Appendicolith in non-operative management of acute appendicitis: Implications for recurrence and future directions

Table 2 Comparative analysis of the impact of appendicoliths on nonoperative management of uncomplicated acute appendicitis

Dimension	Conclusion of Kupietzky et al’s study[1] conclusion (797 patients)	Conclusion of other studies (systematic reviews/meta-analyses)	Difference in perspective
Overall recurrence rate	No significant difference (26.5% vs 19.1%, P = 0.14)	Significantly increased (OR = 2.75; 95%CI: 1.05-7.20)	Study populations differ (current study restricted to uncomplicated cases; other studies include complicated cases)
Treatment failure rate	No statistical difference (26.5% vs 19.1%, P = 0.14; short-term follow-up within 30 days)	Significant failure (OR = 0.42; 95%CI: 0.21-0.84; long-term follow-up including 30 days to 2 years)	Definition of failure varies (short-term vs extended follow-up)
Impact of appendicolith characteristics	No correlation with recurrence (sample size n = 68; insufficient power for subgroup analysis)	Stone size, location (e.g., proximal), and number may increase risk (mechanistic studies suggest mechanical obstruction)	Limited by sample size and study design
Pediatric patients	Not specifically analyzed (mean age 254 years)	Stronger negative impact in children	Age stratification missing
Clinical recommendations	Prioritize surgery (e.g., laparoscopic appendectomy); if NOM is chosen, close surveillance is warranted	Recommend surgery for appendicoliths; inform patients of recurrence risks (approximately 23%-30%) and consider interval appendectomy	Variability in evidence strength

NOM: Nonoperative management.