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Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review
Xinlin Chin1,2,3, Sachini Mallika Arachchige4, Jane L Orbell-Smith5
1General Surgery, Mackay Base Hospital, Mackay, AUS.
Cureus
|February 22, 2024
Summary
Antibiotic treatment for acute appendicitis shows higher recurrence rates (13-38%) compared to appendicectomy. While not routinely recommended, antibiotics may be an option for selected patients who accept surgical risks.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infectious Diseases
Background:
- Appendicectomy is the traditional gold standard for acute appendicitis.
- Antibiotic therapy is emerging as a conservative management option.
- Evidence is needed to compare efficacy and safety of both approaches.
Purpose of the Study:
- To systematically review and compare antibiotic treatment versus appendicectomy for acute appendicitis.
- To evaluate recurrence rates and treatment success in patients managed with antibiotics.
Main Methods:
- Systematic search of CINAHL, Cochrane, Embase, Medline, and PubMed.
- Inclusion of 21 studies (systematic reviews, meta-analyses) with 44,699 participants.
- Analysis of antibiotic regimens, duration, and patient outcomes.
Main Results:
- Antibiotic treatment was used in at least 17,865 participants.
- One-year recurrence rates after antibiotic treatment ranged from 13% to 38%.
- Appendicectomy remains superior due to higher efficacy and lower complication rates.
Conclusions:
- Appendicectomy is the gold standard for uncomplicated acute appendicitis.
- Antibiotic treatment is a viable alternative for select patients unwilling to undergo surgery.
- Patients considering antibiotics must acknowledge recurrence risks and potential need for surgery.
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