A meta-analysis of all recent studies involving nonoperative treatment (NOT) for pediatric acute uncomplicated appendicitis (AUA) highlights indications of safety and efficacy of this alternative treatment.
Perhaps one of the most common general medical emergencies resulting in surgery is acute appendicitis. Likelihood of acute appendicitis incidence peaks in children between the ages of 10 and 18. Typically, acute appendicitis is treated surgically, with an appendectomy (or surgical removal of the appendix). However, this surgical solution can present financial complications in addition to concerns regarding the use of surgery and general anesthesia on children. This begs the question: Is there a viable nonoperative alternative for acute uncomplicated appendicitis (AUA)?
NOT for acute appendicitis is defined as the use of antibiotics as a primary treatment, without surgery. Due, in large part, to a lack of clinical evidence pointing to long-term efficacy, NOT remains both unproven and controversial within the medical community.
The Journal of the American Academy of Pediatrics (2017) recently published a review of all relevant articles citing the use of nonoperative treatment (NOT) for pediatric acute uncomplicated appendicitis. 10 articles were included in this meta-analysis, reporting outcomes for 413 children under the age of 18 diagnosed with AUA that were initially treated with NOT. Efficacy of this treatment method was determined by successful discharge of the patient from the hospital without undergoing surgery for an appendectomy. A side-by-side comparison was also conducted, comparing risks and outcomes for NOT versus appendectomy.
Results show a 97% success rate with the use of NOT as an appendectomy alternative for acute uncomplicated appendicitis during the initial hospital visit. For 17 out of 413 children included in the studies, researchers determined that NOT was an unsuccessful initial treatment, as these individuals underwent appendectomy after being admitted to the hospital.
Notably, the characteristics of each study included in the meta-analysis varied in techniques of diagnosis, antibiotic regimen used to treat acute appendicitis, follow-up periods after initial treatment, and selection criteria for the study participants.
While initial indications demonstrate a promising level of efficacy of NOT for acute appendicitis, there is not currently enough data to definitively support transitioning this treatment method into mainstream implementation. Further research is required to counteract limitations of the studies included in this meta-analysis, paying particular attention to outcomes of recurrent appendicitis as well as duration and completeness of post-discharge follow-up. By conducting further studies on the long-term efficacy and cost-effectiveness of an alternative to surgical treatment, we may be able to improve accessibility to effective treatment and lessen financial burdens for patients all over the world.
Written By: Jennifer Newton