377).
• Propensity score matching used to create comparable groups (n=348) for outcome analysis.

Main Results:

• No significant differences in baseline characteristics except symptom duration.
• Emergency appendectomy group had higher American Society of Anesthesiology (ASA) scores.
• Initial non-operative therapy group showed lower rates of surgical wound infection and postoperative peritonitis/abscess.
• Adhesive small bowel obstruction incidence was significantly lower in the initial non-operative therapy group.

Conclusions:

• Initial non-operative therapy followed by interval appendectomy is a feasible approach for pediatric complicated appendicitis.
• This strategy offers advantages in reducing postoperative complications, particularly long-term obstruction events.
• Initial non-operative therapy with interval appendectomy should be considered a primary treatment option for pediatric complicated appendicitis.