Abstract
BackgroundAppendicitis is the most common cause of acute abdomen. Although emergency surgery used to be the standard treatment for both simple and complex appendicitis, there are now options for interval surgery, laparoscopic surgery, and even non-surgical treatment. In this study, we aimed to establish better treatment strategies for pediatric acute appendicitis and to find out whether minimally invasive treatment is superior to the traditional open approach. We retrospectively reviewed the cases of acute appendicitis treated in our hospital during the period from 2013 to 2018. The patients who underwent appendectomy were divided into four groups. Group 1 underwent early appendectomy with open approach, group2 underwent interval appendectomy with open approach, group 3 underwent early appendectomy with laparoscopic approach, and group 4 underwent interval appendectomy with laparoscopic approach. In addition to the above groups, the non-surgical treatment group was also studied. Clinical presentation, laboratory findings, imaging results, operative time, morbidity, and length of hospital stay were reviewed.ResultsOne hundred six children’s records were reviewed. Thirty-five of them were selected for non-surgery as they were cases with no fecal stone and first onset appendicitis, and 15 of these 35 patients (42.9%) relapsed after antibiotic treatment. As for the appendix diameter, the relapse group was significantly larger than the non-relapse group (p=0.007). In cases of surgery, group 4 had significantly less intraoperative blood loss than group 1 (p<0.001). Group 4 had significantly fewer postoperative complications than groups 1 and 2 [group 4 vs. group 1 (p=0.009), group 4 vs. group 2 (p=0.034)]. The postoperative hospital stay in groups 2 and 4 were significantly shorter than group 1 [group 1 vs. group 2 (p=0.015), group 1 vs. group 4 (p<0.001)]. On the contrary, group 1 had significantly shorter total hospital stay than groups 2 and 4 [group 1 vs. group 2 (p=0.029), group 1 vs. group 4 (p<0.001)].ConclusionInterval laparoscopic appendectomy and non-surgical treatment were safe and effective in children. From the viewpoint of avoiding unnecessary emergency surgery and prolonged hospitalization, we believe that interval laparoscopic appendectomy or non-surgical treatment should be performed after identifying patients who do not require surgery, paying attention to the risk factors for relapse.
Highlights
Appendicitis is the most common cause of acute abdomen
We aimed to find out whether minimally invasive treatment is superior to the traditional open approach in the treatment of children
Fifty-four patients underwent early appendectomy (EA) while 52 received antibiotic treatment. Of these 52 patients, 17 underwent interval appendectomy (IA) according to our treatment algorithm for acute appendicitis
Summary
Appendicitis is the most common cause of acute abdomen. emergency surgery used to be the standard treatment for both simple and complex appendicitis, there are options for interval surgery, laparoscopic surgery, and even non-surgical treatment. Appendectomy has been considered as an effective and safe treatment for acute appendicitis. Some perform an early appendectomy (EA), while others treat with initial antibiotics, followed by an interval appendectomy (IA) 4 to 8 weeks later The latter approach is thought to reduce the complication rate and reduce the incidence of extensive resection (ileocecal resection or right hemicolectomy), a review of the literature comparing EA versus IA has shown mixed results [4, 5]. In recent year, the dogma that surgery is required has changed, and there are growing literatures suggesting that antibiotics without surgery may be an effective treatment for acute appendicitis in children [9,10,11]
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