Is appendoscope a new option for the treatment of acute appendicitis?

Acute appendicitis is one of the most common urgent abdominal interventions.Open appendectomy has been a standard procedure for acute appendicitis for more than 100 years.However, in the last 20 years, after many studies, laparoscopic appendectomy has become a gold standard in solving acute appendicitis.The main goal of our study was to compare results of open and laparoscopic appendectomies with regard to in-hospital stay, time of operation, postoperative complications and postoperative pain.All patients underwent open or laparoscopic appendectomy in the Center of Minimally Invasive Surgery and Emergency Center of the University Clinical Center Ni, Serbia in the period of one year.A total of 126 patients were enrolled and submitted to retrospective analysis.One hundred and twenty-six patients who underwent laparoscopic or open appendectomy surgery were retrospectively analysed.A laparoscopic appendectomy was performed in 58 patients, while 68 patients underwent an open appendectomy.Groups were demographically similar and there was no significant difference between the age structure and gender distribution (t = 0.927; p = 0.057).Average height (p = 0.123), weight (p = 0.200) and BMI (p = 0.425) were mostly similar.Previous surgical operations were more common in patients with open appendectomy, but with no statistical significance (p = 0.141).Percentage of patients with WBC > 10 were the same in both groups (p = 0.927).Diabetes mellitus was more common in patients with open appendectomy, but with no statistical significance (p = 0.563).Acute and perforated appendicitis were similar in both groups (p = 0.490).Average time of operation was the same in both groups (p = 0.751).Number of days of in-hospital stay was shorter in patients who underwent laparoscopic appendectomy (p < 0.001).The analysis of administration of parenteral and oral analgesics showed that postoperative pain was less in the group of patients who underwent laparoscopic appendectomy than in the group of patients with open appendectomy.There was no statistically significant difference with respect to postoperative complications between two groups (p < 0.001).The treatment of appendicitis by using laparoscopic surgery in comparison to open approach provides a better result in terms of duration of hospital stay, recovering time, postoperative complications and postoperative pain.

2412 Cost effectiveness analysis of operative Versus antibiotic management for uncomplicated appendicitis

Transumbilical laparoscopic-assisted appendectomy (TULAA) is increasingly being performed worldwide. The authors report their experience in the treatment of acute uncomplicated appendicitis in children with TULAA. From January 2008 to December 2012 all types of acute appendicitis were divided, according to the clinical and ultrasonographic findings, into complicated (appendiceal mass/abscess, diffuse peritonitis) and uncomplicated. Complicated appendicitis was treated by open appendectomy (OA). All patients with the suspicion of uncomplicated appendicitis were offered TULAA by all surgeons of the team. Conversion to open or laparoscopic appendectomy (LA) was performed in case of impossibility to complete TULAA, depending on the choice of surgeon. The histopathologic examination of appendix was always performed. 444 children (252 males) with acute appendicitis were treated. The mean age was 9.2 years (range, 2 to 14 years). Primary OA was performed in 144 cases. In 300 patients a transumbilical laparoscopic-assisted approach was performed. TULAA was completed in 252 patients. Conversion to OA was performed in 45 patients and to LA in 3. Conversion was related to the impossibility to adequately expose the appendix in 47 patients and bleeding in 1. The mean operative time for TULAA was 42 minutes. Histopathologic examination of the appendix removed by TULAA showed a phlegmonous/gangrenous type in 92.8% of cases. Among the 252 TULAA there were 11 cases of umbilical wound infection. TULAA is a feasible and effective procedure for uncomplicated appendicitis in children. It combines the advantages of open and laparoscopic technique (low operative time, low complications rate, and excellent cosmetic results).

