Almost 90 percent of children with appendicitis remained surgery-free during the first 30 days of a nonoperative protocol, according to results of a small prospective study.

During the initial hospital stay, two of 30 patients required an appendectomy, one because of acute appendicitis and one who had a carcinoid tumor.

Patients treated by the nonoperative protocol had a longer initial hospital stay but returned to school and to normal activities significantly faster that did children who underwent appendectomy, Peter Minneci, MD, of Nationwide Children’s Hospital in Columbus, Ohio, reported here at the American Academy of Pediatrics meeting.

“The 30-day results suggest that nonoperative management is feasible with a high success rate,” said Minneci. “Patients return to school and activities faster and have higher quality-of-life scores.”

Over the past 15 years, eight trials of nonoperative care for adult patients with appendicitis showed that a third of patients had treatment failure during the first year of follow-up. None of the trials controlled for severity of appendicitis, said Minneci.

The trials showed no increase in the rate of perforated appendicitis. The trials also identified risk factors for treatment failure: presence of a fecalith, >48 hours of symptoms, presence of a phlegmon or abscess, and elevated white blood count.

On the basis of the clinical experience in adults, Minneci and colleagues hypothesized that nonoperative management of early appendicitis in children would be feasible and safe and result in a 1-year success rate of 80 percent to 85 percent. To test the hypothesis, the investigators performed a prospective, nonrandomized clinical study.

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