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Non-operative management of appendiceal abscess in children: a systematic review

Song Zhang1, Hai Lan Zhang1, Yu Zuo Bai1

  • 1Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China.

Annals of Medicine
|September 30, 2025
PubMed

Insights

For pediatric appendiceal abscess treated non-operatively, interval appendectomy (IA) offers shorter hospital stays and operative times compared to active observation (AO). Recurrence rates and costs were similar between IA and AO groups.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery

Background:

  • Non-operative treatment (NOT) is a standard initial approach for pediatric appendiceal abscess.
  • Subsequent management options include interval appendectomy (IA) and active observation (AO).

Purpose of the Study:

  • To compare interval appendectomy (IA) versus active observation (AO) following successful non-operative treatment (NOT) of pediatric appendiceal abscess.

Main Methods:

  • A systematic literature search of PubMed was conducted.
  • Key variables analyzed included length of hospital stay (LOS), recurrence rate, complication rate, cost, and operative time.

Main Results:

  • Six studies with 396 patients (145 IA, 251 AO) were analyzed.
  • Interval appendectomy (IA) was associated with shorter LOS and operative time.
  • No significant differences in complication rates or cost were found between IA and AO.
  • The pooled recurrence risk for AO was 9.9% (CI: 4.8-20.6%), with reported rates ranging from 2.4% to 34.2%.

Conclusions:

  • The optimal management strategy after successful non-operative treatment of pediatric appendiceal abscess remains debated.
  • Further high-quality randomized controlled trials are necessary to establish the best treatment approach.
Abstract

Keywords:
Appendiceal abscessInterval appendectomyactive observationchildrennon-operative treatment

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