BackgroundLaparoscopic appendectomy is not yet unanimously considered the “gold standard” in the treatment of acute appendicitis because of its higher operative time, intra-abdominal abscess risk, and costs compared to open appendectomy. This study aimed to compare outcomes and cost of laparoscopic and open appendectomy in a district hospital.MethodsA retrospective analysis of 230 patients who underwent appendectomy at the Division of General Surgery of the Civil Hospital of Ragusa, Italy, from May 2008 to May 2012 was performed. The variables analyzed included patients data (age, gender, previous abdominal surgery, preoperative WBC count, duration of symptoms, ASA risk score), rate of uncomplicated or complicated appendicitis, operative time, postoperative complications, length of hospital stay, and total costs. The patients were divided in two groups according to the surgical approach and compared for each variable. The results were analyzed using the t Student test for quantitative variables, and the Chi-square test with Yates correction and Fisher exact test for categorical.ResultsLaparoscopic appendectomy was performed in 139 patients, open appendectomy in 91. Two cases (1.4%) were converted to open procedure and included in the laparoscopic group data. Patient data and rate of complicated appendicitis were similar in the two study groups. There was no statistical difference (p = 0.476) in the mean operative time between the laparoscopic (52.2 min; range, 20–155) and open appendectomy (49.3 min; range, 20–110) groups. The overall incidence of minor and major complications was significantly lower (p = 0.006) after laparoscopic appendectomy (2.9%, 4 cases) than after open appendectomy (13.2%, 12 cases); rate of intra-abdominal abscess were similar. The length of hospital stay was significantly shorter (p = 0.001) in laparoscopic group (2.75 days; range, 1–8) than in open group (3.87 days; range, 1–19). The mean total cost was 2282 Euro in laparoscopic group and 2337 Euro in open group, with a no significant difference of 55 Euro (p = 0.812).ConclusionLaparoscopic appendectomy is associated with fewer complications, shorter hospital stay, and similar operative time, intra-abdominal abscess rate, and total costs, compared with open appendectomy. Therefore, laparoscopic appendectomy can be recommended as preferred approach in acute appendicitis.

See Article on Page 192-197 Acute appendicitis is the most common indication for surgery in patients admitted to hospital due to an acute abdomen. Although most are uncomplicated, about 20% of all acute appendicitis cases are complicated, leading to local or diffuse peritonitis. An urgent appendectomy is the recommended treatment for both complicated and uncomplicated appendicitis. The appendectomy, which has been the first choice for the treatment of acute appendicitis for over 120 years, is a classic surgical procedure [1]. Nowadays, a laparoscopic appendectomy is widely practiced for its benefits, such as significantly shorter operative time, lower incidence of wound infection, and reduced length of hospital stay [2]. Although an appendectomy is generally well tolerated, it is still considered a major surgical intervention and can be associated with postoperative morbidity in about 2%-23% of patients [3]. According to a study that followed patients for over a decade, 3% of the patients undergoing appendectomy were readmitted for intestinal obstruction related to postoperative adhesion [4,5]. Therefore, physicians are taking higher interest in noninvasive interventions, such as antibiotic therapy, as a primary treatment. Although the appendectomy remains the standard approach for treating appendicitis [6], several studies have already suggested that appendicitis can be treated with antibiotics [5]. Two well-studied appendicitis scoring systems based on clinical symptoms were used to diagnose appendicitis: the Alfredo Alvarado system for adults and the Madan Samuel system for children. The Alvarado score was developed in Philadelphia in the mid-1980s and has a sensitivity of 81% and a specificity of 74% [7]. The Pediatric Appendicitis Score was developed to diagnose appendicitis in children and has a high sensitivity of 100% and specificity of 92% [8]. Although these scoring systems were widely used to diagnose appendicitis in the past, they are no longer practically implicated. Recently, various diagnostic tools, such as computed tomography (CT) and ultrasound, have been developed to diagnose appendicitis. With the improvement of such radiologic tools, determining the severity of and diagnosing appendicitis have become more accurate. The development of radiologic tools has provided many advantages for diagnosing appendicitis and determining its severity. The increased use of CT has reduced the rate of negative (unnecessary) appendectomies [9]. A meta-analysis consisting of data from 31 studies revealed that both the sensitivity and the specificity of CT for appendicitis were as high as 94% [10]. The development of a precise scoring system based on CT to distinguish between complicated and uncomplicated appendicitis has led to an improvement in diagnostic accuracy [11]. This system provides the physician with the evidence needed to decide on a treatment strategy for appendicitis patients. A meta-analysis [12] of randomized controlled trials comparing antibiotics with appendectomies has shown that although antibiotic treatment alone can be successful in 77%-95% of the cases, patients should be made aware of the fact that the failure rate during the first year, with a need for readmission or surgery, is around 25%-30%. However, recently conducted research proposed the use of antibiotics as the single treatment for uncomplicated appendicitis. However, one should note that more accurate selection criteria, based on combinations of clinical risk scores and imaging, are required for patients or subgroups of patients in whom primary antibiotic treatment is more likely to succeed in the long-term, and CT could be of assistance in the process of selecting patients suitable for antibiotics therapy. Although the appendectomy is the best treatment for the appendicitis, studies on the use of antibiotics therapy to treat patients with uncomplicated appendicitis are still meaningful; thus, efforts for such research should be supported.

