Nonoperative Treatment for Acute Uncomplicated Appendicitis in Childhood

Nonoperative treatment (NOT) has emerged as a potential alternative to surgery for acute uncomplicated appendicitis in children; although short-term outcomes are often favourable, concerns remain regarding the durability of treatment, the incidence of complications, and long-term failure. Updated meta-analyses of randomized clinical trials (RCTs) may help clarify the comparative safety and effectiveness versus appendectomy. Objective: To assess the safety and effectiveness of NOT compared with appendectomy for uncomplicated appendicitis in children using the highest level of available evidence. Methods: A systematic review of PubMed, Embase, Scopus, Cochrane, and Web of Science was conducted. Results: In this systematic review and meta-analysis of 8 randomized clinical trials including 1480 children and adolescents, NOT (nonoperative antibiotic treatment) was associated with a significantly higher risk of treatment failure at 1 year and an increased incidence of major complications compared to appendectomy. Although NOT resulted in a modestly faster return to school and daily activities, this benefit may be offset by higher rates of readmission and reintervention. Conclusion: Although NOT offers a shorter initial recovery, higher failure rates and major complications limit its role as a primary treatment strategy. The data suggest that appendectomy offers better outcomes in children and adolescents with uncomplicated appendicitis.