PT  - JOURNAL ARTICLE
AU  - Ulf Kessler
AU  - Selim Mosbahi
AU  - Benedict Walker
AU  - Eva M Hau
AU  - Michael Cotton
AU  - Barbara Peiry
AU  - Steffen Berger
AU  - Bernhard Egger
TI  - Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis
AID  - 10.1136/archdischild-2017-313127
DP  - 2017 Dec 01
TA  - Archives of Disease in Childhood
PG  - 1118--1124
VI  - 102
IP  - 12
4099  - http://adc.bmj.com/content/102/12/1118.short
4100  - http://adc.bmj.com/content/102/12/1118.full
SO  - Arch Dis Child2017 Dec 01; 102
AB  - 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.