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 long-term 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.
Highlights
RationaleIn both adult and pediatric populations, acute appendicitis is one of the most common reasons for emergency abdominal surgery [1]
The rate of complication was comparable in both treatment groups, and nonoperative management (NOM) did not appear to be associated with an increased risk of complications
300,000 appendectomies are performed in the United States of America every year, with 70,000 of those being performed on children, at an average cost of $9000 [3,4]
Summary
Background RationaleIn both adult and pediatric populations, acute appendicitis is one of the most common reasons for emergency abdominal surgery [1]. 300,000 appendectomies are performed in the United States of America every year, with 70,000 of those being performed on children, at an average cost of $9000 [3,4]. The belief was that if acute appendicitis is not treated immediately, it will eventually result in perforation. Today, this idea is being challenged, with many researchers advocating for the natural resolution of appendicitis without the need for surgical intervention [6]. Complications from surgery and the risk of anesthesia occur in up to 10% of children who have appendectomy [8]. Even in nations with the finest diagnostic techniques, such as the United States of America and Canada, the frequency of negative appendectomy is as high as 4.36.3% [9]
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