Uncomplicated Appendicitis In Children May Not Require Surgery: Study

Treating children who have appendicitis with antibiotics, instead of emergency surgery, may help to reduce the time the child spends recovering and reduce the risk of surgical complications, according to the findings of a new study.

Researchers with Ohio State University found that children recovered from uncomplicated appendicitis faster if they were treated with antibiotics instead of undergoing a laparoscopic appendectomy.

The findings were published July 27, in the Journal of the American Medical Association (JAMA).

Appendectomy is a surgical operation done to remove the appendix when it is inflamed or infected. The main concern is when the appendix bursts prior to surgery. This can allow the contents of the intestines to leak out into the body causing tissue damage or lead to sepsis, a life-threatening condition. When left untreated a burst appendix can cause death, which is why emergency appendectomy is often done.

However, in recent years some doctors have attempted to treat appendicitis with antibiotics to prevent it from bursting and requiring emergency surgery.

In this latest study, researchers conducted a non-randomized controlled intervention study including 1,000 children ages seven through 17. Children selected for the study had uncomplicated appendicitis and were treated at one of 10 children’s hospitals across seven U.S. states between May 2015 and October 2018, with a follow-up after one year.

The study compared children who underwent urgent laparoscopic appendectomy surgery within 12 hours of admission to the hospital and children who were treated with antibiotics alone.

A total of 67% of the children received non-operative management with antibiotics alone and did not require an appendectomy surgery by one year. Compared with an urgent appendectomy, initial treatment with antibiotics alone was significantly linked to fewer patient disability days.

Children who received an appendectomy had an average of 11 disability days where they could not participate in normal activities. Children who were treated with antibiotics had an average of 6 disability days.

“Among children with uncomplicated appendicitis, an initial nonoperative management strategy with antibiotics was successful for most children and, compared with urgent surgery, was associated with significantly fewer disability days at 1 year,” the researchers concluded.

The findings may help treat children with appendicitis much earlier and prevent many emergency surgeries from occurring overall if more doctors began following the early antibiotic protocol for appendicitis. The study’s authors determined more research is needed to determine the long-term effects.