No standardized approach is available for the management of complicated appendicitis
defined as appendiceal abscess and phlegmon. This study used meta-analytic techniques
to compare conservative treatment versus acute appendectomy.
Comparative studies were identified by a literature search. The end points evaluated
were overall complications, need for reoperation, duration of hospital stay, and duration
of intravenous antibiotics. Heterogeneity was assessed and a sensitivity analysis
was performed to account for bias in patient selection.
Seventeen studies (16 nonrandomized retrospective and 1 nonrandomized prospective)
reported on 1,572 patients: 847 patients received conservative treatment and 725 had
acute appendectomy. Conservative treatment was associated with significantly less
overall complications, wound infections, abdominal/pelvic abscesses, ileus/bowel obstructions,
and reoperations. No significant difference was found in the duration of first hospitalization,
the overall duration of hospital stay, and the duration of intravenous antibiotics.
Overall complications remained significantly less in the conservative treatment group
during sensitivity analysis of studies including only pediatric patients, high-quality
studies, more recent studies, and studies with a larger group of patients.
The conservative management of complicated appendicitis is associated with a decrease
in complication and reoperation rate compared with acute appendectomy, and it has
a similar duration of hospital stay. Because of significant heterogeneity between
studies, additional studies should be undertaken to confirm these findings.
Copyright 2010. Published by Mosby, Inc.