Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis
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Read the article on link.springer.com ↗Article · Dec 2019 · 1 min read
In brief
In brief
Systematic review of 21 studies demonstrates that nonoperative antibiotic treatment for nonperforated appendicitis in children achieves 92% initial success, though 16% require delayed appendectomy. Complication rates and hospital length of stay are comparable to immediate surgery, supporting antibiotics as a safe alternative, though high-quality randomized trials are needed.
Written by the GCMD Library team from the article.
Abstract
Acute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.