Comparison of conservative versus surgical therapy for acute appendicitis with abscess in five German hospitals

Shekarriz, S; Keck, Tobias; Kujath, P.; Shekarriz, J.; Strate, Tim; Keller, R; Schlöricke, Erik; Nolde, J.; Ehlert, A; Shekarriz, H.

doi:10.1007/s00384-019-03238-w

Cited by 17 publications

(25 citation statements)

References 14 publications

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“…The studies described 845 patients who were treated surgically (group IO) and 756 patients receiving conservative treatment (group CM). A total of 4 and 10 respective randomized controlled (RCT) [21][22][23][24] and retrospective studies (RS) [25][26][27][28][29][30][31][32][33][34] were included. The information from the literatures that are of major concern is shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 8 studies [22][23][24][29][30][31][32][33] reported the total number of complications within the duration from the onset of the disease to the follow-up period ( Figure 2), and a signi cant heterogeneity was found among the studies (P <0.05; I²>50%), Overall, patients in group IO had more overall complications, but the difference was not statistically signi cant, (OR=3.41, 95%CI [0.98, 11.86], P=0.05).In the subgroup of a retrospective study, patients in group CM had lower complications than those with surgery (OR=7.14, 95%CI [1.79, 28.54], P<0.05). However, there was a strong heterogeneity between the studies (P < 0.05; I²> 50%).…”

Section: Overall Complicationsmentioning

confidence: 99%

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What is the main problem in the conservative management of complicated appendicitis? A meta-analysis

Zhang

Ren

Gao

2020

Preprint

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Background: As one of the classified groups of appendicitis, complicated appendicitis has no standardized treatment methods for adults.Method: The efficacy of surgical treatment and conservative treatment for complicated appendicitis was evaluated based on the literatures systematically searched on PubMed, Cochrane and Web of Science. A focus was given to important aspects, such as the outcomes of the length of stay, operation time, postoperative complications and unplanned additional interventions. Result: A total of 14 studies were involved in the meta-analysis, which included 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). The total hospitalization time for patients with surgical treatment was decreased by 1 day (WMD= -1.29, 95% CI [-2.42, -0.16], P= 0.03< 0.05) compared to that of patients with conservative treatment. The incidence of unplanned additional interventions in patients who underwent emergency surgery is lower than that of patients with conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Compared to patients with conservative treatment, patients who received surgery are more likely to develop complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001). The incidence of abdominal abscess in patients with surgery treatment was lower than that of patients with conservative treatment, but the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: In treating complicated appendicitis, patients who received immediate operation, when compared to patients managed under conservative treatment, have shorter hospitalization time and less unplanned interventions; hence significantly reduce the likelihood of readmission. This can decrease the requirements for follow-up treatments and ultimately lower the consumption of medical resources.

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Section: Resultsmentioning

confidence: 99%

Section: Overall Complicationsmentioning

confidence: 99%

What is the main problem in the conservative management of complicated appendicitis? A meta-analysis

Zhang

Ren

Gao

2020

Preprint

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“…1 for the procedure of literature selection), of which 845 patients were treated surgically (group IO) and 756 patients were treated conservatively (group CM). A total of 4 randomized controlled studies (RCT) [20][21][22][23] were included, and 10 retrospective studies (RS) [24][25][26][27][28][29][30][31][32][33] were included. The literature information of major concern is shown in the following table (Table 1)…”

Section: Data Analysis and Processingmentioning

confidence: 99%

“…3. D), among which there were 3 RCTS 20,21,23 , and 9 retrospective studies [24][25][26][27][28][29][30][31][32] . The summarized results showed that patients in the CM group had a lower incidence of incision infection than those in the IO group (OR = 2.733, 95%CI [1.243, 6.012], P = 0.01 < 0.05).…”

Section: Wound Infectionmentioning

confidence: 99%

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What is the main problem in conservative management for complicated appendicitis? A systematic review

Zhang

Ren

Gao³

2020

Preprint

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Background: As a classification of appendicitis, complicated appendicitis has no standardized treatment for adults.Method: According to the related literature systematically searched on PubMed, Embase, Cochrane and Web of Science, we evaluated the efficacy of surgical treatment and conservative treatment for complicated appendicitis, especially focused on the outcomes about the length of stay, operation time, postoperative complications and unplanned additional intervention, in the literature. Result: A total of 14 studies were involved in the meta-analysis, including 845 patients in the immediate operation group (IO) and 756 patients in the conservative management group (CM). Compared with conservative treatment, the total hospitalization time was reduced by 1 day (WMD=-1.29, 95%CI [-2.42, -0.16], P=0.03<0.05). The incidence of unplanned additional intervention in patients undergoing emergency surgery is lower than that of conservative treatment (OR=0.18, 95%CI [0.11, 0.30], P<0.00001). Surgical patients are more likely to have complications such as wound infection (OR=2.41, 95%CI [1.08, 5.38], P=0.03<0.05) and intestinal obstruction (OR=4.14, 95%CI [2.21, 7.75], P<0.00001) than conservative patients. The incidence of abdominal abscess was lower than that of conservative treatment, and the difference was not statistically significant (OR=0.9, 95%CI [0.54, 1.47], P=0.66>0.05). Conclusion: Compared with conservative management patients, immediately operated patients have shorter hospitalization time and less unplanned intervention, which can significantly reduce the readmission opportunity of patients with complicated appendicitis and lighten the burden of follow-up and medical resource consumption.

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巨大な膿瘍形成性虫垂炎に対して保存的治療後に腹腔鏡下虫垂切除術を施行した1例(A case of appendicitis with huge abscess underwent laparoscopic interval appendectomy after conservative treatment)

恵一

敬博

宏典

et al. 2020

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨非穿孔性虫垂炎はしばしば経験する疾患であるが，その治療においてストラテジーは確立されておらず，保存的治療，外科的治療の優劣も十分評価されていないのが現状である。今回我々は，長径100mmの巨大な膿瘍形成性虫垂炎に対しドレナージを行わずに保存的治療を行い，後に待機的腹腔鏡下虫垂切除術（interval laparoscopic appendectomy: ILA）を施行し良好な経過を得ることができた。膿瘍形成性虫垂炎に対しILAで治療を行った報告は散見されるが，100mmの巨大な膿瘍形成性虫垂炎に対する報告は稀である。ILA適応基準など，既出の文献等を参考にし,自験で得た考えを提唱し報告する。症例は69歳の男性。10日前に腹痛を主訴に他の診療所を受診し，ニューキノロン系の抗生剤を処方され内服していたが軽快せず，病院受診を勧められ，右下腹部痛を主訴に当科を受診した。当科受診時に右下腹部から一部は正中に達する腹腔内の巨大な硬結を触知し，膿瘍形成性虫垂炎と診断し保存的治療を行った。約4か月後にILAを行い，術後4日目に退院した。

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Comparison of conservative versus surgical therapy for acute appendicitis with abscess in five German hospitals

Cited by 17 publications

References 14 publications

What is the main problem in the conservative management of complicated appendicitis? A meta-analysis

What is the main problem in the conservative management of complicated appendicitis? A meta-analysis

What is the main problem in conservative management for complicated appendicitis? A systematic review

巨大な膿瘍形成性虫垂炎に対して保存的治療後に腹腔鏡下虫垂切除術を施行した1例(A case of appendicitis with huge abscess underwent laparoscopic interval appendectomy after conservative treatment)

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