Is Appendicectomy Outdated in the Management of Paediatric Appendicitis?

Appendicitis is the most common emergency surgical presentation and is particularly prevalent in the paediatric population. At present, the majority of children are managed with surgical removal of the inflamed appendix, a procedure that was established centuries ago, before the widespread availability of antibiotics. There are anecdotal historical cases of non-operative management of appendicitis, particularly in geographically remote areas. In recent decades, there has been increasing interest in the potential to manage appendicitis non-operatively. This review explores the relative merits of non-operative and surgical management of appendicitis and their current role across the spectrum of disease in clinical practice in the UK. It concludes that both operative and non-operative management are safe and effective treatments in appropriately selected patients. However, the results of further large-scale studies are needed to help refine our application of these treatments in clinical practice. The current evidence supports discussion of both operative and non-operative management as part of informed consent and the shared decision-making process.