Acute appendicitis is the most common emergency in abdominal surgery, but remains a continuing controversy regarding the most appropriate method of removing the inflamed appendix. From January 2002 to December 2012, 1037 women underwent appendectomy (average age: 25±15.7 y; range: 6 to 91 y). Of these, 519 underwent open appendectomy (OA) and 518 underwent laparoscopic appendectomy (LA). For all the patients we determined the postoperative hospital stay, the eventual readmissions within 30 days after discharge, the length of surgical procedures (data were available only for the period from January 2008 to December 2012), the costs for the OA and LA, and the rate of negative appendicitis. In our cohort of patients, 189 women (18.2%) had a negative appendectomy. Considering the postoperative hospital stay (average: 4.2±3.6 d; range: 1 to 32 d in OA group and average: 3.9±3.1 d; range: 1 to 21 d in LA group; P=0.15) there were no statistical differences between 2 groups. The average length of surgical procedures in LA group was 42.3±18.4 minutes (range: 8 to 135 min) and 43.2±19 minutes in the OA group (range: 10 to 135 min) (P=0.63). The average net cost of LA was 1203.61 euros, whereas for OA it was 95.18 euros. In this study, we considered only the surgical materials. LAs are not associated with a lower complication rate than the OAs and, above all, LAs are more expensive than OAs. Also we believe that laparoscopic approach should be used only in case of unclear abdominal pain and not for the treatment of clear acute and uncomplicated appendicitis.

Comparison of open and laparoscopic treatment of acute appendicitis

Introduction:Appendectomy remains the most frequently performed emergency abdominal surgical procedure. 1The lifetime risk of acute appendicitis for men and women is 8.6% and 6.7% respectively.[4] Laparoscopic appendicectomy was first described by Semm in 1983. 5ombining clinical history, physical examination and laboratory studies has led to the development of scoring systems and computer-aided algorithms to help clinicians with decision making in acute appendicitis. 6verall, the actual gain of scoring systems

PurposeThe impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children.MethodsThe correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis of 457 children diagnosed with appendicitis. Based on BMI percentiles, patients were classified as either underweight (n = 36), normal weight (n = 346), overweight (n = 59), or obese (n = 16). Diagnosis accuracy was measured by negative appendectomy rate, perforation rate, and number of consultations. Treatment quality was measured by complication rate and length of hospital stay.ResultsUnderweight patients had the highest negative appendectomy (OR 3.00, P = 0.008) and complication (OR 2.75, P = 0.041) rate. BMI did not influence perforation rate or number of consultations. Both underweight and obese patients stayed in the hospital longer than normal weight patients (regression coefficient 2.34, P = 0.001, and regression coefficient 9.40, P < 0.001, respectively).Furthermore, in obese patients, the hospital stay after open appendectomy was prolonged compared to laparoscopic appendectomy (P < 0.001). No such differences were observed in patients with lower BMI.ConclusionsUnderweight children are misdiagnosed more often, stay in hospital longer, and experience more postoperative complications than children of normal weight. Obesity is associated with longer hospital stays. Laparoscopic appendectomy might shorten the length of hospital stays in these patients. We conclude that in addition to obesity, underweight should also be considered a risk factor for children with appendicitis.

