Is interval appendicectomy justified after successful nonoperative treatment of an appendix mass in children? A systematic review

J Pediatr Surg. 2011 Apr;46(4):767-771. doi: 10.1016/j.jpedsurg.2011.01.019.


Background/purpose: 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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Appendectomy / methods*
  • Appendicitis / complications
  • Appendicitis / surgery*
  • Cecal Neoplasms / complications
  • Cecal Neoplasms / surgery*
  • Child
  • Humans
  • Time Factors