Non-operative Management of Acute Appendicitis in Pediatric Population, A Narrative Review

Taqvai Nakhjiri, Mobina; Ghavami Adel, Maryam

Non-operative Management of Acute Appendicitis in Pediatric Population, A Narrative Review

Document Type : Review Article

Authors

Mobina Taqvai Nakhjiri

Maryam Ghavami Adel

Associate Professor, Department of Pediatric Surgery, Faculty of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital

Abstract

Background and Objective: Acute appendicitis has traditionally been treated with operative approaches. Recent advances in diagnostic techniques have coincided with the introduction of novel non-invasive treatment options. Original studies on this topic indicate that non-operative management of acute appendicitis in the pediatric population is feasible. This review examines the current literature on the efficacy, safety, and long-term outcomes of non-operative treatments and provides an overview of this management strategy.
Materials & Methods: In the pursuit of conducting this narrative review, a systematic search was performed using the Scopus, Embase, ISI, and Google Scholar databases. The inclusion criteria encompassed original articles, review papers, and meta-analyses focusing on the non-surgical treatment of acute appendicitis in the pediatric population. This study employed a descriptive-analytical approach. All relevant literature was thoroughly evaluated, and data were carefully extracted; the findings and insights obtained from these sources were subsequently integrated into various sections of this review.
Results: Non-operative management has been reported to result in a shorter hospital stay and higher patient satisfaction compared to operative management. Key factors in selecting the appropriate candidates for non-operative treatment include younger age, shorter duration of symptoms and fever, mild clinical presentations, lower white blood cell and C-reactive protein (CRP) levels on laboratory tests, and smaller appendix diameter on imaging. Further Randomized Controlled Trials (RCT) with longer follow-up periods and similar antibiotic regimens are needed to address the heterogeneity of previous studies.
Conclusion: Existing evidence from previous studies supports the non-surgical management of uncomplicated acute appendicitis in children. However, it is crucial to develop comprehensive guidelines for patient selection. These guidelines are necessary to reduce the risk of misdiagnosis and to prevent the occurrence of serious complications resulting from inadequate treatment.

Keywords

Pediatrics

Appendicitis

Antibiotics

non-operative management

appendectomy

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