PODIUM PRESENTATIONS

**Background:** Acute appendicitis is the most common acute abdominal surgical condition in children. While surgical management has been the traditional mainstay, nonoperative management (NOMA) has gained momentum in recent years as a potential alternative for uncomplicated cases. This study aimed to compare outcomes between children undergoing NOMA versus upfront surgery for noncomplicated appendicitis.

**Methods:** This was a retrospective review of all children admitted for acute appendicitis (both complicated and uncomplicated) over a 5-year period from June 2017 to June 2022. Data collected included diagnosis, mode of management (surgical or conservative), postoperative course and complications, and duration of hospital stay. Patients with complicated appendicitis were excluded from the primary analysis.

**Key Results:** A total of 311 children were admitted for acute appendicitis during the study period. Uncomplicated appendicitis was identified in 253 patients (81.3%), of whom 221 underwent NOMA and 32 were operated due to persisting symptoms or clinical deterioration. Complicated appendicitis was found in 58 patients (18.7%), all of whom underwent surgery and were excluded from further analysis. Among the 32 surgically managed uncomplicated cases, 22 had a history of prolonged conservative management elsewhere, while 10 showed no clinical relief after a mean of 4 days of conservative management. The mean duration of hospital stay was significantly shorter in the NOMA group (2.3 days) compared to the operative group (8 days). Similarly, the mean time to full feeds was shorter in the NOMA group (2 days) versus the operative group (6 days). Recurrent appendicitis requiring surgical management occurred in 28 out of 253 patients (11.1%) in the NOMA group.

**Clinical Implications:** NOMA for uncomplicated appendicitis in children reduces hospital stay, time to full feeds, and likely postoperative morbidity and costs compared to upfront surgery. The recurrence rate of 11.1% is acceptable, and most patients avoid surgery. These findings support NOMA as a first-line treatment for uncomplicated appendicitis, potentially reducing operative costs and complications. However, the retrospective design and small surgical group limit generalizability, and prospective studies are needed to confirm these results.