ZenToks Publication

Chapter 7

The Role of Interval Appendectomy following Non-Operative Treatment for Acute Appendicitis in Children: A Review

Abstract/Preface

Acute appendicitis is a prevalent surgical emergency in pediatric patients. Traditionally, appendectomy has been considered the standard treatment; however, there is growing evidence supporting non-operative management (NOM) for selected cases of uncomplicated appendicitis and as an initial approach for complicated appendicitis presenting with abscess or phlegmon. The role of interval appendectomy (IA), defined as the elective removal of the appendix weeks after successful NOM, remains a subject of debate. Historically, IA was routinely recommended to prevent recurrent appendicitis and to exclude underlying pathology. Recent evidence, however, challenges this practice by highlighting relatively low recurrence rates following successful NOM, advancements in imaging and follow-up protocols, and the morbidity and costs associated with additional surgery. This review evaluates the current evidence regarding IA in children following NOM for both complicated and uncomplicated acute appendicitis. The literature indicates that routine IA may not be necessary for all children after successful NOM. While certain subgroups, particularly those with appendicoliths, persistent symptoms, or recurrent disease, may benefit from interval appendectomy, a selective rather than routine approach appears increasingly justified. Shared decision-making involving children, parents, and clinicians is crucial when weighing the risks of recurrence against the morbidity and costs of surgery.