Abstract
Background
To compare the risk of complications between initial nonoperative treatment and appendectomy
of uncomplicated (simple) appendicitis in children.
Methods
Systematic literature search. Eligible for inclusion were both and randomized controlled
trials and cohort studies including children in which the outcome of nonoperative
treatment of uncomplicated appendicitis was reported with a minimum follow-up period
of one year. Two authors extracted data independently and assessed quality. Primary
outcome parameter was the percentage of children experiencing complications. Secondary
outcomes were early failures, recurrent appendicitis and appendectomies, for all indications
and on request.
Results
Five of the 2051 articles screened were eligible for inclusion, including 147 children
(nonoperative treatment) and 173 children (appendectomy) with one year follow-up.
Percentage of children experiencing complications ranged from 0 to 13% versus 0–17%
for nonoperative and appendectomy, respectively. Nonoperative treatment avoided an
appendectomy in 62–81% of the children after one year follow-up.
Conclusion
The evidence base for initial nonoperative treatment of acute uncomplicated appendicitis
in children is by far insufficient. It suggests that the percentage of patients experiencing
complications in the initial nonoperative treatment group is comparable to the appendectomy
group, and it may avoid an appendectomy in the large majority of children after one
year follow-up.
Type of study
Systematic review.
Level of evidence
1.
Key words
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Article info
Publication history
Published online: April 24, 2017
Accepted:
April 9,
2017
Received in revised form:
April 7,
2017
Received:
November 20,
2016
Footnotes
☆Funding source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
☆☆Financial disclosure: None of the authors have any financial relationships relevant to this article to disclose.
★Conflict of interest: None.
★★Prospero registration number: CRD42015022061.
☆☆☆R.R. Gorter and S. The wrote the first draft of this manuscript. Neither he nor any other author received a grant, honorarium or any other form of payment for producing this manuscript.
Identification
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