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Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial

Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial
Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial


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.
0003-4932
67-71
Svensson, Jan F.
81a87c5c-ace2-4f69-bfae-3194ccd03cc1
Patkova, Barbora
569d1cb5-a26d-45a1-8940-bc96936943ad
Almström, Markus
9ca7d5c2-3dab-4bed-a1e1-f780d530f5d1
Naji, Hussein
055dc37a-9eab-46b9-9204-d77d930c10da
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Wester, Tomas
8be06244-4516-4a35-9b6d-0b96b110435f
Svensson, Jan F.
81a87c5c-ace2-4f69-bfae-3194ccd03cc1
Patkova, Barbora
569d1cb5-a26d-45a1-8940-bc96936943ad
Almström, Markus
9ca7d5c2-3dab-4bed-a1e1-f780d530f5d1
Naji, Hussein
055dc37a-9eab-46b9-9204-d77d930c10da
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Eaton, Simon
e14103c2-c06a-45e6-87fe-2358a3371283
Pierro, Agostino
74bd6b37-4305-47fd-847d-c19a08718997
Wester, Tomas
8be06244-4516-4a35-9b6d-0b96b110435f

Svensson, Jan F., Patkova, Barbora, Almström, Markus, Naji, Hussein, Hall, Nigel J., Eaton, Simon, Pierro, Agostino and Wester, Tomas (2015) Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Annals of Surgery, 261 (1), 67-71. (doi:10.1097/SLA.0000000000000835). (PMID:25072441)

Record type: Article

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.

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e-pub ahead of print date: 2015
Published date: January 2015
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 375547
URI: http://eprints.soton.ac.uk/id/eprint/375547
ISSN: 0003-4932
PURE UUID: 51710313-48ca-4643-8f74-1431d5b2f837
ORCID for Nigel J. Hall: ORCID iD orcid.org/0000-0001-8570-9374

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Date deposited: 30 Mar 2015 10:43
Last modified: 15 Mar 2024 03:38

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Contributors

Author: Jan F. Svensson
Author: Barbora Patkova
Author: Markus Almström
Author: Hussein Naji
Author: Nigel J. Hall ORCID iD
Author: Simon Eaton
Author: Agostino Pierro
Author: Tomas Wester

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