Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children A Pilot Randomized Controlled Trial

作者：Svensson Jan F^*; Patkova Barbora; Almstrom Markus; Naji Hussein; Hall Nigel J; Eaton Simon; Pierro Agostino; Wester Tomas

来源：Annals of Surgery, 2015, 261(1): 67-71.

DOI：10.1097/SLA.0000000000000835

• antibiotics
• appendicitis
• children
• randomized controlled trial
• surgery

Objective: The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children.
Methods: A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year.
Results: Fifty patientswere enrolled; 26were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and therewere no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n= 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination.
Conclusions: Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.

• 出版日期2015-1