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Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis
  1. Ulf Kessler1,2,
  2. Selim Mosbahi1,
  3. Benedict Walker1,
  4. Eva M Hau2,
  5. Michael Cotton3,
  6. Barbara Peiry1,
  7. Steffen Berger2,
  8. Bernhard Egger1
  1. 1 Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
  2. 2 Department of Paediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  3. 3 Department of Accident and Emergency, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  1. Correspondence to Dr Ulf Kessler, Department of Paediatric Surgery, Bern University Hospital, University of Bern, Inselspital, Bern 3010, Switzerland; ulf-kessler{at}hotmail.com

Abstract

Objectives To compare conservative treatment with index admission appendicectomy in children with acute uncomplicated appendicitis.

Design Systematic review and meta-analysis.

Data sources Medline, Embase and the Cochrane Library (CENTRAL) from 1950 to 18 February 2017.

Eligibility criteria for selecting studies Studies that assessed both appendicectomy and non-operative management of acute uncomplicated appendicitis in children of less than 18 years of age. Endpoints were postintervention complications, readmission and efficacy (successful outcome of the initial therapy).

Results Five studies met the inclusion criteria (conservative treatment n=189; surgical intervention n=253). Compared with patients undergoing index admission appendicectomy, conservative treatment showed a reduced treatment efficacy (relative risk 0.77, 95% CI 0.71 to 0.84; p<0.001) and an increased readmission rate (relative risk 6.98, 95% CI 2.07 to 23.6; p<0.001), with a comparable rate of complications (relative risk 1.07, 95% CI 0.26 to 4.46). Exclusion of patients with faecoliths improved treatment efficacy in conservatively treated patients. One study was randomised, with the remaining four comprising cohorts assembled by patient or physician choice. Different antibiotic regimens were used between investigations. Follow-up varied from 1 to 4 years.

Conclusions Conservative treatment was less efficacious and was associated with a higher readmission rate. Index admission appendicectomy should in the present still be considered to be the treatment of choice for the management of uncomplicated appendicitis in children.

  • Appendicitis
  • Appendicectomy
  • Conservative Treatmant

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Footnotes

  • UK, SM, BW and EMH contributed equally.

  • Contributors UK conceptualised and designed the study, drafted the initial manuscript, performed and interpreted the statistical analysis, was part of the writing committee, critically reviewed and revised the manuscript, and performed the revisions as proposed by the reviewers. EMH, SM and BW performed the literature search, extracted the data, performed and interpreted the statistical analysis, were part of the writing committee, and critically reviewed the manuscript. MC interpreted the data, was part of the writing committee, and critically reviewed and revised the manuscript. BP conceptualised the study, was part of the writing committee and critically reviewed the manuscript. BE and SB performed the duplicate data extraction, analysed and interpreted the data, were part of the writing committee, and critically reviewed the manuscript for important intellectual content. UK, SM, BW, and EMH contributed equally to this work.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data arise from this study.

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