• Annals of surgery · Dec 2019

    Meta Analysis

    Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis.

    Although feasible, non-surgical antibiotic treatment of uncomplicated acute appendicitis is associated with both a lower treatment success rate and higher complication rate than primary surgical appendicectomy.

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    • Mauro Podda, Chiara Gerardi, Nicola Cillara, Nicola Fearnhead, Carlos Augusto Gomes, Arianna Birindelli, Andrea Mulliri, Richard Justin Davies, and Salomone Di Saverio.
    • Department of General, Emergency and Robotic Surgery, San Francesco Hospital, Nuoro, Italy.
    • Ann. Surg. 2019 Dec 1; 270 (6): 1028-1040.

    ObjectiveThe aim of this meta-analysis was to summarize the current available evidence on nonoperative management (NOM) with antibiotics for uncomplicated appendicitis, both in adults and children.Summary Background DataAlthough earlier meta-analyses demonstrated that NOM with antibiotics may be an acceptable treatment strategy for patients with uncomplicated appendicitis, evidence is limited by conflicting results.MethodsSystematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized and nonrandomized studies comparing antibiotic therapy (AT) and surgical therapy-appendectomy (ST) for uncomplicated appendicitis. Literature search was completed in August 2018.ResultsTwenty studies comparing AT and ST qualified for inclusion in the quantitative synthesis. In total, 3618 patients were allocated to AT (n = 1743) or ST (n = 1875). Higher complication-free treatment success rate (82.3% vs 67.2%; P < 0.00001) and treatment efficacy based on 1-year follow-up rate (93.1% vs 72.6%; P < 0.00001) were reported for ST. Index admission antibiotic treatment failure and rate of recurrence at 1-year follow-up were reported in 8.5% and 19.2% of patients treated with antibiotics, respectively. Rates of complicated appendicitis with peritonitis identified at the time of surgical operation (AT: 21.7% vs ST: 12.8%; P = 0.07) and surgical complications (AT: 12.8% vs ST: 13.6%; P = 0.66) were equivalent.ConclusionsAntibiotic therapy could represent a feasible treatment option for image-proven uncomplicated appendicitis, although complication-free treatment success rates are higher with ST. There is also evidence that NOM for uncomplicated appendicitis does not statistically increase the perforation rate in adult and pediatric patients receiving antibiotic treatment. NOM with antibiotics may fail during the primary hospitalization in about 8% of cases, and an additional 20% of patients might need a second hospitalization for recurrent appendicitis.

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    Although feasible, non-surgical antibiotic treatment of uncomplicated acute appendicitis is associated with both a lower treatment success rate and higher complication rate than primary surgical appendicectomy.

    Daniel Jolley  Daniel Jolley
     
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