Non-Operative Management of Acute Uncomplicated Appendicitis in Children

Abstract

Objective: To compare the efficacy of non-surgical conservative management with surgical management in cases of uncomplicated acute appendicitis in children. Study design: Prospective comparative study. Settings: Pediatric surgery Department, Ghulam Muhammad Mahar Medical College Sukkur. Study duration: 1st February 2020 to 31st May 2021. Materials and Methods: Ninety patients of either gender with age range from 5-12 years, diagnosed as uncomplicated acute appendicitis, were divided in two groups. Group C patients were managed conservatively with antibiotics (ceftriaxone 100 mg/kg/day, amikacin 10mg/kg/day and metronidazole 22.5 mg/kg/day) and maintenance fluids were started. Patients were observed for improvement or any signs of deterioration. Those who deteriorated within 24 hours were managed with surgical management immediately. Follow-ups were carried out after discharge on the 7th day, 1 month, and six months. Patients reporting a recurrence of symptoms were managed with appendicectomy. Group S patients were managed with appendicectomy with the open technique. Patients were observed for post-operative complications. Results: Demographic data of both groups was comparable. In group C, 34 (75.56%) patients were successfully treated with conservative management, whereas in group S, 39 (86.67%) were successfully treated with surgical management. The difference was insignificant with a p-value of 0.114. In group C, 5 (11.11%) patients did not respond to conservative management and they were managed with appendicectomy and recurrence of symptoms was seen in 6 (13.33%) patients in group C, they were also managed with appendicectomy. In group S, 6 (13.33%) patients suffered post-operative complications. Mean length of stay in hospital was 4.31±1.20 and 4.09±1.12 days in group C and S respectively. This difference was statistically insignificant with a p-value of 0.368. Conclusion: It is concluded in our study that uncomplicated acute appendicitis in children can be successfully managed with non-surgical conservative management.

Keywords

• Acute appendicitis
• Appendicectomy
• Conservative management
• Non-surgical management
• Pediatric surgery
• Uncomplicated acute appendicitis