title: Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review.
abstract: OBJECTIVE
  Interval appendicectomy (IA) is commonly performed after successful nonoperative treatment of appendix mass (AM); although, this approach has recently been challenged. We systematically reviewed the pediatric literature with regard to the justification for this practice.
  
  
  METHODS
  Using a defined search strategy, studies were identified and data were extracted independently by 2 reviewers. Incidences of recurrent appendicitis, complications after IA, and carcinoid tumor were estimated accounting for interstudy heterogeneity. Cost and length of stay of IA were analyzed.
  
  
  RESULTS
  Three studies (127 cases) reporting routine nonsurgical treatment were identified; all were retrospective. There was marked interstudy heterogeneity and variable follow-up. After successful nonoperative treatment of AM, the risk of recurrent appendicitis is 20.5% (95% confidence interval [CI], 14.3%-28.4%). The incidence of complications after IA (23 studies, n = 1247) is 3.4% (95% CI, 2.2-5.1), and the incidence of carcinoid tumor found at IA (15 studies, n = 955) is 0.9% (95% CI, 0.5-1.8). No reports compared costs. Mean length of stay for IA was 3 days (range, 1-30 days).
  
  
  CONCLUSIONS
  Prospective studies comparing routine IA with nonoperative treatment without IA in children are lacking. Available data suggest that 80% of children with AM may not need IA. A prospective study to evaluate the natural history of this condition compared with the morbidity and costs of IA is warranted.
authors.affiliation: Department of Paediatric Surgery, Southampton General Hospital, UK; Department of Paediatric Surgery, UCL Institute of Child Health, London, UK. Electronic address: n.hall@suht.swest.nhs.uk.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Hall
authors.affiliation: Department of Paediatric Surgery, Southampton General Hospital, UK.
authors.forename: Ceri E
authors.initials: CE
authors.lastname: Jones
authors.affiliation: Department of Paediatric Surgery, UCL Institute of Child Health, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.affiliation: Department of Paediatric Surgery, Southampton General Hospital, UK.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stanton
authors.affiliation: Department of Paediatric Surgery, Southampton General Hospital, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Burge
mesh_terms: D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D002430:Cecal Neoplasms / Q000150:complications / Q000601:surgery*; D002648:Child; D006801:Humans; D013997:Time Factors