Efficacy of Antibiotic Therapy Alone Versus Antibiotics With Percutaneous Drainage in Periappendiceal Abscess: A Systematic Review and Meta-Analysis

Abstract

Acute appendicitis is one of the most common surgical emergencies. Simple appendicitis can be a complicated periappendiceal abscess. Despite the fact that there are several treatment options for periappendiceal abscesses, there is no consensus on the optimal treatment method; some surgeons prefer appendectomy, while others prefer relying on non-operative approaches using antibiotic therapy with or without percutaneous drainage. The aim of this study was to compare the efficacy of antibiotics-only therapy to antibiotics plus percutaneous drainage in the management of periappendicular abscess. An electronic database and clinical trial register search was performed on the PubMed, EMBASE, SCOPUS, ClinicalTrials.gov, and Cochrane libraries. After the removal of duplicate records, the studies went through a screening process to determine their eligibility. A meta-analysis was performed for the length of hospital stay and treatment success rate for the comparison groups (antibiotics-only and antibiotics plus percutaneous drainage), in which the mean difference with a 95% confidence interval, and odds ratio using the Mantel-Haenszel method were calculated. The heterogeneity among the studies was assessed using the I² value. Four studies were included in the review and the meta-analysis. Most of the included studies had a retrospective design with the exception of one study, which was a randomized controlled trial. A total of 1,422 patients were included in the four studies; the majority of them (1192, 83.8%) received antibiotics only for the treatment of periappendiceal abscesses, while the rest (230, 16.2%) had percutaneous drainage plus antibiotic therapy. Patients in the antibiotics-only group had a statistically significant mean difference of 2.77 (confidence interval (CI): 3.99-1.55) days of hospital stay less than the percutaneous drainage plus antibiotics group, with a P-value of <0.001. Moreover, they had an average odds ratio of 0.51 (CI: 0.08-3.27) of having more treatment success than the percutaneous drainage plus antibiotics group. However, this was not statistically significant, with a P-value of 0.47. In conclusion, antibiotics-only therapy had a slightly higher odds ratio in terms of treatment success, but this was not statistically significant. In addition, patients in the antibiotics-only group had a decreased length of hospital stay. On the other hand, patients in the antibiotics plus percutaneous drainage group had lower rates of recurrence and required fewer interval appendectomies. More well-designed randomized controlled trials are needed to further solidify the evidence.

Keywords: antibiotic therapy; meta-analysis; percutaneous drainage; periappendiceal abscess; recurrence rate.

Figure 1. PRISMA flow diagram of the study selection process.

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyse

Figure 2. Meta-analysis results for the length of hospital stay comparison for the two groups.

References: [13-16]

Figure 3. Meta-analysis results for the treatment success comparison for the two groups.

References: [13-16]