Comparison of conservative treatment with appendectomy for acute uncomplicated pediatric appendicitis: a meta-analysis

Abstract

Aim: We aimed to compare conservative treatment with surgery for uncomplicated pediatric appendicitis to estimate effectiveness and safety. Methods: Data recorded until September 2018 were searched, and relevant academic articles from PubMed, EMBASE, the Cochrane Library and other libraries were selected. STATA version 13.0 (Stata Corporation, TX, USA) was used for statistical analysis. Results: We identified nine eligible papers. The study reported a significant difference in the success rate of treatment in 1 month and in 1 year, and no difference in the incidence of complications. The patients with fecaliths showed low treatment efficacy in conservative treatment group (p < 0.05). Conclusion: Standardized conservative treatment as inpatients for pediatric appendicitis is safe and feasible. Appendectomy was the better choice for patients with fecaliths.

Does non-operative treatment of appendicitis can replace surgery? - literature overview

“…[7] Studies have also shown that for patients with acute appendicitis with fecaliths or perforated appendicitis surgical treatment is more effective. [6,21] However, it should be mentioned that the results of conservative treatment published recently are noticeably better than in articles published 5-10 years ago. [22] If non-operative therapy fails, primary uncomplicated appendicitis is likely to develop into a complicated form and appendix perforation with peritonitis or perityphlitic abscess and possibly sepsis may occur, requiring secondary, often more invasive surgery.…”

“…[7] Other studies have shown that conservative treatment usually involves a longer hospital stay (the difference is usually 1 day) and requires longer patient observation. [6,21,26,27] The disadvantages of appendectomy also include the high cost of the procedure, especially laparoscopic surgery. [15,27] The study revealed that the higher cost of the surgical procedure combined with a shorter length of stay did not differ significantly from the cost of stay of a patient treated conservatively.…”

“…Another one are hemorrhage, surgical site infection, injury to surrounding structures, ileus, adhesive small bowel obstruction, the potential need for reoperation. However, even with the great development of examination methods, a normal appendix can be found during surgery [5,6]. On the other side, there is a long story of nonoperative therapy of acute appendicitis, which started in 1959, when Coldrey was the first to mention the successful treatment of appendicitis using the conservative approach.…”

Management of Acute Appendicitis during COVID-19 Pandemic in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…4 Although curative, appendectomy is invasive procedure requiring general anesthesia with associated perioperative risks and postoperative complications in about 10% within 30 postoperative days. 5,6 Non-operative management (NOM) of AA, with multiple reported case series of successful treatment of soldiers during wartime or submariners during long missions. 7 During COVID-19 outbreak, there has been a renewed interest in managing patients with AA nonoperatively with antibiotics, thereby reducing the amount of theatre time, staff time and surgical resources.…”

“… 4 Although curative, appendectomy is invasive procedure requiring general anesthesia with associated perioperative risks and postoperative complications in about 10% within 30 postoperative days. 5 , 6 …”