Management of uncomplicated acute appendicitis: a protocol for systematic review and network meta-analysis of randomised-controlled trials

Abstract

Objectives: While multiple studies have shown the safety and efficacy of non-operative management, appendectomy remains the standard treatment for uncomplicated acute appendicitis (UAA). This study presents a protocol for a meta-analysis comparing antibiotic therapy, endoscopic retrograde appendicitis therapy (ERAT) and appendectomy in patients with UAA.

Methods and analysis: We will conduct a systematic search of several databases, including PubMed, Web of Science, Embase, the China National Knowledge Infrastructure and the Cochrane Library. The search will cover the full range of database records up to September 2024. Eligible studies will include randomised-controlled trials (RCTs) evaluating the efficacy of antibiotic therapy, ERAT and appendectomy for UAA. The primary outcome will be treatment success, while secondary outcomes will include major complications, hospital costs, length of stay and recurrence of appendicitis. Two independent reviewers will select studies, extract data and assess bias risk. A Bayesian approach will be used for the network meta-analysis.

Ethics and dissemination: Ethical approval is not required as the study will use data from published RCTs. The findings will be disseminated through publication in peer-reviewed journals.

Prospero registration number: CRD42024554427.

Keywords: Adult gastroenterology; Gastrointestinal infections; Network Meta-Analysis; Systematic Review.

Figure 1. Selection of studies for inclusion.