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¿Puede la terapia con antibióticos reemplazar la cirugía en la apendicitis aguda sin complicaciones en niños? Un

Kai Lu¹, Shilong Shu¹, Junwei Wang²

¹Department of General Surgery, Zigong Fourth People's Hospital, 643000, No. 400, Dangui Avenue, Ziliujing District, Zigong, Sichuan Province, China.

Journal of pediatric surgery

|August 20, 2025

Resumen

El tratamiento no quirúrgico (NOM) para la apendicitis no complicada pediátrica (UA) muestra tasas de fracaso más altas que el tratamiento quirúrgico (OM). OM se recomienda como tratamiento primario, con NOM reservado para casos seleccionados después de una evaluación cuidadosa.

Área de la Ciencia:

Cirugía pediátrica
Gastroenterología
Ensayos clínicos

Sus antecedentes:

El tratamiento no quirúrgico (NOM) para la apendicitis no complicada pediátrica (UA) carece de pruebas sólidas de grandes ensayos controlados aleatorios (ECA).
Se debate la eficacia y la seguridad de la NOM frente al manejo operativo (OM) para la UA pediátrica.
Este metanálisis aborda la controversia mediante la síntesis de datos actualizados de ECA.

Objetivo del estudio:

Evaluar la eficacia del tratamiento no quirúrgico (NOM) para la apendicitis no complicada pediátrica (UA).
Comparar las tasas de fracaso del tratamiento, la calidad de vida y los costos entre NOM y OM.
Proporcionar recomendaciones basadas en la evidencia para el tratamiento pediátrico de la UA.

Principales métodos:

Búsqueda sistemática de la literatura de las principales bases de datos (Web of Science, Embase, Cochrane, PubMed) hasta el 18 de abril de 2025.
La inclusión de ECA comparando el NOM con el OM para la UA pediátrica.
Metaanálisis utilizando RevMan 5.3, centrado en las tasas de fracaso del tratamiento inicial, 1 año después del alta, y en general.

Principales resultados:

Se analizaron cinco ECA con 1423 pacientes (NOM: 738; OM: 685).
La NOM demostró tasas significativamente más altas de fracaso inicial (OR: 3.14), de un año después del alta (OR: 20.53) y de fracaso total del tratamiento (OR: 8.47) en comparación con la OM.
La NOM se relacionó con más eventos adversos, estadías hospitalarias más largas y reingresos hospitalarios aumentados, a pesar de menos días de ausencia escolar.

Conclusiones:

Los ECA actualizados a gran escala indican que el tratamiento no quirúrgico (NOM) es menos eficaz que el tratamiento quirúrgico (OM) para la apendicitis no complicada pediátrica (UA).
La gestión operativa (MO) debe seguir siendo la estrategia de tratamiento primaria.
La NOM puede considerarse para casos pediátricos específicos de UA, dependiendo de una evaluación exhaustiva de los riesgos y beneficios.

Palabras clave:

Los antibióticos La apendicitis Gestión no operativa Gestión operativa En niños

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