Although nonoperative treatment of appendicitis (NOTA) in the pediatric population has been well reported recently, patient selection and treatment scheme varies among studies, making it difficult to establish treatment standards for NOTA.

In a single medical center, patients younger than 18 years who were diagnosed with appendicitis: 1) with abdominal pain not exceeding 24 hours, 2) without radiologic evidence of appendicolith or appendiceal perforation or pelvic abscess, and 3) without signs of frank generalized peritonitis were offered NOTA, and their data were prospectively collected.

Twenty-two patients with uncomplicated appendicitis agreed to NOTA and were enrolled in the study. The initial success rate (resolution of abdominal pain and hospital discharge without appendectomy) was 100% (22 out of 22 patients). At a median follow-up period of 23.8 months, two patients had recurrence at two and three months after completion of NOTA. These patients underwent laparoscopic appendectomy.

Stringent patient selection may be necessary to apply NOTA safely for all children with uncomplicated appendicitis. Further studies concerning patient selection and conformed treatment protocols for NOTA are required.

We describe our experience in managing congenital diaphragmatic hernia (CDH) in neonates.

From February 1995 to July 2014, 64 neonates diagnosed with CDH were managed. The medical records of these neonates were retrospectively reviewed.

There were 40 males and 24 females. CDH was on the left side in 44 cases (68.8%), on the right side in 19 cases (29.7%) and bilateral in 1 case (1.6%). Forty-six patients (71.9%) received surgical repair of the hernia while 18 patients (28.1%) died prior to surgery. The timing of surgery was mean 7.0 days after birth. Extracorporeal membrane oxygenation was used in six patients (9.4%), High-frequency oscillation ventilation was used in 49 patients (76.6%), and nitric oxide was used in 42 patients (65.6%). Thirty-three cases (71.7%) of CDH repair were done via open laparotomy, 3 cases (6.6%) by open thoracotomy. and minimally invasive thoracoscopic repair was done in 10 cases (21.7%). Ten cases (21.8%) required patch repair of the CDH. Barotrauma and pneumothorax of the contralateral lung was seen in 16 cases, leading to death in 15 of these cases. The overall survival rate was 48.4% (31/64) and postoperative survival rate was 67.4% (31/46). When all patients are divided into 3 groups by era and analyzed by logistic regression models, the mortality outcome of recent era (2009–2014) was significantly better than that of intermediate era (2002–2008) (29% vs. 71%, p=0.006) and tended to be better than that of past era (1995–2001) (42% vs. 71%, p=0.062).

The overall survival of neonates with CDH at our center has improved over the last two decades. Sixty-four neonates with CDH were managed at a single center and their overall survival was 48.4%. The risk factors for mortality include the occurrence of pneumothorax and right side lesions.