The current management of acute uncomplicated appendicitis: should there be a change in paradigm? A systematic review of the literatures and analysis of treatment performance

World Journal of Emergency Surgery : WJES
Samuel Ho Ting PoonWai Lun Law

Abstract

Appendectomy has long been the mainstay of intervention for acute appendicitis, aiming at preventing perforation, peritonitis, abscess formation and recurrence. With better understanding of the disease process, non-operative management (NOM) with antibiotics alone has been proved a feasible treatment for uncomplicated appendicitis. This article aimed at systematically reviewing the available literatures and discussing the question whether NOM should replace appendectomy as the standard first-line treatment for uncomplicated appendicitis. A search of the Embase, Pubmed and Cochrane Library was performed using the keywords 'acute appendicitis' and 'antibiotic therapy'. Meta-analysis with inverse variance model for continuous variable and Mantel Haenzel Model for dichotomous variable was performed to evaluate the one year treatment efficacy, morbidities rate, sick leave duration and length of hospital stay associated with emergency appendectomy and NOM. Six randomized control trials were identified out of 1943 publications. NOM had a significant lower treatment efficacy rate at one year, 0.10 (95% CI 0.03-0.36, p < 0.01), when compared to appendectomy. The morbidities rate was comparable between the two interventions. The length o...Continue Reading

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Citations

Feb 6, 2020·Surgical Infections·Kovi E Bessoff, Joseph D Forrester
Mar 12, 2020·World Journal of Emergency Surgery : WJES·Paola FugazzolaLuca Ansaloni
Jul 17, 2020·Techniques in Coloproctology·H Javanmard-EmamghissiUNKNOWN COVID: HAREM (Had Appendicitis, Resolved/Recurred Emergency Morbidity/Mortality) Collaborators Group
Dec 18, 2019·Nigerian Medical Journal : Journal of the Nigeria Medical Association·Ikeoluwa Kendra Bolakale-Rufai, David O Irabor
Feb 11, 2020·Current Problems in Diagnostic Radiology·Kulyada EurboonyanunPiyachat Srimunta
Jun 12, 2021·Cost Effectiveness and Resource Allocation : C/E·César Augusto Guevara-CuellarElizabeth Parody-Rúa
Sep 4, 2021·The British Journal of Surgery·H Javanmard-EmamghissiUNKNOWN COVID: HAREM (Had Appendicitis and Resolved/Recurred Emergency Morbidity/Mortality) Collaborative Group
Sep 22, 2021·Surgical Infections·Philip S Barie

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