Zvi Steiner1,2, Genady Buklan3,4, Michael Gutermacher3,4, Ita Litmanovitz5,4, Tal Landa3, Shmuel Arnon5,4. 1. Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel. zvi.steiner@clalit.org.il. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. zvi.steiner@clalit.org.il. 3. Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel. 4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 5. Department of Neonatology, Meir Medical Center, Kfar Saba, Israel.
Abstract
PURPOSE: Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center's experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria. METHODS: Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis. RESULTS: Included in CAT: 362 children, 19 underwent appendectomy within 1-2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6-43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations. CONCLUSION: We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.
PURPOSE: Appendectomy versus conservative antibiotic treatment (CAT) for children with acute uncomplicated appendicitis (AUA) remains unresolved, with concerns regarding the practicality of CAT. We analyzed our center's experience with CAT for AUA, using a protocol with strict inclusion, exclusion and treatment criteria. METHODS: Non-randomized, prospective cohort study included all children admitted betwee 2014 and 2016, with clinical and laboratory tests suspicious for AUA. Data collected included clinical signs and symptoms; laboratory, ultrasound and pathology results. Follow-up was conducted through clinic visits, telephone conversations and national registry analysis. RESULTS: Included in CAT: 362 children, 19 underwent appendectomy within 1-2 days. Overall, 75 were readmitted for recurrent acute appendicitis during 22 months (6-43) follow-up. Thirty were treated successfully with antibiotics a second time. The remaining 45 had appendectomy. Overall, 86.8% underwent CAT with no surgery. Histology of all recurrent AUA revealed no perforations. CONCLUSION: We confirm the feasibility of conservative management of AUA in children. A rigorous diagnostic plan with strict inclusion and exclusion criteria will lead to high success rate of CAT with a strong safety profile. CAT does not compete with surgery or render appendectomy unnecessary. It is a safe alternative to surgery in selected cases.
Authors: Ramon R Gorter; Sarah-May M L The; Marguerite A W Gorter-Stam; Hasan H Eker; Roel Bakx; Johanna H van der Lee; Hugo A Heij Journal: J Pediatr Surg Date: 2017-04-18 Impact factor: 2.545
Authors: Justin B Mahida; Daniel L Lodwick; Kristine M Nacion; Jason P Sulkowski; Karen L Leonhart; Jennifer N Cooper; Erica J Ambeba; Katherine J Deans; Peter C Minneci Journal: J Pediatr Surg Date: 2016-03-02 Impact factor: 2.545
Authors: Ulf Kessler; Selim Mosbahi; Benedict Walker; Eva M Hau; Michael Cotton; Barbara Peiry; Steffen Berger; Bernhard Egger Journal: Arch Dis Child Date: 2017-08-17 Impact factor: 3.791
Authors: Paolo De Coppi; Michela Pozzobon; Martina Piccoli; Maria Vittoria Gazzola; Luisa Boldrin; Elisa Slanzi; Roberta Destro; Luigi Zanesco; Giovanni Franco Zanon; Piergiorgio Gamba Journal: J Surg Res Date: 2006-05-02 Impact factor: 2.192
Authors: Peter C Minneci; Justin B Mahida; Daniel L Lodwick; Jason P Sulkowski; Kristine M Nacion; Jennifer N Cooper; Erica J Ambeba; R Lawrence Moss; Katherine J Deans Journal: JAMA Surg Date: 2016-05-01 Impact factor: 14.766
Authors: Jan F Svensson; Barbora Patkova; Markus Almström; Hussein Naji; Nigel J Hall; Simon Eaton; Agostino Pierro; Tomas Wester Journal: Ann Surg Date: 2015-01 Impact factor: 12.969