Incidental appendectomy during laparotomy for idiopathic intussusception in children: a dual-center retrospective cohort study.

BACKGROUND

The role of incidental appendectomy (IA) during surgery for idiopathic intussusception in children remains controversial. This study evaluated the potential benefits and risks of performing IA during laparotomy.

METHODS

We performed a dual-center retrospective cohort study of children who underwent open reduction for idiopathic intussusception (2014-2021). Patients were grouped by whether IA was performed. Primary outcomes were perioperative complications (PCs) and recurrent intussusception (RI); secondary outcomes were operative time, time to postoperative oral intake (PO time), length of stay (LOS), and hospitalization cost. Univariable and multivariable analyses were applied, with subgroup analysis for ileocolic cases.

RESULTS

A total of 177 children were included, of whom 114 underwent IA and 63 did not. Baseline demographics were similar, but non-IA patients had more air enema attempts (median 2 vs. 1; P < 0.001) and a higher proportion of ileocolic intussusception (85.7% vs. 69.3%; P < 0.001). Intraoperatively, red or swollen appendices were more frequently removed (86.0% vs. 3.2%). Histopathology revealed acute inflammation in 60%, chronic inflammation in 25%, and no abnormalities in 15%. Rates of PCs (11.4% vs. 14.3%) and RI (6.1% vs. 11.1%) did not differ significantly between groups. In adjusted analyses, IA was associated with longer operative time (exp(β) = 1.292, 95% CI: 1.048 - 1.593; P = 0.016) and higher total costs (exp(β) = 1.350, 95% CI: 1.176 - 1.550; P < 0.001), without significant effects on PO time or LOS. Subgroup analysis of ileocolic cases (n = 133) yielded consistent results.

CONCLUSIONS

In pediatric idiopathic intussusception, IA did not decrease recurrence or perioperative complications but prolonged surgery and increased costs. As most resected appendices showed only minor inflammatory changes, routine IA should be reconsidered. Prospective multicenter studies are needed to validate these findings and guide surgical decision-making.