Nonoperative Treatment Versus Appendectomy for Acute Nonperforated Appendicitis in Children: Five-year Follow Up of a Randomized Controlled Pilot Trial

Infographic · Sep 2020 · 1 min read

In brief

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.

46% of children treated nonoperatively for acute appendicitis required appendectomy within 5 years, but only 17% had histologically confirmed recurrence.
No child initially treated with antibiotics progressed to complicated appendicitis during 5-year follow-up, suggesting nonoperative management is safe.
Most treatment failures (9/11) occurred within the first year; only 2 children developed recurrent appendicitis between years 1-5.
Appendectomy group had zero failures at 5 years, confirming surgical treatment remains definitive for acute nonperforated appendicitis.
Nonoperative treatment may avoid surgery in over half of pediatric appendicitis cases without increased risk of perforation or complications.

Written by the GCMD Library team from the infographic.

The infographic uses a red and gray color scheme with a circular flow diagram in the center showing a scalpel icon between two treatment pathways. On the left, an illustration shows the appendix location in a child's body. On the right, two boxes display emergency visit and cost statistics. Red arrows connect the treatment failure concept to both surgical and medical management options.

Objective: The aim of this study was to evaluate the safety and feasibility of nonoperative treatment of acute nonperforated appendicitis in children during 5 years of follow-up.

Methods: A 4-year follow-up of a previous randomized controlled pilot trial, including 50 children with acute nonperforated appendicitis, was performed. The patients were initially randomized to nonoperative treatment with antibiotics or appendectomy with 1-year follow-up previously reported. Data were extracted from the computerized notes and telephone interviews.The primary outcome was treatment failure, defined as need for a secondary intervention under general anesthesia, related to the previous diagnosis of acute nonperforated appendicitis.

Results: The children were followed up for at least 5 years [median 5.3 (range 5.0-5.6)] after inclusion. There were no failures in the appendectomy group (0/26) and 11 failures in the nonoperative group (11/24). Nine failures had occurred during the first year after inclusion, 2 of whom had histologically confirmed appendicitis. There were 2 further patients with recurrent acute appendicitis 1 to 5 years after inclusion. Both these patients had uncomplicated laparoscopic appendectomies for histologically confirmed acute appendicitis. There were no losses to follow-up.

Conclusions: At 5 years of follow-up 46% of children treated with antibiotics for acute nonperforated appendicitis had undergone an appendectomy, although acute appendicitis was only histologically confirmed in 4/24 (17%). Treatment with antibiotics seems to be safe in the intermediate-term; none of the children previously treated nonoperatively re-presented with complicated appendicitis.

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