Treatment of Appendicitis in Children

Surgical Management

The American College of Surgeons recommends laparoscopic appendectomy as the preferred treatment approach for children with acute appendicitis, offering better treatment success rates, lower recurrence rates, and improved quality of life 1, 2
Surgery should be performed within 24 hours of admission for uncomplicated appendicitis, with early appendectomy (within 8 hours) recommended for complicated appendicitis 3, 2
Conventional three-port laparoscopic appendectomy is preferred over single-incision approaches due to shorter operative times, less postoperative pain, and lower incidence of wound infection 1
In pediatric patients with favorable anatomy, single incision/transumbilical extracorporeal laparoscopic-assisted appendectomy may be considered as an alternative to traditional three-port laparoscopic appendectomy 1

Non-operative management (NOM) with antibiotics can be discussed as an alternative to surgery in selected children with uncomplicated appendicitis in the absence of an appendicolith 4
When choosing NOM, patients and families should be advised about the possibility of treatment failure and the risk of misdiagnosing complicated appendicitis 4
Initial intravenous antibiotics with subsequent conversion to oral antibiotics is recommended based on the patient's clinical condition 4

Simple ligation of the appendicular stump is recommended over stump inversion in both open and laparoscopic appendectomy, as it is associated with shorter operative times, less postoperative ileus, and quicker recovery 6, 2
Routine histopathology after appendectomy is recommended to identify unexpected findings 2
Wound ring protectors are recommended in open appendectomy to decrease the risk of surgical site infection 5

For perforated appendicitis in children, early appendectomy within 8 hours is recommended 2
Prophylactic abdominal drainage after laparoscopic appendectomy for complicated appendicitis in children is not recommended as it does not prevent postoperative complications and may be associated with negative outcomes 5
In very young children (<5 years), diagnosis may be delayed due to atypical presentation, potentially leading to higher rates of perforation 7