There are reports being published of children with acute appendicitis who received non-operative treatment with antibiotics rather than an appendectomy. Georgiou et al. (10.1542/peds.2016-3003) have compiled a systematic review and meta-analysis of studies done to date to determine the safety and efficacy of non-operative treatment (NOT) for appendicitis that we are early releasing this week. Ten articles inclusive of 413 children who got NOT were included in the meta-analysis, 6 of which compared NOT with appendectomy, one being a randomized controlled trial. The bottom line that bears your scrutiny is that NOT is as effective as surgical treatment 97% of the time although surgery resulted in a slightly shorter length of stay although in about 20% of cases of NOT, an appendectomy was needed with recurrent appendicitis occurring about 14% of the time. The authors conclude their analysis suggesting that NOT is a safe approach to appendicitis although it can increase length of stay and may still in a minority of circumstances require a surgical operation anyway.
So what do you think? Are the pediatric surgeons you work with using NOT or still preferring to operate?Does this review make you reconsider your approach? We hope you will share with us your thoughts on NOT for appendicitis by responding to this blog, posting a comment on our journal website with the article, or sharing a thought on our Facebook or Twitter pages. We hope this study will trigger more randomized trials with long-term follow-up to better determine if the NOT approach is a cut above the surgical one.