Comparing Conservative Treatment With Antibiotics and Appendectomy for Acute Appendicitis in Adult: A Comprehensive Systematic Review
Keywords:
Acute appendicitis, appendectomy, antibiotics, nonoperativeAbstract
Background: Acute appendicitis is the most common reason for an emergency abdominal surgery, with a lifetime appendectomy risk of 12% for males and 23% for females. Although conservative (i.e., nonoperative) treatment of acute uncomplicated appendicitis with antibiotics has yet to be routinely recommended over appendectomy. Methods: This systematic review focused on full-text English literature published between 2014 and 2024 using the PRISMA 2020 guidelines. Editorials and review pieces published in the same journal as the submission without a DOI were not accepted. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: For patients who do not have a strong desire for emergency surgery or refuse emergency surgery, a conservative treatment that mainly entails anti-infection may be temporary.
References
Weledji EP, Zisuh A V., Ngounou E. Management of appendicitis: appendicectomy, antibiotic therapy, or both? Ann Med Surg. 2023;85(4):897–901.
Liu ZH, Li C, Zhang XW, Kang L, Wang JP. Meta-analysis of the therapeutic effects of antibiotic versus appendicectomy for the treatment of acute appendicitis. Exp Ther Med. 2014;7(5):1181–6.
Xu H, Yang S, Xing J, Wang Y, Sun W, Rong L, et al. Comparison of the efficacy and safety of antibiotic treatment and appendectomy for acute uncomplicated appendicitis: a systematic review and meta-analysis. BMC Surg [Internet]. 2023;23(1):1–18. Available from: https://doi.org/10.1186/s12893-023-02108-1
Pata F, Nardo B, Ielpo B, Di Martino M, Murzi V, Di Saverio S, et al. Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis. Surg (United States) [Internet]. 2023;174(6):1292–301. Available from: https://doi.org/10.1016/j.surg.2023.08.029
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC randomized clinical trial. JAMA - J Am Med Assoc. 2015;313(23):2340–8.
Herrod PJJ, Kwok AT, Lobo DN. Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: Meta-Analysis. BJS Open [Internet]. 2022;6(4):1–12. Available from: https://doi.org/10.1093/bjsopen/zrac100
Rocha LL, Rossi FMB, Pessoa CMS, Campos FND, Pires CEF, Steinman M. Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: What do meta-analyses say? World J Emerg Surg [Internet]. 2015;10(1):1–6. Available from: http://dx.doi.org/10.1186/s13017-015-0046-1
Yadao S, Lamture Y, Huse S. Uses of Antibiotics Alone in Case of Uncomplicated Appendicitis. Cureus. 2022;14(8).
Ramadan S, Olsson Å, Ekberg O, Buchwald P. Predictive factors for recurrent acute appendicitis after conservative treatment. Scand J Gastroenterol [Internet]. 2024;0(0):1–6. Available from: https://doi.org/10.1080/00365521.2024.2359438
Ozdemir K, Harmantepe AT, Dulger UC, Gonullu E, Dikicier E, Bayhan Z, et al. Comparison of treatment methods in plastron appendicitis: a tertiary center experience. Malawi Med J. 2023;35(4):224–7.
Akbar HF, Kareem T, Saleem N, Seerat MI, Hussain MI, Javed I, et al. The Efficacy of Conservative Management in Uncomplicated Acute Appendicitis - A Single-Center Retrospective Study. Cureus. 2022;14(Appac Iii):10–5.
Javanmard-Emamghissi H, Hollyman M, Boyd-Carson H, Doleman B, Adiamah A, Lund JN, et al. Antibiotics as first-line alternative to appendicectomy in adult appendicitis: 90-day follow-up from a prospective, multicentre cohort study. Br J Surg. 2021;108(11):1351–9.
Lotfallah A, Aamery A, Moussa G, Manu M. Surgical Versus Conservative Management of Acute Appendicitis During the COVID-19 Pandemic: A Single-Centre Retrospective Study. Cureus. 2021;13(3).
Brucchi F, Bracchetti G, Fugazzola P, Viganò J, Filisetti C, Ansaloni L, et al. A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trials. World J Emerg Surg [Internet]. 2024;19(1):1–15. Available from: https://doi.org/10.1186/s13017-023-00531-6
Chin X, Mallika Arachchige S, Orbell-Smith JL, Da Rocha D, Gandhi A. Conservative Versus Surgical Management of Acute Appendicitis: A Systematic Review. Cureus. 2024;16(1):1–10.
De Almeida Leite RM, Seo DJ, Gomez-Eslava B, Hossain S, Lesegretain A, De Souza AV, et al. Nonoperative vs Operative Management of Uncomplicated Acute Appendicitis: A Systematic Review and Meta-analysis. JAMA Surg. 2022;157(9):828–34.
Poprom N, Numthavaj P, Wilasrusmee C, Rattanasiri S, Attia J, McEvoy M, et al. The efficacy of antibiotic treatment versus surgical treatment of uncomplicated acute appendicitis: Systematic review and network meta-analysis of randomized controlled trial. Am J Surg [Internet]. 2019;218(1):192–200. Available from: https://doi.org/10.1016/j.amjsurg.2018.10.009
CODA. A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis. N Engl J Med. 2020;383(20):1907–19.
Coccolini F, Fugazzola P, Sartelli M, Cicuttin E, Sibilla MG, Leandro G, et al. Conservative treatment of acute appendicitis. Acta Biomed. 2018;89(9):119–34.
Alajaimi J, Almansoor M, Almutawa A, Almusalam MM, Bakry H. Are Antibiotics the New Appendectomy? Cureus. 2023;15(9):1–9.
Talan DA, Saltzman DJ, Deugarte DA, Moran GJ. Methods of conservative antibiotic treatment of acute uncomplicated appendicitis: A systematic review. J Trauma Acute Care Surg. 2019;86(4):722–36.
Yang Z, Sun F, Ai S, Wang J, Guan W, Liu S. Meta-analysis of studies comparing conservative treatment with antibiotics and appendectomy for acute appendicitis in the adult. BMC Surg. 2019;19(1):1–10.
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