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Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis

George Vaos1, Anastasia Dimopoulou1, Eleana Gkioka2

  • 1Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.

Journal of Pediatric Surgery
|August 18, 2018
PubMed

Insights

Conservative treatment (CT) for complicated acute appendicitis (CAA) in children reduced overall complications and wound infections. Immediate surgery (IS) led to shorter hospital stays, but did not impact abscess or ileus rates. Further research is needed.

Area of Science:

  • Pediatric Surgery
  • Gastrointestinal Surgery
  • Evidence-Based Medicine

Background:

  • Complicated acute appendicitis (CAA) in children presents a clinical challenge.
  • Treatment options include immediate surgery (IS) and conservative treatment (CT).
  • Optimal management strategies require careful consideration of outcomes.

Purpose of the Study:

  • To conduct a meta-analysis comparing immediate surgery (IS) with conservative treatment (CT) for pediatric complicated acute appendicitis (CAA).
  • To evaluate postoperative morbidity and length of hospital stay (LOS) between the two treatment approaches.

Main Methods:

  • Systematic literature search for relevant studies from 1969 to date.
  • Inclusion of trials comparing IS with CT in children with CAA.
  • Meta-analysis of postoperative morbidity and length of hospital stay (LOS) as primary outcomes.

Main Results:

  • Conservative treatment (CT) was associated with significantly lower rates of overall complications (OR 0.22) and wound infection (OR 0.40).
  • Neither intraabdominal abscess (OR 1.03) nor postoperative ileus (OR 0.29) rates were significantly different between IS and CT.
  • Immediate surgery (IS) showed a trend towards a shorter length of hospital stay (SMD -0.25).

Conclusions:

  • Conservative treatment (CT) appears beneficial for reducing overall complications and wound infections in pediatric CAA.
  • Immediate surgery (IS) may offer shorter hospital stays but does not influence the risk of intraabdominal abscess or postoperative ileus.
  • Significant heterogeneity across studies highlights the need for high-quality randomized controlled trials (RCTs) to establish definitive management guidelines for pediatric CAA.
Abstract

Keywords:
ChildrenComplicated acute appendicitisConservative treatmentImmediate appendectomy

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