Document Type

Article

Publication Date

4-27-2026

Identifier

DOI: 10.1007/s00383-026-06445-z; PMCID: PMC13121297

Abstract

BACKGROUND: This review summarizes considerations within the existing recent literature that guide the practice of interval appendectomy (IA) after initial non-operative management (NOM) of complicated appendicitis (CA) in children.

METHODS: A systematic review of English language articles published from 2000 to 2025 was conducted in Medline, Embase, and Cochrane Central Register of Controlled Trials to address four elements which could impact the decision for IA after NOM of CA: (1) the incidence of recurrent appendicitis; (2) the time period in which recurrence occurs; (3) the patient or disease-related risk factors which increase recurrence; and (4) the incidence of appendiceal neoplasms identified by IA.

RESULTS: Of the 3,022 articles initially reviewed, 46 met inclusion criteria. Recurrence was reported in 2–50% of patients. When IA is pursued, the optimal timing remains undefined, although evidence suggests most recurrences occur within three to six months, so there may be potential benefit to performing IA within three months after the initial presentation. Risk factors for recurrent appendicitis are not well characterized, though the presence of an appendicolith may increase recurrence risk. Across studies, the incidence of appendiceal neoplasms was rare, with most studies not documenting any cases; all reported neoplasms were neuroendocrine tumors.

CONCLUSION: Current evidence does not favor any single approach to IA, including routine IA, selective IA, or indefinite NOM; rather a shared-decision ought to be made between the surgeon and patient’s caregivers. Utilization and timing of IA must balance surgical risks with the risk of recurrent disease; however, the risk of neoplasm should not primarily drive management.

LEVEL OF EVIDENCE: I−IIV.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00383-026-06445-z.

Journal Title

Pediatric surgery international

Volume

42

Issue

1

PubMed ID

42043565

Keywords

Complicated appendicitis; Interval appendectomy; Non-operative management; Pediatric

Comments

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Publisher's Link: https://link.springer.com/article/10.1007/s00383-026-06445-z

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