Surgery versus Conservative Antibiotic Treatment in Acute Appendicitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ansaloni, Luca; Catena, Fausto; Catena, Fausto; Ercolani, Giorgio; Gazzotti, Filippo; Pasqualini, Eddi; Pinna, Antonio Daniele

doi:10.1159/000324595

Cited by 104 publications

(110 citation statements)

References 98 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5 Nevertheless, given the severity of disease seen in the developed world, the case for conservative treatment in sub-Saharan Africa may be difficult to justify at present. Delay in clinical presentation due to poor access to appropriate surgical facilities has been considered as one of the most important determinants of clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…4 In the developed world, the focus of research has been on the role of advanced imagining, non-operative management and the benefits of laparoscopic appendicectomy. 5 However, the available literature shows that appendicitis in the developing world has a very different profile, which is associated with significant morbidity and even mortality. 2,6,7 Late clinical presentation and difficulty in accessing healthcare facilities are often major contributing factors to this advanced disease profile.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

View full text Add to dashboard Cite

INTRODUCTION Acute appendicitis in the developing world has a markedly different disease profile to that in the developed world. METHODS A retrospective study was undertaken over a four-year period at a university hospital in South Africa to review the disease spectrum and the clinical outcome of acute appendicitis. RESULTS A total of 1,004 patients (54% male, median age: 18 years) with intraoperatively confirmed appendicitis were reviewed. Over half (56%) were from the urban district within the city of Pietermaritzburg and the remaining 44% were from the rural health district. The median duration of illness from onset to definitive care was 4 days. Sixty per cent of appendices were perforated and associated with intra-abdominal contamination. Forty per cent of patients required reoperation to control intra-abdominal sepsis. Ten per cent required admission to the intensive care unit. The median overall length of hospital stay was 5 days. The mortality rate was 1%.Rural patients had a longer median duration of illness (3 vs 5 days, p<0.001) as well as a more advanced disease profile associated with perforation and severe intra-abdominal sepsis (19% vs 71%, p<0.001). Female patients had a longer median duration of illness (3 vs 4 days, p<0.001), were more likely to present with severe intra-abdominal sepsis (31% vs 54%, p<0.001) and were more likely to require a laparotomy (50% vs 73%, p<0.001). The total cost of managing the entire cohort of 1,004 patients over the 4-year period was £2,060,972. CONCLUSIONS Acute appendicitis in South Africa is a serious disease associated with significant morbidity. Late presentation is common. Female and rural patients have the worst clinical outcomes, with significant cost to the health system.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

View full text Add to dashboard Cite

show abstract

“…Nonetheless, the impact of antibiotics as a primary treatment of acute appendicitis has been controversial with systematic reviews and meta-analyses presenting inconsistent results [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Madanat¹,

Shaban²,

Naghawi³

et al. 2017

BIO

View full text Add to dashboard Cite

Abstract:Appendectomy is the mainstay of treatment for acute appendicitis. Considering the complications of surgery, antibiotic treatment has also been gaining increasing interest in cases of acute appendicitis. This study aimed to compare the efficacy of antibiotics to surgery for acute uncomplicated appendicitis. The PubMed, Medline, Medscape and Cochrane databases were searched for studies comparing antibiotics versus surgery. The six outcome measures identified were thirty-day post-therapeutic peritonitis, length of hospital stay, prevalence of total complications, prevalence of normal appendix, prevalence of mean duration of pain and duration of disability. Five prospective RCTs with a total of 1430 patients (644 in the antibiotic group and 786 in the surgical group) were included in this study. Antibiotic treatment had a success rate of 75.3%. Regarding overall mean duration of disability, the antibiotic group had a significantly shorter duration of disability than that of the surgery group (P < 0.05). The total number of complications in the antibiotic group was 3.6% while that of the surgical group was 11.6%. The overall difference for mean duration of pain, and length of hospital stay between antibiotic therapy and surgery were not found to be statistically significant (P > 0.05). Although the conservative approach has a success rate lower than appendectomy, it is a possible alternative in certain clinical scenarios. Appendectomy remains the mainstay treatment for acute appendicitis. However, additional studies clarifying the certain etiologies of appendicitis that are responsive to antibiotic treatment are needed to further support its use.

show abstract

“…The Ansaloni study: although a non-surgical approach in AA can reduce overall complication rate, the lower efficacy prevents antibiotic treatment from being a viable alternative to surgery. Since only a small number of RCTs of poor methodological quality are available, welldesigned RCTs are needed for further investigation [18]. 2.…”

Section: Introductionmentioning

confidence: 99%

Conservative treatment for uncomplicated acute appendicitis in adults

Pisano¹,

Coccolini²,

Bertoli³

et al. 2013

Emerg Med Health Care

Self Cite

View full text Add to dashboard Cite

Background: Acute appendicitis is a very common disease with a life time risk of approximately 7-8%. Worldwide, the standard of care for appendicitis is appendectomy that is to date considered generally a "routine and safe operation". However, the mortality rate of appendectomy is 0.7% and 2.4% in patients without and with perforation, respectively. Aim: The paper aims to investigate the debate on surgical and non surgical treatment of acute uncomplicated appendicitis. Methods: Pubmed and embase were queried for "acute appendicitis, antibiotics, surgery, conservative treatment, diagnosis". All prospective randomized studies, meta-analysis, systematic reviews and significant retrospective studies were retrieved. A brief analysis of single RCT and meta-analysis was conducted. Finally, the topic was developed by focusing on several clinical aspects. Discussion and conclusions: The comparison of surgery and antibiotics, in terms of efficacy to treat acute appendicitis, is intrinsically complex due to the huge disparity of management and treatment options. After establishing an institutional validated clinical score, uncomplicated appendicitis in adult can be safely and successfully treated by antibiotic therapy an in-hospital setting if the patient is well informed. Nevertheless, outpatient antibiotic treatment cannot be proposed as a routine clinical practice. High risk patients should be treated with antibiotics whilst any treatment failure should be considered for mandatory surgery.

show abstract

Surgery versus Conservative Antibiotic Treatment in Acute Appendicitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 104 publications

References 98 publications

Acute appendicitis in the developing world is a morbid disease

Acute appendicitis in the developing world is a morbid disease

A Meta-Analysis of Antibiotics Versus Surgery for the Treatment of Acute Appendicitis

Conservative treatment for uncomplicated acute appendicitis in adults

Contact Info

Product

Resources

About