Our Summary

Doctors don’t agree on the best way to treat severe cases of appendicitis in children. This study looked at two different methods: non-operative management (NOM), which involves treatment without surgery, and operative management (OM), which does include surgery.

The researchers looked at different studies that compared these two treatment methods in children with severe appendicitis. They divided the studies into groups based on the type of appendicitis: either an appendiceal abscess or phlegmon (AAb/AP), which is a type of swelling caused by infection, or free perforated appendicitis (FPA), which is when the appendix has burst.

They looked at 14 studies involving 1,288 patients in total. The results showed that for children with AAb/AP, the NOM method had fewer complications and fewer cases of patients needing to be readmitted to the hospital. For children with FPA, the OM method had better results.

In terms of costs, there wasn’t a big difference between the two methods. However, children treated with OM had shorter hospital stays. The NOM method worked about 90% of the time, but about 15% of patients had their appendicitis return.

In conclusion, for children with AAb/AP, the NOM method had better results in terms of fewer complications and readmissions. But for children with FPA, the OM method was better.

FAQs

  1. What are the two different methods of treating severe cases of appendicitis in children?
  2. How do the results from the study compare between non-operative management (NOM) and operative management (OM) for different types of appendicitis?
  3. What is the recurrence rate of appendicitis in children treated with the non-operative management (NOM) method?

Doctor’s Tip

It is important to discuss the best treatment option with your doctor based on your individual case and preferences. Additionally, make sure to follow your doctor’s post-operative instructions for a smooth recovery.

Suitable For

Overall, appendectomy is typically recommended for patients with severe appendicitis, especially those with a burst appendix (FPA). However, in cases of appendiceal abscess or phlegmon (AAb/AP), non-operative management may be a viable option with good outcomes. It is important for healthcare providers to carefully consider the individual patient’s condition and weigh the risks and benefits of each treatment method before making a recommendation for appendectomy.

Timeline

Before appendectomy:

  • Patient experiences symptoms of appendicitis such as abdominal pain, nausea, vomiting, and fever.
  • Patient undergoes physical examination and diagnostic tests such as blood tests and imaging studies to confirm the diagnosis of appendicitis.
  • If appendicitis is confirmed, the patient is scheduled for an appendectomy surgery.

After appendectomy:

  • Patient undergoes the surgical procedure to remove the inflamed appendix.
  • Patient is monitored in the hospital for a period of time to ensure recovery and manage pain.
  • Patient may experience some discomfort and pain at the incision site.
  • Patient is discharged from the hospital once they are stable and able to tolerate oral intake.
  • Patient is advised to rest and avoid strenuous activities for a period of time.
  • Patient may need to follow up with their healthcare provider for post-operative care and monitoring.
  • Patient typically recovers fully within a few weeks and can resume normal activities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about appendectomy include:

  1. What are the risks and benefits of non-operative management (NOM) versus operative management (OM) for severe appendicitis in children?
  2. How will the decision between NOM and OM be made for my child’s specific case of severe appendicitis?
  3. What factors will be considered in determining the best treatment approach for my child?
  4. What are the potential complications and outcomes associated with each treatment method?
  5. How likely is it that my child’s appendicitis will return after non-operative management?
  6. How long is the recovery time expected to be for each treatment method?
  7. Will my child need to be readmitted to the hospital after treatment, and if so, how common is this?
  8. Are there any long-term effects or considerations to keep in mind with either treatment method?
  9. How will the cost of treatment be affected by choosing NOM versus OM?
  10. Are there any alternative treatment options for severe appendicitis in children that we should consider?

Reference

Authors: Fugazzola P, Coccolini F, Tomasoni M, Stella M, Ansaloni L. Journal: J Pediatr Surg. 2019 Nov;54(11):2234-2241. doi: 10.1016/j.jpedsurg.2019.01.065. Epub 2019 Feb 25. PMID: 30857730