Киришүү. Кыргыз Республикасынын улуттук статистикалык комитетинин маалыматына таянсак жалпы өлкөнүн жарандарынын арасында улгайган жана кары адамдардын саны жылдан жылга карай өсүүдө.Ал эми ошол адамдырдын 12ден 18 пайызга чейинкиси курч аппендицит дарты менен хирургиялык бөлүмдөргө жаткырылат жана дарыланышат. Курч аппендицит кечиктирилгис хирургияда кеңири таралган жа на жакшы изилденген оорулардын бири экенине карабастан улгайган жана кары адамдарда курч аппендицитти аныктоо жана даарылоо толук изилденбеген бойдон калууда. Изилдөөнүн максаты. Улгайган жана кары адамдардагы курч аппендицит дартында лапароскопиялык жол менен жана ачык түрдө жасалган операциялардын жыйынтыктарын баалоо. Материалдар жана методдор. Изилдөө Кыргыз Республикасынын Саламаттык сактоо министрлигинин Академик М. М. Мамакеев атындагы Улуттук хирургиялык борборунда дарыланган улгайган жана кары адамдардын арасында жургүзүлдү. 01.01.2022 жылдан баштап 01.01.2024 жылга чейин академик М. М. Мамакеев атындагы Улуттук хирургия борборуна курч аппендицит дарты аныкталып, операция болуп дарыланган 60 жаштан 90 жашка чейинки бейтаптардын оору баяндарына ретроспективдүү изилдөө жүргүзүлдү. Изилдөөгө жалпысынан 166 бейтап катышты, алардын 58 бейтап негизги топко, ал эми 108 бейтап контролдук топко бөлүндү. Натыйжалар жана талкуулоо. Операциялардын узактыгын эсептегенде ачык жол менен жасалган аппендэктомиянын узактыгы лапароскопиялык операциянын узактыгынан бир топ эле узак болгон. Ачык аппендэктомия 50±20 минут. Лапароскопиялык аппендэктомия - 30±5 минут. Бейтаптардын операциядан кийинки ооруканада жаткан убактысын карап көргөнүбүздө лапароскопиялык жол менен операция болгон бейтаптардын убактысы 4,0±2,0 күндү түзсө, ачык жол менен операция болгондордун убактысы 7,0±4,0 күндү түзгөн. Улгайган жана кары адамдарда курч аппендицитти дарылоодо видеолапароскопиялык технологияларды колдонуу экономикалык жагынан да алганда натыйжалуу болуп эсептелет. Ал лапароскопиялык операциянын узактыгы аз экени жана бейтаптардын операциядан кийинки убакта ооруканада жатуусунун кыска убакытка созулганы менен түшүндүрүлөт. Жыйынтыгы. Лапароскопиялык аппендэктомия улгайган жана кары адамдардагы курч аппендицитти дарылоодо тандалып алына турган операциянын түрү болуп саналат. Введение. По данным Национального статистического комитета Кыргызской Республики, количество пожилых людей среди граждан страны в целом увеличивается из года в год. От 12 до 18 % из числа этих людей госпитализируются и лечатся по поводу острого аппендицита. Несмотря на то, что острый аппендицит является одним из наиболее распространенных и хорошо изученных воспалительных сос тояний, требующих экстренного хирургического вмешательства, его диагностика и лечение у лиц пожилого и старческого возраста остаю тся малоизученными. Цель исследования. Оценка результатов лапароскопических и открытых операций при остром аппендиците у лиц пожилого и старческого возраста. Материалы и методы. Исследование проводилось среди пациентов пожилого и старческого возраста Национального хирургического центра имени академика Мамакеева М. М. Министерства здравоохранения Кыргызской Республики. Проведено ретроспективное исследование историй болезни пациентов в возрасте от 60 до 90 лет с диаг нозом «острый аппендицит», пролеченных хирургическим путем в Национальном хирургическом центре имени М. М. Мамакеева в период с 01.01.2022 по 01.01.2024 годы. Всего в исследовании приняли участие 166 пациентов, из них 58 человек были распределены в основную группу, а 108 - в контрольную. Результаты и обсуждение. При расчете продолжительности операции открытая аппендэктомия проводилась достоверно дольше, чем лапароскопическая операция. Открытая аппендэктомия длилась 50±20 минут, лапароскопическая аппендэктомия - 30±5 минут. Время пребывания пациентов в стационаре после лапароскопической операции составило 4,0±2,0 дня, а после открытой операции - 7,0±4,0 дня. Использование видеолапароскопической технологии при лечении острого аппендицита у лиц пожилого и старческого возраста считается экономически целесообразным. Это объясняется тем, что данные операции характеризуются более низкой длительностью оперативного пособия и меньшей продолжительностью стационарного лечения. Заключение. Лапароскопическая аппендэктомия является более эффективным методом оперативного лечения больных пожилого и старческого возраста с диагнозом «острый аппендицит». Introduction. According to the National Statistical Committee of the Kyrgyz Republic, the number of elderly people among the country's citizens as a whole is increasing from year to year. Between 12 and 18 percent of these people are hospitalized and treated for acute appendicitis. Despite the fact that acute appendicitis is one of the most common and well-studied diseases requiring emergency surgical intervention, the diagnosis and treatment of acute appendicitis in elderly and senile people remains poorly studied. Operations for acute appendicitis occupy first place among general surgical operations. Currently, appendectomy is performed through an open incision (Volkovich-Dyakanov incision) and laparoscopically. The purpose of the study. Evaluation of the results of laparoscopic and open operations for acute appendicitis in elderly and senile people. Materials and methods. The study was conducted among elderly and senile patients of the National Surgical Center named after Academician M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic. A retrospective study of the case histories of patients aged 60 to 90 years with a diagnosis of acute appendicitis, treated surgically at the National Surgical Center named after Mamakeev from 01.01.2022 to 01.01.2024, was conducted. A total of 166 patients took part in the study, of which 58 patients were assigned to the main group, and 108 patients to the control group. Results and discussion. When calculating the duration of the operation, the duration of open appendectomy was significantly longer than the duration of laparoscopic surgery. Open appendectomy 50±20 minutes. Laparoscopic appendectomy - 30±5 minutes. When considering the time of stay of patients in the hospital after surgery, the stay after laparoscopic surgery was 4.0±2.0 days, and the stay after open surgery was 7.0±4.0 days. The use of video laparoscopic technology in the treatment of acute appendicitis in elderly and senile patients is considered cost-effective. This is explained by the fact that laparoscopic operations are characterized by a shorter duration of surgery and a shorter duration of inpatient treatment. Conclusion. Laparoscopic appendectomy is the method of choice for surgical treatment of elderly and senile patients diagnosed with acute appendicitis.

