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Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and

Ulf Kessler1,2, Selim Mosbahi1, Benedict Walker1

  • 1Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland.

Archives of Disease in Childhood
|August 19, 2017
PubMed

Insights

Conservative treatment for acute uncomplicated appendicitis in children is less effective and leads to higher readmission rates. Index admission appendicectomy remains the preferred treatment choice for uncomplicated appendicitis in pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Medicine

Background:

  • Acute uncomplicated appendicitis is common in children.
  • Management options include conservative (non-operative) treatment and surgical appendicectomy.
  • Optimal treatment strategy requires clear efficacy and safety data.

Purpose of the Study:

  • To compare the efficacy and safety of conservative treatment versus index admission appendicectomy for acute uncomplicated appendicitis in children.
  • To evaluate post-intervention complications and readmission rates for both treatment approaches.

Main Methods:

  • Systematic review and meta-analysis of studies published from 1950 to February 2017.
  • Included studies assessed non-operative management and appendicectomy in children (<18 years) with acute uncomplicated appendicitis.
  • Endpoints: post-intervention complications, readmission, and successful initial therapy.

Main Results:

  • Conservative treatment showed reduced efficacy (RR 0.77) and increased readmission rates (RR 6.98) compared to appendicectomy.
  • Complication rates were comparable between the two groups (RR 1.07).
  • Excluding patients with faecoliths improved conservative treatment efficacy.

Conclusions:

  • Conservative treatment for pediatric acute uncomplicated appendicitis is less efficacious and has higher readmission rates.
  • Index admission appendicectomy is recommended as the current treatment of choice for uncomplicated appendicitis in children.
Abstract

Keywords:
AppendicectomyAppendicitisConservative Treatmant

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