• Yunfei Zhang, Qin Deng, Hai Zhu, Bailin Chen, Lin Qiu, and Chunbao Guo.
• Department of Pediatric General Surgery and Liver Transplantation, Childrens Hospital, Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
• Eur J Trauma Emerg Surg. 2021 Aug 1; 47 (4): 1041-1047.

BackgroundInitial non-operative management of children with complicated appendicitis has been well studied but when comparing emergency procedures the long-term effectiveness of interval appendectomy remains undefined. This study aimed to determine the effects of interval appendectomy from the perspective of long-term follow-up.MethodsA retrospective review of patients with complicated appendicitis between 2010 and 2017 was performed. The medical records of 471 patients with initial non-operative therapy and 377 patients treated with emergency appendectomy who served as controls were reviewed. Propensity score matching was performed to adjust for any potential selection bias in the two strategies. A comparison of the clinical outcomes, including short- and long-term postoperative complications, was conducted in the 348 matched patients.ResultsOn presentation, there were no differences in age, weight, sex distribution, white blood cell (WBC), or procalcitonin (PCT) between the two groups, except for days of symptoms. The patients undergoing emergency appendectomy had a high American Society of Anesthesiology (ASA) score (p = 0.002). The patients who underwent initial non-operative therapy had a lower complication rate, including surgical wound infection [odds ratio (OR), 3.77; 95% CI 2.59-5.50; p < 0.001) and postoperative peritonitis or abscess (OR, 3.81; 95% CI 1.79-8.12; p < 0.001) than those who underwent emergency appendectomy. Furthermore, the incidence of adhesive small bowel obstruction (ASBO) was lower in patients who underwent initial non-operative therapy than in patients who underwent emergency appendectomy (OR, 4.6; 95% CI 0.99-21.41; p = 0.032).ConclusionsInitial non-operative therapy with interval appendectomy was feasible for most patients with appendiceal abscesses and had advantages in terms of postoperative complications, especially regarding long-term obstruction events. Therefore, initial non-operative therapy with interval appendectomy should be considered the first treatment of choice for pediatric patients with complicated appendicitis.© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.

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