Comparison of the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis: a systematic review and meta-analysis

Abstract

Objective This meta-analysis aimed to compare the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis. Methods We searched the randomized controlled studies (RCTs) comparing appendectomy with antibiotic treatment for uncomplicated acute appendicitis in the electronic database including Pubmed, Embase, Cochrane, Web of Science, CNKI, VIP, and WanFang. The primary outcomes included complication-free treatment success at 1 year, complications, surgical complications, and the complicated appendicitis rates. Secondary outcomes included negative appendicitis, length of hospital stay, the quality of life at 1 month, and the impact of an appendicolith on antibiotic therapy. Results Twelve randomized controlled studies were included. Compared with surgery group, the antibiotic group decreased the complication-free treatment success at 1 year (RR 0.81; 95% CI 0.73–0.91; z = 3.65; p = 0.000). Statistically significance was existed between antibiotic group and surgical group with both surgical types(open and laparoscopic) (RR 0.43; 95% CI 0.31–0.58; z = 5.36; p = 0.000), while no between the antibiotic treatment and laparoscopic surgery (RR 0.72; 95% CI 0.41–1.24; z = 1.19; p = 0.236). There was no statistically significant differences between two groups of surgical complications (RR 1.38; 95% CI 0.70–2.73; z = 0.93; p = 0.353), the complicated appendicitis rate (RR 0.71; 95% CI 0.36–1.42; z = 0.96; p = 0.338), negative appendectomy rate (RR 1.11; 95% CI 0.69–1.79; z = 0.43; p = 0.670), duration of hospital stay (SMD 0.08; 95%CI -0.11-0.27; z = 0.80; p = 0.422), and quality of life at 1 month (SMD 0.09; 95%CI -0.03-0.20; z = 1.53; p = 0.127). However, in the antibiotic treatment group, appendicolith rates were statistically higher in those whose symptoms did not improve (RR 2.94; 95% CI 1.28–6.74; z = 2.55; p = 0.011). Conclusions Although the cure rate of antibiotics is lower than surgery, antibiotic treatment is still a reasonable option for patients with uncomplicated acute appendicitis who do not want surgery without having to worry about complications or complicating the original illness.

Diagnostic value of laboratory parameters for complicated appendicitis: A two‑center study

“…Complicated appendicitis accounts for 18-34% of acute appendicitis cases ( 1 ). Conservative treatment is the first option for uncomplicated appendicitis ( 1 , 7 , 8 , 26 ). Therefore, it is necessary to choose an effective and simple method to distinguish complicated and uncomplicated appendicitis.…”

Comparison of Clinical, Pathological, and Procedural Characteristics of Adult and Pediatric Acute Appendicitis before and during the COVID-19 Pandemic

“…Regarding uncomplicated AA, the 1-year success rate of NOM is lower than that of surgical treatment. However, delayed appendectomy due to the failure of NOM did not increase complication rates compared to open approach [ 28 ]. At UHC Zagreb, surgical management was the sole treatment approach for AA patients during the pandemic.…”

The Efficacy of Antibiotics in Acute Appendicitis Treatment : A Comprehensive Systematic Review

“…Though the definition of them varies among studies, generally the uncomplicated acute appendicitis may absence of perforation, abscess or peritonitis and may or may not include non-perforated gangrenous or a fecalith. 3 Conservative treatment with antibiotics is an alternative choice for appendicitis; although the risk of failure is about 13% higher, but the risk of complications is lower. For instance, the odds of overall complications, bowel obstruction, and reoperation were 0.24 (95%CI: 0.13 to 0.44), 0.35 (95%CI: 0.17 to 0.71), and 0.17 (95%CI: 0.04 to 0.75) respectively, when compared to appendectomy.…”