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Showing content from https://pubmed.ncbi.nlm.nih.gov/28213607/ below:

Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis

Review

Affiliations

• ¹ Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.
• ² Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
• ³ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada; and.
• ⁴ Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom; n.j.hall@soton.ac.uk.
• ⁵ University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.

• PMID: 28213607
• DOI: 10.1542/peds.2016-3003

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Review

Roxani Georgiou et al. Pediatrics. 2017 Mar.

• ¹ Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom.
• ² Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
• ³ Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Canada; and.
• ⁴ Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom; n.j.hall@soton.ac.uk.
• ⁵ University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.

• PMID: 28213607
• DOI: 10.1542/peds.2016-3003

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Context: Nonoperative treatment (NOT) with antibiotics alone of acute uncomplicated appendicitis (AUA) in children has been proposed as an alternative to appendectomy.

Objective: To determine safety and efficacy of NOT based on current literature.

Data sources: Three electronic databases.

Study selection: All articles reporting NOT for AUA in children.

Data extraction: Two reviewers independently verified study inclusion and extracted data.

Results: Ten articles reporting 413 children receiving NOT were included. Six, including 1 randomized controlled trial, compared NOT with appendectomy. The remaining 4 reported outcomes of children receiving NOT without a comparison group. NOT was effective as the initial treatment in 97% of children (95% confidence interval [CI] 96% to 99%). Initial length of hospital stay was shorter in children treated with appendectomy compared with NOT (mean difference 0.5 days [95% CI 0.2 to 0.8]; P = .002). At final reported follow-up (range 8 weeks to 4 years), NOT remained effective (no appendectomy performed) in 82% of children (95% CI 77% to 87%). Recurrent appendicitis occurred in 14% (95% CI 7% to 21%). Complications and total length of hospital stay during follow-up were similar for NOT and appendectomy. No serious adverse events related to NOT were reported.

Limitations: The lack of prospective randomized studies limits definitive conclusions to influence clinical practice.

Conclusions: Current data suggest that NOT is safe. It appears effective as initial treatment in 97% of children with AUA, and the rate of recurrent appendicitis is 14%. Longer-term clinical outcomes and cost-effectiveness of NOT compared with appendicectomy require further evaluation, preferably in large randomized trials, to reliably inform decision-making.

Copyright © 2017 by the American Academy of Pediatrics.

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• Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis.

  Huang L, Yin Y, Yang L, Wang C, Li Y, Zhou Z. Huang L, et al. JAMA Pediatr. 2017 May 1;171(5):426-434. doi: 10.1001/jamapediatrics.2017.0057. JAMA Pediatr. 2017. PMID: 28346589 Free PMC article.

• Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis.

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• Conservative antibiotic treatment for acute uncomplicated appendicitis is feasible.

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• Parental Knowledge of Appendicitis and Its Management Options Among Children of Makkah Region, Saudi Arabia.

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• Pediatric Patient and Caregiver Values in Treatment Decision-making for Uncomplicated Appendicitis.

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• SAGES guideline for the diagnosis and treatment of appendicitis.

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• Non-operative treatment versus appendectomy for acute uncomplicated appendicitis: A randomized controlled trial.

  Sajjad MN, Naumeri F, Hina S. Sajjad MN, et al. Pak J Med Sci. 2021 Sep-Oct;37(5):1276-1281. doi: 10.12669/pjms.37.5.4016. Pak J Med Sci. 2021. PMID: 34475898 Free PMC article.

• Conservative therapy for appendicitis in children.

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