Routine Interval Appendectomy Unnecessary?

HILTON HEAD ISLAND, S.C. — Interval appendectomy may be unnecessary after a bout of medically managed appendicitis in children, Dr. Devin Puapong said at the annual meeting of the American Pediatric Surgical Association.

Surgeons often cite a high risk of recurrence as the primary reason for an elective interval appendectomy. But according to Dr. Puapong of the Kasier Permanente Los Angeles Medical Center, “Recurrence of appendicitis after initial nonoperative treatment is very uncommon and not associated with any major complications. We feel [interval appendectomy] may not be necessary.”

Dr. Puapong conducted a retrospective study of Kaiser's medical records database, which included 6,446 children treated for appendicitis from 1992 to 2002.

Of those, only 72 were initially managed with medical therapy; 11 went on to have an interval appendectomy, and the other 61 were observed. The length of stay in the observed patients was significantly longer (15 days vs. 7 days).

Over a mean follow-up of 7.5 years, there were only five recurrences of appendicitis (a rate of 8%). All recurrences occurred within 1 year and most were within 2–3 months, Dr. Puapong said.

Four of the recurrences were in patients who presented with an initial abscess, but because of the small number, the association was not statistically significant. Nor were age, gender, type of initial appendicitis, and drainage of initial abscess significantly associated with recurrence. No major complications were observed in any of the patients with recurrence, although two were found to have a prolonged ileum.