title: Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis.
abstract: OBJECTIVE
  Although nonoperative treatment for uncomplicated appendicitis is now an accepted approach, there are few reports in children. The aim of this study was to compare long-term outcomes between operative and nonoperative treatment in children.
  
  
  METHODS
  Between April 2007 and December 2013, all uncomplicated appendicitis patients were asked to select either operative (laparoscopic surgery) or nonoperative treatment on admission. For nonoperative treatment, intravenous injection of antibiotics was continued until serum C-reactive protein concentration decreased to below 0.5mg/dL. A questionnaire survey on satisfaction with treatment was added afterwards and performed more than 1year after treatment.
  
  
  RESULTS
  Eighty-six patients chose operative treatment, and 78 chose nonoperative treatment. The success rate of nonoperative treatment was 98.7%. There was no difference in the length of hospital stay between the two groups. Ileus occurred in two operatively-treated patients, while recurrence of appendicitis occurred in 22 nonoperatively-treated patients (28.6 %) after an average of 4.3years of follow-up. The overall nonoperative treatment failure including both early failure and recurrence occurred more frequently among those with appendicoliths than without appendicoliths. Satisfaction levels were higher for operative treatment.
  
  
  CONCLUSIONS
  Although the success rate of nonoperative treatment was very high, a considerable number of patients experienced recurrence.
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan. Electronic address: tanaka.yujiro@pref.saitama.lg.jp.
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Uchida
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawashima
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan.
authors.forename: Michimasa
authors.initials: M
authors.lastname: Fujiogi
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan; Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo 113-8655, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Takazawa
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan; Department of Pediatric Surgery, University of Tokyo Hospital, Tokyo 113-8655, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Deie
authors.affiliation: Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama 339-8551, Japan.
authors.forename: Hizuru
authors.initials: H
authors.lastname: Amano
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000097:blood / Q000188:drug therapy* / Q000601:surgery*; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D017060:Patient Satisfaction; D012008:Recurrence; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Nonoperative; Recurrence; Satisfaction; Uncomplicated appendicitis