Antibiotic Therapy vs Laparscopic Appendectomy in Pediatric Chronic Appendicitis
Antibiotic Therapy vs Laparscopic Appendectomy in Pediatric Chronic Appendicitis
This clinical trial will compare antibiotic therapy with laparoscopic appendectomy in the
 treatment of pediatric chronic appendicitis in china. Enrolled patients will be randomised
 and an allocation ratio of 1:1 will be made via weighted minimisation, where half of the
 patients will receive antibiotic therapy with intravenous Ceftazidime sodium, while the other
 half will have a laparoscopic appendicectomy.
In recent years, nonoperative treatment has challenged appendectomy as a first-line treatment
 of acute uncomplicated appendicitis by demonstrating its safety and short-term efficacy in
 adults. Several randomized controlled trials comparing appendectomy to antibiotics alone in
 children with acute uncomplicated appendicitis have been reported from other countries. These
 studies reveal that non-operative management of appendicitis is a safe treatment for
 appendicitis and is associated with a significantly lower risk of complications than
 appendectomy. However, the success rate of nonoperative management was 75% at 1year. Chronic
 appendicitis has been described as a possible cause of persistent right lower quadrant (RLQ)
 pain and laparoscopic appendectomy has been shown to benefit a large number of children，but
 there are no high-quality clinical trials. There are more than 200 million children in China.
 According to preliminary clinical data, the incidence of pediatric appendicitis in China is
 higher than Europe and America. Due to the Chinese parents have different cultures and
 educational backgrounds, more high-quality clinical trials are needed to guide parents to
 choose appropriate treatment for chronic appendicitis in children. Therefore, the
 investigators propose a multi-institutional trial in which patients and their families choose
 between antibiotics therapy (AT group) or laparoscopic appendectomy (LAAPT group) to chronic
 appendicitis in children aged 3-15 years. The investigators hypothesize that laparoscopic
 appendectomy will be successful in 90% of patients at 1 year follow-up and will be associated
 with fewer disability days, higher quality of life scores, and higher pain reduce scores than
 antibiotic therapy. This study will enroll 200 patients, age 3-15 years, with chronic
 appendicitis at 8-10 hospitals.
Inclusion Criteria:

 1. Patients were eligible if they were between 3 and 15 years of age, and they suffered
 from chronic appendicitis.

 2. US showing hyperemia and fecalith, ≤ 1.1 cm in diameter, compressible or
 non-compressible, no abscess, no phlegmon or CT showing hyperemia and fecalith, fat
 stranding, ≤ 1.1 cm in diameter, no abscess, no phlegmon.

 Exclusion Criteria:

 1. Exclusion criteria consisted of (a history of) chronic back pain

 2. previous abdominal surgery (with the exception of diagnostic laparoscopies or a
 laparoscopic sterilization)

 3. specific gastro-intestinal entities (such as inflammatory bowel disease)
 4.gynaecological disease (all female patients consulted a gynaecologist)