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Meta-Analysis
. 2020 Mar;36(3):261-269.
doi: 10.1007/s00383-019-04610-1. Epub 2019 Dec 14.

Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Sonia Maita  1 , Björn Andersson  2 , Jan F Svensson  2   3 , Tomas Wester  4   5
Affiliations
Meta-Analysis

Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Sonia Maita et al. Pediatr Surg Int. 2020 Mar.

Abstract

Acute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.

Keywords: Antibiotics; Appendectomy; Appendicitis; Children; Nonoperative treatment; Nonperforated.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Prisma flowchart showing the process of selecting articles for analysis
Fig. 2
Fig. 2
Treatment efficacy. Sixteen studies were included in the analysis of treatment efficacy, defined as discharge without further complications
Fig. 3
Fig. 3
Complications. Eight studies reported complications. Negative appendectomy was included among complications in the appendectomy group
Fig. 4
Fig. 4
Length of hospital stay. Length of initial hospital stay was compared based on data from seven studies
Fig. 5
Fig. 5
Recurrent appendicitis. Twenty-one studies were included in the meta-analysis of recurrent appendicitis after discharge from the initial hospital stay. The analysis also included patients who underwent appendectomy due to recurrent abdominal pain with normal appendix, and interval appendectomies
Fig. 6
Fig. 6
Total length of hospital stays. This included the initial hospital stay and hospital stay during readmissions
See this image and copyright information in PMC

Comment in

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