Beyond Surgery: Reassessing Appendectomy in Uncomplicated Pediatric Appendicitis cases

Author(s): Mohammad Syfur Rashid*, Abdul Hanif Tablu, KM Shaiful Islam, Mitali Hossain, Shariful Alam, Syeda Tamanna Tanjil

Aim: The study aimed to reassess appendectomy in uncomplicated pediatric patients with conservative management.

Background: Pediatric appendicitis, prevalent with a 7-8% lifetime risk, often requires appendectomy, a traditional approach with inherent risks. Recent medical literature challenges this, advocating non-operative interventions like antibiotics or observational management. Surgical complications occur in over 10% of cases. Laparoscopic surgery and a low threshold for intervention contribute to unnecessary surgeries. Approximately 20% of cases are complicated, prompting exploration of non-operative approaches for early uncomplicated cases. Antibiotics, once seen as a prelude to surgery, can now be a safe primary treatment, with a 63% success rate. Limited literature on non-operative treatment in children suggests a 97% effectiveness, offering social and economic benefits, though recurrent appendicitis remains a concern.

Methods: This prospective observational study, conducted at Dhaka Medical College Hospital in Bangladesh from July 2017 to March 2019, focused on uncomplicated acute appendicitis in children up to 12 years. Informed consent was obtained, and an approved research protocol was followed. Inclusion and exclusion criteria were established. A questionnaire collected data on key variables and administered conservative antibiotic treatment. Patients were assessed and followed up over 6 months with clinical examinations and investigations. Data analysis using SPSS-22 included descriptive statistics. The study aimed to evaluate the effectiveness of conservative treatment for uncomplicated acute appendicitis in pediatric patients under 12 years old.

Result: The study, encompassing 62 pediatric appendicitis cases, reveals a concentrated age distribution (mean age: 8.95±2.10 years) in middle childhood. Males dominate (61.3%), suggesting a gender-related factor. Clinical findings exhibit prevalent symptoms of anorexia (80.65%), fever >38°C (80.65%), and acute abdomen triage (83.87%). Pain management, assessed through the Visual Analog Scale, demonstrates a progressive reduction from the first to the fifth day. The appendix diameter decreases significantly over time, indicative of treatment response. Observations underscore a median 16-month post-treatment period, 24-hour symptomto- management time, and 84-hour hospitalization. Successful conservative treatment is notable in 95.1% of cases, emphasizing its efficacy in managing uncomplicated pediatric appendicitis.

Conclusion: The evolving landscape of appendicitis management in pediatric patients suggests a reevaluation of the traditional surgical approach, with non-operative interventions showing promise in terms of safety and efficacy. Further research, particularly in the form of large randomized studies in children, is warranted to establish the long-term effectiveness and potential benefits of non-operative treatments for acute uncomplicated appendicitis.

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