Jan F Svensson1, Barbora Patkova, Markus Almström, Hussein Naji, Nigel J Hall, Simon Eaton, Agostino Pierro, Tomas Wester. 1. *Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden †Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden ‡Surgery Unit, UCL Institute of Child Health, London, United Kingdom §Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada ‖Department of Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom.
Abstract
OBJECTIVE: The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children. METHODS: A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year. RESULTS:Fifty patients were enrolled; 26 were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and there were no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n = 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination. CONCLUSIONS: Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.
RCT Entities:
OBJECTIVE: The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children. METHODS: A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year. RESULTS: Fifty patients were enrolled; 26 were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and there were no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n = 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination. CONCLUSIONS: Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.
Authors: Elke Zani-Ruttenstock; Augusto Zani; Emma Bullman; Eveline Lapidus-Krol; Agostino Pierro Journal: Pediatr Surg Int Date: 2014-11-05 Impact factor: 1.827
Authors: Suvi Sippola; Jussi Haijanen; Lauri Viinikainen; Juha Grönroos; Hannu Paajanen; Tero Rautio; Pia Nordström; Markku Aarnio; Tuomo Rantanen; Saija Hurme; Jukka-Pekka Mecklin; Juhani Sand; Airi Jartti; Paulina Salminen Journal: JAMA Surg Date: 2020-04-01 Impact factor: 14.766
Authors: S Shekarriz; T Keck; P Kujath; J Shekarriz; T Strate; R Keller; E Schlöricke; J Nolde; A Ehlert; H Shekarriz Journal: Int J Colorectal Dis Date: 2019-01-22 Impact factor: 2.571
Authors: Anne Andert; H P Alizai; C D Klink; N Neitzke; C Fitzner; C Heidenhain; A Kroh; U P Neumann; M Binnebösel Journal: Langenbecks Arch Surg Date: 2017-07-27 Impact factor: 3.445
Authors: David A Talan; Darin J Saltzman; William R Mower; Anusha Krishnadasan; Cecilia M Jude; Ricky Amii; Daniel A DeUgarte; James X Wu; Kavitha Pathmarajah; Ashkan Morim; Gregory J Moran Journal: Ann Emerg Med Date: 2016-12-11 Impact factor: 5.721
Authors: Salomone Di Saverio; Mauro Podda; Belinda De Simone; Marco Ceresoli; Goran Augustin; Alice Gori; Marja Boermeester; Massimo Sartelli; Federico Coccolini; Antonio Tarasconi; Nicola De' Angelis; Dieter G Weber; Matti Tolonen; Arianna Birindelli; Walter Biffl; Ernest E Moore; Michael Kelly; Kjetil Soreide; Jeffry Kashuk; Richard Ten Broek; Carlos Augusto Gomes; Michael Sugrue; Richard Justin Davies; Dimitrios Damaskos; Ari Leppäniemi; Andrew Kirkpatrick; Andrew B Peitzman; Gustavo P Fraga; Ronald V Maier; Raul Coimbra; Massimo Chiarugi; Gabriele Sganga; Adolfo Pisanu; Gian Luigi De' Angelis; Edward Tan; Harry Van Goor; Francesco Pata; Isidoro Di Carlo; Osvaldo Chiara; Andrey Litvin; Fabio C Campanile; Boris Sakakushev; Gia Tomadze; Zaza Demetrashvili; Rifat Latifi; Fakri Abu-Zidan; Oreste Romeo; Helmut Segovia-Lohse; Gianluca Baiocchi; David Costa; Sandro Rizoli; Zsolt J Balogh; Cino Bendinelli; Thomas Scalea; Rao Ivatury; George Velmahos; Roland Andersson; Yoram Kluger; Luca Ansaloni; Fausto Catena Journal: World J Emerg Surg Date: 2020-04-15 Impact factor: 5.469