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Purpose <p>Reliable predictors of recurrence after non-operative management (NOM) for pediatric uncomplicated acute appendicitis (UCAA) are lacking. Patients and families often face uncertainty and anxiety about recurrence. We evaluated elective interval appendectomy (E-IA) after NOM, focusing on same-day discharge (SDD).</p> Methods <p>We retrospectively reviewed patients aged ≤ 18&#xa0;years who underwent laparoscopic E-IA after successful NOM for UCAA between 2017 and 2025. UCAA was defined as ultrasound grade I/IIa appendicitis without perforation, abscess, or diffuse peritonitis. Characteristics, perioperative outcomes, histopathology, and patient/family and staff satisfaction were analyzed.</p> Results <p>A total of 120 patients underwent E-IA (SDD, n = 40; inpatient management, n = 80). Median age was 13.0&#xa0;years; fecalith was present in 25 patients (20.8%). Median interval from scheduling to surgery was 48.5&#xa0;days and operative time was 38.0&#xa0;min. Complications occurred in 3 patients (2.5%), with no unplanned visits or readmissions. SDD was successful in 39/40 patients (97.5%). Recurrence before E-IA occurred in 5 patients (4.2%); all improved with repeat NOM and underwent E-IA. Patient/family and staff satisfaction were 83.3% and 89.3%, respectively. All specimens showed either acute inflammatory findings or chronic/resolving reparative changes, with none classified as histologically normal.</p> Conclusions <p>E-IA after NOM for UCAA was associated with low morbidity and SDD feasibility, suggesting a potentially new treatment concept for UCAA.</p>

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Elective interval appendectomy following non-operative management for uncomplicated acute appendicitis: a feasible same-day discharge strategy in children

  • 期刊论文

  • 发表日期：

    2026年7月3日

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  • Ryoichi Abiko,
  • Hiroki Goto,
  • Ayaka Fukada,
  • Taishi Iwakami,
  • Masahiro Shimizu,
  • Yuki Yoneda,
  • Yoshimasa Motoyama,
  • Joel Cazares,
  • Hiroyuki Koga,
  • Masayuki Kitajima,
  • Ai Futagawa,
  • Yasushi Innami,
  • Yasuhiro Okada,
  • Todd Ponsky,
  • Yuichi Nagakawa,
  • Naoki Ohashi,
  • Atsuyuki Yamataka

摘要

Purpose

Reliable predictors of recurrence after non-operative management (NOM) for pediatric uncomplicated acute appendicitis (UCAA) are lacking. Patients and families often face uncertainty and anxiety about recurrence. We evaluated elective interval appendectomy (E-IA) after NOM, focusing on same-day discharge (SDD).

Methods

We retrospectively reviewed patients aged ≤ 18 years who underwent laparoscopic E-IA after successful NOM for UCAA between 2017 and 2025. UCAA was defined as ultrasound grade I/IIa appendicitis without perforation, abscess, or diffuse peritonitis. Characteristics, perioperative outcomes, histopathology, and patient/family and staff satisfaction were analyzed.

Results

A total of 120 patients underwent E-IA (SDD, n = 40; inpatient management, n = 80). Median age was 13.0 years; fecalith was present in 25 patients (20.8%). Median interval from scheduling to surgery was 48.5 days and operative time was 38.0 min. Complications occurred in 3 patients (2.5%), with no unplanned visits or readmissions. SDD was successful in 39/40 patients (97.5%). Recurrence before E-IA occurred in 5 patients (4.2%); all improved with repeat NOM and underwent E-IA. Patient/family and staff satisfaction were 83.3% and 89.3%, respectively. All specimens showed either acute inflammatory findings or chronic/resolving reparative changes, with none classified as histologically normal.

Conclusions

E-IA after NOM for UCAA was associated with low morbidity and SDD feasibility, suggesting a potentially new treatment concept for UCAA.