Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible

Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible 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. Keywords Appendectomy · Appendicolith · Children · Conservative http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Pediatric Surgery International Springer Journals

Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible

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Publisher
Springer Berlin Heidelberg
Copyright
Copyright © 2018 by Springer-Verlag GmbH Germany, part of Springer Nature
Subject
Medicine & Public Health; Pediatrics; Surgery; Pediatric Surgery
ISSN
0179-0358
eISSN
1437-9813
D.O.I.
10.1007/s00383-018-4226-4
Publisher site
See Article on Publisher Site

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. Keywords Appendectomy · Appendicolith · Children · Conservative

Journal

Pediatric Surgery InternationalSpringer Journals

Published: Jan 17, 2018

References

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