Background: The normal treatment based on acute appendicitis is appendectomy. Traditional appendectomy procedures have been open appendectomy (OA), but laparoscopic appendectomy (LA) has the benefits of minimally invasive surgery. Aim: To compare laparoscopic and open appendectomy in the treatment of acute appendicitis in patients about safety and efficacy. Methodology: A comparative observational study was conducted involving 80 patients (40 with local anesthesia and 40 with overall anesthesia) in the Department of General Surgery at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. Included in the patients were those over 10 years who were diagnosed with acute appendicitis. The variables analyzed included operative time, postoperative recovery, complications, hospital stay and return to normal activity. Results: OA had a shorter operating time (31.4 vs. 54.9 min, p&lt;0.0001). LA patients experienced earlier bowel movements and diet tolerance (92.5% vs. 70% and 85% vs. 62.5%; p&lt;0.001), lower analgesic requirements, shorter hospital stays (1.4 vs. 2.7 days; p=0.015), and faster return to normal activity (11.5 vs. 16.1 days; p&lt;0.001). Wound-related complications were significantly lower in LA (infection: 10% vs. 82.5%; dehiscence: 0% vs. 32.5%; p&lt;0.001). Major intra-abdominal complications were comparable. Conclusion: Laparoscopic appendectomy, despite longer operative time, offers superior postoperative recovery, fewer wound complications, and earlier return to normal activities, making it the preferred approach for uncomplicated acute appendicitis when feasible.

Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese

Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open appendectomy in the treatment of complicated appendicitis in children. Patients and methods: During the period from October 2012 to March 2016, 390 children with acute complicated appendicitis diagnosed clinically and with laboratory and available imaging studies were operated. LA performed for 200 cases and open conventional appendectomy for 190 cases. Three ports technique was used in laparoscopic cases. The operating table is shifted in Trendelenburg position and towards the left side. The surgeon stands on the left side of the patient. The appendicular mesoappendix was secured using electro cautery. The base was secured by extracorporeal ties and the appendix was retrieval within the umbilical port. The wounds were closed. Open appendectomy was done through McBurny incision as the traditional approach. Results: A total of 390 children diagnosed with acute complicated appendicitis were operated. The mean age was 12.04 years in group A and 12.2 in group B. There were 260 were boys and 130 were girls. The mean operative time in the laparoscopic group was 56.4 min; while in the conventional group was 63.42 min. Conclusion: LA was a suitable, effective and safe procedure in complicated cases that did not involve the base. It was associated with lower complications rate with all the advances of minimal invasive surgery when compared to the conventional open appendectomy. Keywords: appendectomy, children, complicated, laparoscopic

In recent years there has been worldwide increase in childhood obesity. However, in the beginning laparoscopic appendectomy in obese children was contraindicated, now it is commonly used for the treatment of appendicitis. The purpose of this study was to compare open versus laparoscopic appendectomy in extremely obese children. The hospital records of 1,383 consecutive patients, who underwent appendectomy for acute appendicitis between 2000 and 2009 were analyzed. 238 children (17.2%) were extremely obese. Extremely obese was defined, as greater than 2 standard deviations above the standardized mean weight for age. 61 of 238 (25.6%) patients had open appendectomy and 177 (74.3%) underwent laparoscopic appendectomy. The length of hospital stay, operation time, complication rate and frequency of taking postoperative pain relief were compared between open and laparoscopic appendectomy in extremely obese children. The incidence of complicated and non-complicated appendicitis was similar both in open and laparoscopic appendectomy group. Laparoscopic appendectomy for acute appendicitis in extremely obese children is associated with significantly shorter operating time (46.8 vs. 59.87 min, P < 0.05), lower overall complication rate (5 vs. 8.2%, P < 0.05) and lesser postoperative analgesia requirement (6.97× vs. 4.73×, P < 0.05). Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in extremely obese children.

