Komplike Olmayan Apandisit Ön Tanılı Çocuklarda Cerrahi Olmayan Tedavinin Klinik Sonuçları

Öz

Amaç Ameliyatsız tedavi yaklaşımı, apendiksteki enfeksiyonun baskılandığı ve antibiyotiklerle tedavi edildiği komplike olmayan apandisit tedavisinde kullanılan diğer bir yöntemdir. Çalışmamızın amaçları komplike olmayan apandisit ön tanılı çocuk hastalarda ameliyatsız tedavinin klinik sonuçlarının ve rekürrens gelişmesi için risk faktörlerinin araştırılmasıdır. Yöntemler Ocak 2016 ve Ocak 2021 tarihleri arasında üçüncü basamak bir çocuk cerrrahisi merkezinde komplike olmayan apandisit ön tanılı ve ameliyatsız tedavi uygulanmış hastaların tıbbi verileri değerlendirildi. Hastaların tanımlayıcı bilgileri, tedavi süreci ve klinik sonuçları kaydedildi. Ameliyatsız tedavi sonrası rekürrens gelişen ve gelişmeyen iki hasta grubunun verileri istatistiksel olarak karşılaştırıldı. Bulgular Ortanca yaşı 13 (6-17) yıl olan 41 hastanın verileri değerlendirildi. Sekiz (%19.5) hastada apendikolit vardı. Ortanca IV antibiyotik tedavi süresi 4 (3-7) gün ve hastaların ortanca abdominal hassasiyetlerinin kaybolma süresi 2 (1-4) gündü. Ameliyatsız tedaviden ortanca 7 (1-14) ay sonra 8 (%19.5) hastada rekürrens gelişti. Rekürrens gelişen grupta abdominal hassasiyetin kaybolma süresi diğer gruba göre istatistiksel anlamlı olarak daha uzundu (p=0.01). Sonuç Çalışmamız apendikolitin rekürrens gelişimi için risk faktörü oluşturmadığını ortaya koydu. Abdominal hassasiyetin kaybolması için geçen zaman rekürrens gelişimi için yüksek riskli hastaların tespitinde faydalı olabilir.

Anahtar Kelimeler

• apandisit
• ameliyatsız tedavi
• antibiyotik
• çocuk

Clinical Outcomes of Non-Operative Treatment of Suspected Uncomplicated Appendicitis in Children

Abstract

Aim Non-operative treatment approach is another method used in the treatment of uncomplicated appendicitis, in which the infection in the appendix is suppressed and treated with antibiotics. Our study aims to investigate the clinical outcomes and the risk factors for recurrence in our pediatric patients with suspected uncomplicated appendicitis, who underwent non-operative treatment. Methods The medical data of the patients who underwent non-operative treatment with the diagnosis of suspected uncomplicated appendicitis between January 2016 and January 2021 in a tertiary pediatric surgery center were analyzed. Demographic data, treatment process, and clinical results of the patients were recorded. Statistical evaluation was made by comparing the two groups with and without recurrence after non-operative treatment. Results The median age of 41 patients whose data were evaluated was 13 (6-17) years. Eight patients (19.5%) had appendicolith. The median duration of IV antibiotic treatment was 4 (3-7) days, and the patients' abdominal tenderness disappeared in a median of 2 (1-4) days. Recurrence developed in 8 (19.5%) patients after a median of 7 (1-14) months after non-operative treatment. It was found that the time to the disappearance of abdominal tenderness was statistically longer in the group that developed recurrence than that in the group that did not (p=0.01). Conclusion Our study revealed that appendicolith was not a risk factor for the development of recurrence. The time to the disappearance of abdominal tenderness may be useful for detecting patients at a higher risk of recurrence.

Keywords

• appendicitis
• non-operative treatment
• antibiotic
• children

Kaynakça

1. 1- Omling E, Salö M, Saluja S, et al. Nationwide study of appendicitis in children. Br J Surg. 2019;106(12):1623-1631. DOI: 10.1002/bjs.11298
2. 2- Addiss DG, Shaffer N, Fowler BS, et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-925. DOI: 10.1093/oxfordjournals.aje.a115734
3. 3- Mariage M, Sabbagh C, Grelpois G, et al. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol. 2019;9(1):1-4. DOI: 10.5005/jp-journals-10018-1286
4. 4- López JJ, Deans KJ, Minneci PC. Nonoperative management of appendicitis in children. Curr Opin Pediatr. 2017;29(3):358-362. DOI: 10.1097/MOP.0000000000000487
5. 5- Coldrey E. Five years of conservative treatment of acute appendicitis. J Int Coll Surg. 1959;32:255–261
6. 6- Weiner, D.J., Katz, A., Hirschl, R.B, et al. Interval appendectomy in perforated appendicitis. Pediatr Surg Int 10, 82–85 (1995). DOI: 10.1007/BF00171160
7. 7- Svensson JF, Patkova B, Almström M, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg. 2015;261(1):67-71. DOI: 10.1097/SLA.0000000000000835
8. 8- Tanaka Y, Uchida H, Kawashima H, et al. Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg. 2015;50(11):1893-1897. DOI: 10.1016/j.jpedsurg.2015.07.008

