No Surgery Required for Children's Appendicitis

Acute appendicitis in children was effectively managed with antibiotics

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Untreated appendicitis can have serious consequences. But surgery may not be the only option for children with appendicitis.

A research team tested whether appendicitis in children could be treated effectively with antibiotics, avoiding the serious procedure and recovery period associated with surgery.

Appendicitis occurs when the appendix, a very small organ near the intestines, becomes inflamed or infected, swollen and painful.

The researchers found that appendicitis was successfully treated with antibiotics in almost all of the children who were treated with them. This treatment meant kids could return to school sooner and felt better than the children whose appendicitis was treated with surgery.

"See a doctor if you have severe abdominal pain."

Katherine J. Deans, MD, and Peter C. Minneci, MD, co-directors of the Center for Surgical Outcomes at The Research Institute at Nationwide Children's Hospital in Columbus, Ohio led this study.

The study enrolled 77 children, ages 7 to 17, with appendicitis. The children and their families were given the option to have surgery or treatment that involved taking antibiotics with no surgery. Thirty children opted for antibiotics and no surgery and 47 chose surgery.

The group that was not treated with surgery received intravenous antibiotics of piperacillin-tazobactam or ciprofloxacin and metronidazole and observation. They were given pain medication, and food was limited for the first 12 hours. Once patients were eating, antibiotics were given by mouth instead of intravenously.

Children in the surgery group were given intravenous antibiotics and had their appendix surgically removed in a procedure called an appendectomy within 12 hours of being admitted to the hospital.

The children in the study were evaluated immediately after treatment and 30 days later to determine if their treatment was successful — meaning no appendectomy was required — and to evaluate their recovery period.

The results showed that 93 percent of the children treated without surgery had a successful recovery that did not require an appendectomy. After 30 days, the success rate in this group was 90 percent.

The no-surgery group had an average of three days of recovery, compared to 17 days for the group of children who had surgery. They returned to school two days earlier than the surgery group. Parents and children in the no-surgery group felt better during the recovery period than the families in the surgery group.

“[F]or families who are averse to surgery, initial non-operative therapy may be the least stressful and most appealing choice because it may eliminate the need for an operation and its inherent risks while expediting a quicker return to activities,” the authors wrote.

"Non-operative management of uncomplicated acute appendicitis in children is feasible with a high 30-day success rate and short-term benefits including a quicker recovery and improved quality of life scores," they concluded.

This study was published April 12 in the Journal of the American College of Surgeons.

A grant from the National Institutes of Health and funding from the Research Institute at the Nationwide Children’s Hospital provided financial support for this research.

The authors declared no conflicts of interest.

Review Date: 
April 16, 2014
Last Updated:
April 19, 2014