Appropriate Treatment for Complicated Appendicitis in Children

Abstract

Purpose: Although emergent appendectomy (EA) for complicated appendicitis (CA) is straightforward, interval appendectomy (IA) following non-operative management (NOM) is sometimes chosen to treat CA because of exacerbated inflammation. We reviewed our institutional experience of CA cases with a focus on the predictor of NOM failure and the outcome of treatments.

Methods: A total of 144 children with CA treated between 2009 and 2018 were retrospectively analyzed. All operations were attempted laparoscopically.

Results: EA was performed on 104 children (Group EA). The remaining 40 initially underwent NOM: 25 underwent IA successfully (Group IA-S), 9 had failed NOM (Group IA-F), and 6 never underwent surgery. On comparing the pretreatment evaluation of EA with NOM, NOM tended to be chosen for cases involving diarrhea and those with an elevated CRP level, those with a larger abscess, or those that took longer to diagnose (p < 0.01 each). On the other hand, EA tended to be chosen for cases involving fecalith (p = 0.006). In the NOM group, the presence of fecalith was likely an independently significant predictor of NOM failure (odds ratio 25.06). On the outcome of treatments, Group IA-S had a significantly shorter duration of surgery, and Group EA had a significantly shorter length of hospitalization (p < 0.001 each). Group IA-F had the highest rate of conversion to laparotomy (p = 0.01).

Conclusions: On the outcome of CA treatments, IA had a shorter operative time, and EA had a shorter length of hospitalization. However, considerable attention to the fact that the presence of fecalith will more likely lead to NOM failure is needed for the treatment decision.