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?
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]