Management of uncomplicatted accute appendicitis in children

Abstract

Purpose: To review the existing evidence in 2017-2018 and spreading the information, with solid scientific basis, regarding the use of no operative treatment for children with uncomplicated acute appendicitis. Methods: A literature search for the years 2017/2018 was performed using the following descriptors: uncomplicated acute appendicitis, children, paediatric appendicitis, pediatric appendicitis, management, medical treatment, clinical treatment, antibiotics treatment, no operative treatment and surgical treatment, appendectomy. Randomized controlled trials were considered the best source of information. Results: On the reviewed literature, one can say that the no operative approach for uncomplicated acute appendicitis in children presents similar outcome, hospital length of stay, antibiotic days, reduced degree and duration of pain, and overall perioperative complication rates, but there may be more inpatient readmissions and missing other diseases when compared with surgical treatment. However, this new approach reduces negative appendectomy rate, shorter days of sick leave and care leave, expedited return for the child go back to school and other normal activities, decreased hospital charge and less long term complications. Conclusion: Antibiotics treatment alone appears to be a safe first-line therapy in selected children with uncomplicated acute appendicitis and deserves a randomized controlled trial in tertiary hospitals in Brazil. Those patients who require future appendectomy do not experience significant complications. A multicenter Brazilian trial comparing antibiotics-first to appendectomy, including outpatient management, is feasible to evaluate efficacy and safety of this new approach.