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Interval appendectomy after nonoperative management of complicated appendicitis in children: a review

Joan E Lee1, Jason P Sulkowski1

  • 1Section of Pediatric Surgery, Department of Surgery, University of Chicago, USA.

Seminars in Pediatric Surgery
|July 8, 2026
PubMed

Insights

Interval appendectomy after nonoperative management for complicated appendicitis in children is controversial. While it may reduce recurrence, it carries risks and costs, making shared decision-making essential.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Review

Background:

  • Complicated appendicitis (CA) in children can be managed nonoperatively (NOM).
  • Interval appendectomy (IA) is sometimes performed after NOM to prevent recurrence and rule out neoplasm.
  • Recurrence rates after NOM vary widely (2%-50%), with appendicoliths as a potential predictor.

Purpose of the Study:

  • To review the role of interval appendectomy (IA) in pediatric complicated appendicitis (CA) following nonoperative management (NOM).
  • To analyze recurrence risk, operative morbidity, neoplasm risk, and resource utilization associated with IA.
  • To identify factors guiding selective IA in children.

Main Methods:

  • Systematic review of existing literature on interval appendectomy after nonoperative management of complicated appendicitis in children.
  • Analysis of reported outcomes including recurrence rates, complications, and oncologic risk.
  • Evaluation of cost-effectiveness and factors influencing decision-making.

Main Results:

  • Recurrence after NOM ranges from 2% to 50%, often occurring within 6 months.
  • The oncologic rationale for IA is weak due to the extremely low risk of pediatric appendiceal neoplasms.
  • IA is associated with 3-18% complication rates, increased anesthesia exposure, hospitalization, and costs.

Conclusions:

  • Routine interval appendectomy after successful NOM for pediatric complicated appendicitis is controversial.
  • Shared decision-making, informed by evidence on risks and benefits, is crucial for families.
  • Cost analyses suggest early appendectomy or observation may be preferable to routine IA.

Keywords:
AppendicitisComplicated appendicitisInterval appendectomyNonoperative managementPediatric surgery

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