&lt;p dir="ltr"&gt;Acute appendicitis is a clinical term for inflammation of the vermiform appendix with a sudden onset. Symptoms depend both on the age of a patient and on the position of appendix intraabdominally. The aetiology remains unknown, although, there are multiple theories. The lifetime risk of acute appendicitis in Western countries has been established as 7-8%, with 8.6% for males and 6.7% for females. The standard treatment has been surgery for many decades, but non-operative treatment, in the form of antibiotics, has more recently come to light as a feasible alternative to appendectomies.&lt;/p&gt;&lt;p dir="ltr"&gt;Aims: The aim of this thesis was to assess intermediate and long-term outcomes of non- operative treatment in both children and adults. This included assessing safety and feasibility of non-operative treatment and its complications. An additional aim was to ascertain the failure rate of non-operative treatment and recurrence of acute uncomplicated appendicitis in children and try to establish the reasons for the treatment failure.&lt;/p&gt;&lt;p dir="ltr"&gt;Methods: Study I was a 5-year follow-up of all participants who underwent surgery or non- operative treatment with antibiotics in a previous randomised controlled pilot trial. Data was extracted from the hospital notes and telephone interviews.&lt;/p&gt;&lt;p dir="ltr"&gt;Study II was a long-term follow-up of adults with acute appendicitis who were involved in two randomised controlled trials, which compared non-operative treatment with appendectomy. The first trial consisted of 40 patients (13 female) and second trial was a multicentre study with 252 male patients. National registers were used to retrieve data at follow up, including the Swedish National Patient Register, the Cancer Register, the Cause of Death Register and Statistics Sweden.&lt;/p&gt;&lt;p dir="ltr"&gt;Study III was a systematic review that was registered in PROSPERO (CRD42024592607) and done according to PRISMA statement. We searched three databases (PubMed, Medline, Web of Science). Eligible studies were randomised controlled trials or prospective cohort studies with children aged &lt;18 years that received non-operative treatment for uncomplicated appendicitis and reporting at least 30 days follow-up. We carried out a meta- analysis.&lt;/p&gt;&lt;p dir="ltr"&gt;Results: In Study I, we followed up all 50 children (26 children in the appendectomy group, 24 children in the nonoperative group) for at least 5 years. The surgical group was without failures and in the nonoperative group there were 11 failures and recurrences. In the first year there were nine failures, two of them had an appendicitis on the histopathology. Another two recurrences, that were histopathologically confirmed appendicitis occurred one to five years after the initial trial. At the 5-year follow-up, 54% of children had been successfully treated nonoperatively with antibiotics alone.&lt;/p&gt;&lt;p dir="ltr"&gt;In Study II, in total, we were able to trace down 259 patients in the Patient Register, 137 patients in the non-operative group and 122 in the surgical group. At the end of follow-up, 82 (60%) patients had had successful non-operative treatment without an appendectomy. In the non-operative group there were 21 (15%) failures during the first admission. Thirty-four recurrences happened after discharge, all with a diagnostic code of acute appendicitis. After successful initial treatment, 82/116 (71%) remained without appendectomy.&lt;/p&gt;&lt;p dir="ltr"&gt;In Study III, through a systematic search we were able to identify 2343 abstracts. Thirty studies were eligible, 8 randomised controlled trials and 22 prospective cohort studies reporting 27 different patient cohorts. An early failure rate occurred in 10% (95% CI 7-14%) and the recurrence rate was 29% (95% CI 24-34%) at the end of follow-up. When analysing studies with faecalith, a failure rate was higher (17% versus 6.4%) with P-value &lt;0.0001.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions: Studies I and II demonstrated intermediate- and long-term safety of non- operative treatment alone in children and adults. This treatment does not increase the risk of malignancy and other complications and patients avoid surgery. Study III demonstrated a low initial failure rate and the recurrence rate was 29%. Non-operative treatment was less successful in children with a faecalith, particularly during first admission. These results can be used for discussion about treatment options of uncomplicated appendicitis with child patients and their caregivers.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. &lt;b&gt;Patkova B&lt;/b&gt;, Svenningsson A, Almström M, Eaton S, Wester T, Svensson JF. Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial. Ann Surg. 2020 Jun;271(6):1030-1035. &lt;a href="https://doi.org/10.1097/SLA.0000000000003646"&gt;https://doi.org/10.1097/SLA.0000000000003646&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Pátková B,&lt;/b&gt; Svenningsson A, Almström M, Svensson JF, Eriksson S, Wester T, Eaton S. Long-Term Outcome of Nonoperative Treatment of Appendicitis. JAMA Surg. 2023 Oct 1;158(10):1105-1106. &lt;a href="https://doi.org/10.1001/jamasurg.2023.2756"&gt;https://doi.org/10.1001/jamasurg.2023.2756&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Patková B&lt;/b&gt;, Svenningsson A, Jumah S, Wester T, Eaton S. Failure and recurrence of non-operative treatment of uncomplicated appendicitis in children; a systematic review and meta-analysis. [Manuscript]&lt;/p&gt;