title: Conservative treatment in uncomplicated acute appendicitis: reassessment of practice safety.
abstract: The success rate of conservative treatment for children with uncomplicated appendicitis was prospectively evaluated among 197 children. All who received intravenous antibiotics for 3-5 days, and if symptoms resolved, were discharged home on oral antibiotics for 5 days. Failure rate, symptoms, laboratory signs, and sonographic findings were evaluated for prognostic markers of treatment failure. Children were followed for 18 months. The success rate of conservative treatment was 87%, with shorter hospital stays compared to children who eventually needed surgery (72 [60-84] vs. 84 h [72-126], P = 0.001). Vomiting and/or nausea and intraluminal fluid on sonography were the only prognostic signs of failed treatment (P = 0.028 and P = 0.0001, respectively). After multi-regression analysis, intraluminal fluid was the only prognostic sign for failed treatment (odds ratio = 10.2; 95% CI 3.3-31.8, P = 0.001). Patients who failed conservative treatment were successfully operated without significant morbidity. Pathology findings were compatible with acute or subacute inflammation in 94% of operated AA, with no perforated appendices.
  
  
  CONCLUSIONS
  When applying rigorous criteria for children with uncomplicated appendicitis, a high success rate can be achieved with conservative treatment. Those who fail conservative treatment have a benign medical course without serious complications. Intraluminal fluid may increase risk for conservative treatment failure. What is Known: • Conservative treatment in uncomplicated acute appendicitis is a reasonable alternative to appendectomy. What is New: • Using rigorous criteria for conservative treatment in uncomplicated acute appendicitis is safe and feasible. • Intraluminal fluid should be considered a contraindication to conservative treatment.
authors.affiliation: Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel. zvi.steiner@clalit.org.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. zvi.steiner@clalit.org.il.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Steiner
authors.affiliation: Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Genady
authors.initials: G
authors.lastname: Buklan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Radiology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Rodica
authors.initials: R
authors.lastname: Stackievicz
authors.affiliation: Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Gutermacher
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Neonatology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Ita
authors.initials: I
authors.lastname: Litmanovitz
authors.affiliation: Department of Pediatric Surgery, Meir Medical Center, 44281, Kfar Saba, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Golani
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Department of Neonatology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Arnon
mesh_terms: D000208:Acute Disease; D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D000072700:Conservative Treatment / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents
keywords: Acute appendicitis; Appendectomy; Children; Conservative treatment; Intraluminal fluid