Non-operative management of uncomplicated acute appendicitis in children

Abstract

Introduction. Appendectomy is considered the standard treatment for acute appendicitis. However, numerous current studies have questioned its role as the sole valid standard for managing children with this condition. The objective of this article was to evaluate the efficacy of treating uncomplicated acute appendicitis in children with antibiotics alone. Methods. A prospective longitudinal study was carried out in a cohort of patients aged 5 to 14 years with a diagnosis of uncomplicated acute appendicitis. They received treatment only with antibiotics at a hospital in Northern Peru between January 2023 and February 2024. They were followed up for at least 12 months upon discharge. Efficacy was defined as the remission of appendicitis symptoms with antibiotic treatment during hospitalization and the absence of recurrence during follow-up. Variables were compared between the groups with and without effective treatment using the chi-square test and multivariate analysis with a logistic regression model, with a significance level of 5% (p<0.05). Results. The initial success rate for treating uncomplicated acute appendicitis in children with antibiotics alone was 100%. During follow-up, four cases of recurrence occurred, resulting in an overall success rate of 87.6%. These patients underwent surgery, and none of them developed appendiceal perforation, peritonitis, or intra-abdominal abscess. Conclusions. Antibiotic treatment alone appears to be an effective alternative for the management of uncomplicated acute appendicitis in children.