NOT (non-op treatment) for Appendicitis

June 5, 2017

Short Attention Span Summary

Non-operative treatment (NOT) for appendicitis
This meta-analysis looked at 5 studies of antibiotics for pediatric appendicitis and found that the success rate was 90.5%, with more treatment failure in children with an appendicolith.  Interestingly, in March 2017 Pediatrics, a separate meta-analysis found the rate of recurrent appendicitis in children treated non-operatively was 14%.  That’s high.  This is just my opinion, but I’m not on board with treating this non-operatively.  Appendicitis is hard to diagnose, has a higher morbidity and mortality if ruptured, and requires more imaging (possibly repeat CT) if it comes back after non-op treatment.  If 10-14% have recurrence, how much is that increasing morbidity and radiation exposure in these kids?  I am open to learning more, so feel free to comment, but is it worth it when a definitive surgical fix has existed for over 132 years?

Spoon Feed
Non-operative treatment is an option for pediatric acute appendicitis.  But I don’t plan to recommend it to patients.  Neither does Skeptical Scalpel or Journal Watch.

Source
Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis. JAMA Pediatr. 2017 Mar 27. doi: 10.1001/jamapediatrics.2017.0057. [Epub ahead of print]

Written by Clay Smith.  Peer reviewed by Thomas Davis.