Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Maita, Sonia; Andersson, Barbro; Svensson, Jan F.; Wester, Tomas

doi:10.1007/s00383-019-04610-1

Cited by 70 publications

(63 citation statements)

References 38 publications

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“…Kessler et al[15] determined that the operative treatment group yielded a 98% effectiveness, while the non-operative treatment (NOT) group resulted in a significantly lower 74% effectiveness rate. This contrasts the rather positive findings of Georgios et al[14] who found a 97% success rate with NOT, and Maita et al[16], who found a 92% effectiveness with NOT in their meta-analyses.Not surprisingly, results of individual control trials and studies are similar in their disagreement. Knappen et al[5] used a prospective cohort study of 45 children aged 7-17 years from multiple institutions to study the success rate of NOT of acute uncomplicated appendicitis (AUA).…”

Section: Introductioncontrasting

confidence: 85%

“…[1]Yet treating pediatric acute appendicitis non-operatively rather than by open or laparoscopic appendectomy still elicits great debate,[2–4]spawned by the results of control trials and observational studies[5–9], reviews[10–13] and meta-analyses. [14–16]The meta-analyses are not in agreement. Kessler et al[15] determined that the operative treatment group yielded a 98% effectiveness, while the non-operative treatment (NOT) group resulted in a significantly lower 74% effectiveness rate.…”

Section: Introductionmentioning

confidence: 97%

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Management of Acute Appendicitis in Children during Coronavirus Disease-2019, a Perspective of Pediatric Surgeons from South Asia

Parveen

Hoque

et al. 2020

Preprint

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Background: Non-operative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and potentially influenced by the preferences of the physician. Owing to the effects of the COVID pandemic on healthcare, practice of NOT has generally increased by necessity and may, in a post-COVID world, change surgeons perceptions of NOT. Objective: The objective was to determine if the practice of NOT has increased in usage in South Asia and whether these levels of practice would be sustained after the pandemic subside. Methods: A survey was addressed to pediatric surgeons regarding their position, institute, country, number of appendicitis cases managed and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). It also directly posed the question as to whether they would continue with the COVID imposed level of NOT after the effect of the pandemic diminishes. Results: A total of 134 responses were collected. A significant increase in the practice of NOT was observed for the entire cohort, though no effect was observed when grouped by country or institute. When grouped by position, seniors increased the practice of NOT the most, while juniors reported the least change. The data suggests that only Professors would be inclined to maintaining the COVID level of NOT practice after the pandemic. Conclusions: Increased practice of NOT during the COVID pandemic was observed in South Asia, particularly by senior surgeons. Only Professors appear inclined to consider maintaining this increased level of practice in the post-COVID world.

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Section: Introductioncontrasting

confidence: 85%

Section: Introductionmentioning

confidence: 97%

Management of Acute Appendicitis in Children during Coronavirus Disease-2019, a Perspective of Pediatric Surgeons from South Asia

Parveen

Hoque

et al. 2020

Preprint

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“…They also reported that 16% later on needed appendectomy due to recurrent appendicitis. 9 Huang L et al reported 90.5% success rate of NOT for acute uncomplicated appendicitis in a previous metaanalysis. 10 Bachur and co-authors analyzed data of various United States' hospitals retrospectively and revealed that NOT was associated with more emergency visits and hospitalization, and ultimately 46% had appendectomy in one year follow up, thus necessitating the need for further multi-centric RCT.…”

Section: Introductionmentioning

confidence: 97%

“…Still to establish efficacy of NOT in children further randomized controlled trials (RCT) are needed. 8,9 Sonia Maita and co-authors in a recent metaanalysis reported success rate of NOT as 92% after analyzing the published literature. They also reported that 16% later on needed appendectomy due to recurrent appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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):---------. 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.

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“…Due to new conservative modalities for the treatment of uncomplicated acute appendicitis, current strategies for the distinguishment of high risk and low risk acute appendicitis are under pressure. Successful and safe application of conservative antibiotic treatment for clinically uncomplicated appendicitis has been demonstrated [ 1 ]. Even frequent spontaneous resolution of histologically phlegmonous appendicitis has been claimed [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

The application of artificial intelligence methods to gene expression data for differentiation of uncomplicated and complicated appendicitis in children and adolescents - a proof of concept study –

2021

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Background Genome wide gene expression analysis has revealed hints for independent immunological pathways underlying the pathophysiologies of phlegmonous (PA) and gangrenous appendicitis (GA). Methods of artificial intelligence (AI) have successfully been applied to routine laboratory and sonographic parameters for differentiation of the inflammatory manifestations. In this study we aimed to apply AI methods to gene expression data to provide evidence for feasibility. Methods Modern algorithms from AI were applied to 56.666 gene expression data sets from 13 patients with PA and 16 with GA aged 7–17 years by using resampling methods (bootstrap). Performance with respect to sensitivities and specificities where investigated with receiver operating characteristic (ROC) analysis. Results Within the experimental setting a best performing discriminatory biomarker signature consisting of a set of 4 genes could be defined: ERGIC and golgi 3, regulator of G-protein signaling 2, Rho GTPase activating protein 33, and Golgi Reassembly Stacking Protein 2. ROC analysis showed a mean area under the curve of 84%. Conclusions Gene expression based application of AI methods is feasible and represents a promising approach for future discriminatory diagnostics in children with acute appendicitis.

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Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Cited by 70 publications

References 38 publications

Management of Acute Appendicitis in Children during Coronavirus Disease-2019, a Perspective of Pediatric Surgeons from South Asia

Management of Acute Appendicitis in Children during Coronavirus Disease-2019, a Perspective of Pediatric Surgeons from South Asia

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

The application of artificial intelligence methods to gene expression data for differentiation of uncomplicated and complicated appendicitis in children and adolescents - a proof of concept study –

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