Non-operative treatment versus appendectomy for acute uncomplicated appendicitis: A randomized controlled trial

  • Muhammad Nadeem Sajjad, Dr King Edward Medical University, Lahore
  • Fatima Naumeri King Edward Medical University, Lahore https://orcid.org/0000-0003-3532-5553
  • Sehrish Hina, Dr King Edward Medical University, Lahore
Keywords: Acute appendicitis, Children, Non-operative treatment, Conservative management, Uncomplicated appendicitis, Non-perforated appendicitis, Appendectomy

Abstract

Objectives: To compare the outcome of non-operative treatment (NOT) with antibiotics versus surgical management of uncomplicated appendicitis in children.

Methods: This randomized clinical trial (NCT 04030741) was carried out in Pediatric Surgery Department, Mayo Hospital from September 2018 to September 2019. Total sample size was 180, and after informed consent patients were randomly allocated in two groups. All children between 5 and 15 years of age and having pediatric appendicitis score (PAS) ≥7 were included. Patients with previous abdominal surgery, peritonitis, appendicular mass, or intra-abdominal abscess were excluded. Children in NOT group (Group A) were given intravenous Meropenem and Metronidazole for 48 hours and after starting oral, antibiotics were continued orally for 7 days. In Group B, children underwent appendectomy. Failure of NOT was labeled if there was abscess formation or peri-appendiceal fluid collection on ultrasound, development of peritonitis or recurrence of appendicitis.

Results: In Group A, mean age was 9.56±1.8 years and in Group B 10.11±1.8 years. There were 123 male and 57 female patients. Group B had 100% successful outcome. NOT (Group A) had successful outcome in 75 patients (83.3%) and failure was noted in 15 (16.7%). Five needed operation within 48 hours, all had appendicolith, and 10 patients presented within 6 months. Raised total leukocyte count (p value < 0.0001) and C reactive protein (p value < 0.04) levels were noted with failure of NOT.

Conclusions: In this study, success of NOT was 84% so a trial of NOT in cases of uncomplicated appendicitis should be considered in children.

doi: https://doi.org/10.12669/pjms.37.5.4016

How to cite this:
Sajjad MN, Naumeri F, Hina S. Non-operative treatment versus appendectomy for acute uncomplicated appendicitis: A randomized controlled trial. Pak J Med Sci. 2021;37(5):1276-1281. doi: https://doi.org/10.12669/pjms.37.5.4016

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Muhammad Nadeem Sajjad, Dr, King Edward Medical University, Lahore

Post Graduate Resident, Pediatric Surgery Department, KEMU/Mayo Hospital, Lahore

Fatima Naumeri, King Edward Medical University, Lahore

Associate Professor, Pediatric surgery Department, King Edward Medical University, Lahore

Sehrish Hina, Dr, King Edward Medical University, Lahore

Post Graduate Resident (Rotation), East Surgery Ward, KEMU/Mayo Hospital, Lahore

Published
2021-07-15
How to Cite
Sajjad, M. N., Naumeri, F., & Hina, S. (2021). Non-operative treatment versus appendectomy for acute uncomplicated appendicitis: A randomized controlled trial. Pakistan Journal of Medical Sciences, 37(5). https://doi.org/10.12669/pjms.37.5.4016
Section
Original Articles