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

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.