Volume 30, Issue 176, October 2026

An evaluation of the efficacy and safety of conservative versus surgical treatment of acute appendicitis in children: a review of clinical reports and discussion

Daniel Glinka^♦, Cezary Jasiński, Barbara Durma, Szymon Siudak, Oliwia Dudek, Zuzanna Domagała, Martyna Olszyna, Maria Ryśkiewicz, Daria Kózka, Agata Choroś

Collegium Medicum, Jan Kochanowski University, Kielce, Poland

^♦Corresponding author
Daniel Glinka, Collegium Medicum, Jan Kochanowski University, Kielce, Poland

ABSTRACT

Introduction: Appendectomy has traditionally been the standard treatment for acute appendicitis [AA]. However, new studies show the appendix is a necessary organ and an integral part of the body; together with advances in diagnostic imaging and pharmacological therapy, these findings encourage further exploration of nonsurgical treatments. Methods: A literature review was conducted in the MEDLINE (PubMed) database covering the years January 2016 - July 2026. The analysis included 10 studies, all of which included patients under 18. Results: The initial clinical efficacy of NOM (up to 30 days) is high, ranging from 90% to 97%. However, in long-term follow-up (≥1 year), efficacy drops to 56–82% due to recurrences. The main predictor of nonoperative management [NOM] failure is the presence of an appendicolith, which increases the risk of treatment failure more than tenfold and constitutes an absolute contraindication to this method. Factors that negatively affect the success of NOM also include severe baseline pain and relying only on ultrasound for diagnosis. Both strategies demonstrate equivalent, high clinical safety. From an economic perspective, the annual costs of both methods are equivalent because of recurrence-related hospitalizations. With successful NOM, patients have a higher quality of life (median PedsQL: 92.4 vs. 87.0) and return to full activity faster. Conclusions: NOM is a safe and sufficient treatment option for children with uncomplicated acute appendicitis. Improved outcomes depend on precise patient selection using high-detail imaging to exclude a fecal stone.

Keywords: acute appendicitis, appendectomy, uncomplicated acute appendicitis, pediatric appendicitis, nonoperative management, conservative management, antibiotic therapy.

Medical Science, 2026, 30, e198ms3953

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Published: 07 October 2026