Original CommunicationA meta-analysis comparing conservative treatment versus acute appendectomy for complicated appendicitis (abscess or phlegmon)
Section snippets
Study selection
A database search using Medline, EMBASE, Ovid, and Cochrane was performed on all studies to compare CT and AA for patients who presented with complicated appendicitis. The following MeSH search headings were used: “complicated appendicitis,” “perforated appendicitis,” “appendiceal abscess,” “appendiceal mass,” “conservative treatment,” “acute appendectomy,” “interval appendectomy,” “comparative study,” and “treatment outcome.” The above terms and their combinations were also searched as text
Eligible studies
Using the search key words listed above, 74 publications were identified. In all, 48 studies were excluded after reviewing the title and abstract. These results included 21 studies reporting on only 1 modality of treatment, 11 studies reporting on appendiceal mass/abscess formation, and 5 studies reporting on histologic or radiologic evaluation of appendiceal specimens. Furthermore, the excluded studies consisted of 5 case-based discussions on appendiceal masses/abscesses and 6 studies that did
Discussion
No standardized approach is available to the management of patients who present with appendicitis complicated by a local or contained perforation and with an appendiceal abscess or mass formation. Traditionally, appendectomy was considered the treatment of choice for complicated appendicitis, based on the surgical principle of removing the offending organ to resolve infection. However, the current meta-analysis showed that CT of complicated appendicitis results in a decreased overall
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2023, Journal of Pediatric SurgeryCitation Excerpt :Some argue for the use of initial early appendectomy with some studies citing benefits such as shorter duration of hospital stays, fewer radiographic studies performed per patient, and fewer post-admission complications and repeat hospitalizations compared to interval appendectomy [2,3]. However, other retrospective studies and meta-analyses have shown that interval appendectomy up to 6 to 9 weeks after the diagnosis of perforated appendicitis may be a superior strategy citing decreased rates of overall post-operative complications such as wound infections and intrabdominal abscesses compared to early appendectomy [4,5]. Some have also argued that interval management may be a more optimal utilization of hospital resources and result in less economic burden to the healthcare system [6,7].