A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children

Abstract

More than a century after its introduction, appendectomy has remained the gold standard treatment for acute appendicitis. In adults with acute uncomplicated appendicitis, nonoperative management (NOM) has been shown to be a viable treatment option. To date, there has been relatively limited data on the nonoperative management of acute appendicitis in the pediatric population. The primary objective of this study was to systematically review the available literature in the pediatric population and compare the efficacy and recurrence between initial nonoperative treatment strategy and appendectomy in children with uncomplicated appendicitis. In July 2021, we conducted systematic searches of the PubMed and Google Scholar databases. We only included full-text comparative original studies published within the last decade, and we excluded articles that solely examined NOM without comparing it to appendectomy. Two writers worked independently on the data collection and analysis. It was found that NOM had a high initial success rate and a low rate of recurrent appendicitis. After months of follow-up, the vast majority of patients with uncomplicated acute appendicitis who received initial nonoperative treatment did not require surgical intervention. Furthermore, the rate of complication was comparable in both treatment groups, and NOM did not appear to be associated with an increased risk of complications. The most significant drawback stemmed from the fact that the included articles in this study had a wide range of study designs and inclusion criteria. According to current evidence, NOM is feasible and cost-effective. Antibiotic therapy can be given safely in a small subset of individuals with uncomplicated appendicitis. To optimize outcomes, physicians should evaluate the clinical presentation and the patient's desire when selecting those to be managed nonoperatively. Again, more research, preferably large randomized trials, is required to compare the longterm clinical efficacy of NOM with appendicectomy. Finally, additional research is required to establish the characteristics of patients who are the best candidates for nonoperative treatment.

Nonoperative Management of Appendicitis in Children: An Update

“…In the most recently published systematic review, 12 studies were included that defined initial treatment success as “resolution of acute appendicitis leading to hospital discharge without the need for surgical intervention.” 13 The reported initial success rate of just over 90% was similar to other published figures. They defined recurrence as “the percentage of patients who experienced recurrent appendicitis after completing the initial antibiotic course.” This occurred in 21% of patients in whom nonoperative management had been initially successful.…”

New Criteria Could Improve the Success Rate of Non-operative Management of Acute Appendicitis in Children

“…This approach provided early antibiotic initiation and suppressed the inflammatory process. To date, meta-analyses are demonstrating that being fever-free at the time of admission is not an inclusion criterion for non-operative management [ 20 , 21 ]. Similarly, early antibiotic initiation has been reported to cause low recurrence rates of non-operative treatment [ 4 , 14 , 15 ].…”

Effects of COVID-19 Pandemic on the Frequency of Complicated Appendicitis in Pediatric Populations

“…Despite recent claims about the conservative management of AA in uncomplicated cases, appendectomy remains the only safe treatment, which can be done either through open or laparoscopic surgery (5). As AA is a progressive disease, untreated cases may develop complications like gangrene, perforations, abscess, or phlegmon.…”