9. 9- Svensson JF, Hall NJ, Eaton S, et al. A review of conservative treatment of acute appendicitis. Eur J Pediatr Surg. 2012;22(3):185-194. DOI: 10.1055/s-0032-1320014
10. 10- Georgiou R, Eaton S, Stanton MP, et al. Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis. Pediatrics. 2017;139(3):e20163003. DOI: 10.1542/peds.2016-3003
11. 11- Minneci PC, Mahida JB, Lodwick DL, et al. Effectiveness of Patient Choice in Nonoperative vs Surgical Management of Pediatric Uncomplicated Acute Appendicitis. JAMA Surg. 2016;151(5):408-415. DOI: 10.1001/jamasurg.2015.4534
12. 12- Wu JX, Sacks GD, Dawes AJ, et al. The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children. J Pediatr Surg. 2017;52(7):1135-1140. DOI: 10.1016/j.jpedsurg.2016.10.009
13. 13- Zampieri N, Camoglio FS. Are we doing right suggesting a non-operative management for suspected appendicitis in children? J Pediatr Surg. 2017;52(10):1702-1703. DOI: 10.1016/j.jpedsurg.2017.05.019
14. 14- Wang LT, Prentiss KA, Simon J, et al. The use of white blood cell count and left shift in the diagnosis of appendicitis in children. Pediatr Emerg Care. 2007 Feb;23(2):69-76. DOI: 10.1097/PEC.0b013e31802d1716
15. 15- Grönroos JM. Do normal leucocyte count and C-reactive protein value exclude acute appendicitis in children? Acta Paediatr. 2001 Jun;90(6):649-51.
16. 16- Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology. 2006;241(1):83-94. DOI: 10.1148/radiol.2411050913
17. 17- Chicaiza HP, Malia L, Mulvey CH, et al. Revisiting the Appendiceal Diameter via Ultrasound for the Diagnosis of Acute Appendicitis. Pediatr Emerg Care. 2018 Nov;34(11):757-760. DOI: 10.1097/PEC.0000000000001278
18. 18- Singh JP, Mariadason JG. Role of the faecolith in modern-day appendicitis. Ann R Coll Surg Engl. 2013 Jan;95(1):48-51. DOI: 10.1308/003588413X13511609954851
19. 19- Mahida JB, Lodwick DL, Nacion KM, et al. High failure rate of nonoperative management of acute appendicitis with an appendicolith in children. J Pediatr Surg. 2016 Jun;51(6):908-11. DOI: 10.1016/j.jpedsurg.2016.02.056
20. 20- Mudri M, Coriolano K, Bütter A. Cost analysis of nonoperative management of acute appendicitis in children. J Pediatr Surg. 2017;52(5):791-794. DOI: 10.1016/j.jpedsurg.2017.01.050
21. 21- Hartwich J, Luks FI, Watson-Smith D, et al. Nonoperative treatment of acute appendicitis in children: A feasibility study. J Pediatr Surg. 2016;51(1):111-116. DOI: 10.1016/j.jpedsurg.2015.10.024
22. 22- Knaapen M, van der Lee JH, Heij HA, et al. Clinical recovery in children with uncomplicated appendicitis undergoing non-operative treatment: secondary analysis of a prospective cohort study. Eur J Pediatr. 2019;178(2):235-242. DOI: 10.1007/s00431-018-3277-9
23. 23- Knaapen M, van der Lee JH, Bakx R, et al. APAC collaborative study group. Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial). BMJ Open. 2017 Nov 15;7(11):e018145. DOI: 10.1136/bmjopen-2017-018145
24. 24- Mosuka EM, Thilakarathne KN, Mansuri NM, et al. A Systematic Review Comparing Nonoperative Management to Appendectomy for Uncomplicated Appendicitis in Children. Cureus. 2021;13(10):e18901. Published 2021 Oct 19. DOI: 10.7759/cureus.18901