Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial
Topic overview
Five-year follow-up of 50 children with acute nonperforated appendicitis shows 46% of those treated with antibiotics eventually required appendectomy, though only 17% had histologically confirmed appendicitis. No patients treated nonoperatively developed complicated appendicitis, suggesting antibiotic treatment is safe but has moderate failure rates requiring surgical intervention.
Key takeaways
- 46% of children treated nonoperatively for acute appendicitis required appendectomy within 5 years, but only 17% had histologically confirmed appendicitis.
- Antibiotic treatment appears safe in intermediate-term follow-up; no patients developed complicated appendicitis after initial nonoperative management.
- Most treatment failures (9/11) occurred within the first year; only 2 recurrences happened between years 1-5.
- Appendectomy group had zero failures, while nonoperative group had 46% failure rate, raising questions about patient selection for conservative management.
- Histologic confirmation was low (17%) among those who eventually required surgery, suggesting some appendectomies may have been for non-appendiceal pathology.
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