Is Appendectomy Necessary after Successful Treatment of Acute Appendicitis?

About three-quarters of children do not need an appendectomy after acute appendicitis or appendix mass, according to a new study.

Despite a lack of evidence, many surgeons recommend a routine interval appendectomy after successfully treating appendix mass in children with antibiotics. In their study, researchers aimed to compare routine appendectomy with active observation.
_______________________________________________________________________________________________________________________________________________
RELATED CONTENT
Could Antibiotics Be an Effective Alternative to Appendectomy?
An Unusual Etiology of Appendicitis: A Girl With Appendicitis and Pinworms
_______________________________________________________________________________________________________________________________________________

The researchers recruited 106 children aged 3 to 15 years from the Children’s Interval Appendectomy (CHINA) study at 19 specialist pediatric surgery centers, 17 of which were in the United Kingdom, 1 was in Sweden, and 1 was in New Zealand. Out of the 106 patients, 52 were assigned to interval appendectomy and 54 were assigned to active observation.

Data was analyzed on an intention-to-treat basis, and incidences of recurrent acute appendicitis or appendix mass within 1 year after enrollment in non-operative treatment and severe complications after interval appendectomy were observed.

Overall, 6 children (12%) in the non-operative treatment group had histologically proven recurrent acute appendicitis, and 3 children (6%) in the interval appendectomy group had severe complications.

“Adoption of a wait-and-see approach, reserving appendectomy for those who develop recurrence or recurrent symptoms, results in fewer days in hospital, fewer days away from normal daily activity, and is cheaper than routine interval appendicectomy” the researchers concluded. “These high-quality data will allow clinicians, parents, and children to make an evidence-based decision regarding the justification for interval appendicectomy.”

—Melissa Weiss

Reference:

Hall NJ, Eaton S, Stanton MP, Pierro A, and Burge DM. Active observation verses interval appendectomyafter successful non-operative treatment of an appendix mass in children (CHINA study): an open-label, randomised controlled trial [published online February 6, 2017]. Lancet Gastroenterology and Hepatology. doi: http://dx.doi.org/10.1016/S2468-1253(16)30243-6