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Non-operative management of uncomplicated acute appendicitis in children: where is the evidence?
  1. Katie E Rollins,
  2. Dileep N Lobo
  1. Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Unit, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK
  1. Correspondence to Professor Dileep N Lobo, Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham NG7 2UH, UK; dileep.lobo{at}nottingham.ac.uk

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Appendicitis is the most common emergency condition in children, with a lifetime incidence of 7% to 8%. Appendicectomy has been the mainstay of treatment of acute appendicitis in both adults and children for over 100 years, with the laparoscopic approach being favoured in recent times. However, in addition to the need for general anaesthetia, there are potential risks and complications associated with the procedure. Moreover, in children, surgical procedures are associated frequently with both physiological and psychological stress for the patient and their parents, as well as having an economic impact. The management of uncomplicated acute appendicitis, in both adults and children, is currently in a state of significant flux. Evidence from a number of randomised controlled trials and case-controlled series have been combined in systematic reviews and meta-analyses, and in the adult literature the role of primary antibiotic therapy for the management of uncomplicated acute appendicitis is becoming supported increasingly.1 Surgery is generally regarded as a more effective initial treatment option than antibiotic therapy due to the largely unknown long-term risk of recurrent appendicitis following non-operative management. However, in adults, surgery is associated with greater complication rates and increased incidence of readmission than primary antibiotic therapy.1 Nevertheless, antibiotic therapy is not recommended currently as the first-line treatment strategy.2

Within the field of paediatrics, the evidence base for non-operative treatment is limited, with just one randomised controlled trial3 investigating its role in acute non-perforated appendicitis. However, this was a pilot study, …

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