Scholarlink

<p>Acute uncomplicated appendicitis in children is traditionally treated by appendectomy, but recent trials suggest initial antibiotics may be an effective alternative. However, paediatric data are limited and long-term outcomes remain unclear. This comprehensive meta-analysis of RCTs and observational studies was done to compare non-operative management (NOM) versus surgical management in children (&lt; 18 years).&#xa0;We searched PubMed, Web of Science, and Cochrane Library through mid-2025 for studies of children with imaging-proven uncomplicated appendicitis treated initially with antibiotics or appendectomy. Five randomised trials and five observational cohorts met the inclusion criteria. The primary outcome was treatment success (resolution without surgery). Secondary outcomes included complication rates. Pooled risk ratios (RR) were calculated using random-effects models.&#xa0;In pooled analysis, initial antibiotic therapy achieved high short-term success (roughly 90% of children) compared with near-100% success after immediate surgery. Complication rates were similar between groups. Importantly, recurrence among non-operatively managed children was substantial, whereas recurrence after appendectomy was negligible. The combined analysis of the ten studies revealed a pooled RR for treatment success favouring surgery (RR: 0.75, 95%CI: 0.68–0.83). The findings from the observational studies closely aligned with those of RCTs. The pooled results of all studies indicated nearly identical outcomes.&#xa0;Non-operative management is feasible and safe for many children with uncomplicated appendicitis, but it yields a lower definitive cure rate than surgery and carries a notable recurrence risk. Appendectomy remains the most reliable treatment, especially if an appendicolith is seen on imaging. The findings can inform shared decision-making, helping clinicians and families weigh the trade-offs of antibiotics versus appendectomy in paediatric appendicitis.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Antibiotics Versus Surgery for Uncomplicated Acute Appendicitis in Children: an Updated Meta-Analysis and Systematic Review

  • 期刊论文

  • 发表日期：

    2025年12月10日

查看全文
  • Mohamed AbdAlla Salman,
  • Ahmed Salman,
  • Ahmed Elewa,
  • Mahmoud Ali,
  • Amr Elserafy,
  • Mohamed Tourky,
  • Evelyn Nkem Emechap,
  • Usama Shaker Mohamed

摘要

Acute uncomplicated appendicitis in children is traditionally treated by appendectomy, but recent trials suggest initial antibiotics may be an effective alternative. However, paediatric data are limited and long-term outcomes remain unclear. This comprehensive meta-analysis of RCTs and observational studies was done to compare non-operative management (NOM) versus surgical management in children (< 18 years). We searched PubMed, Web of Science, and Cochrane Library through mid-2025 for studies of children with imaging-proven uncomplicated appendicitis treated initially with antibiotics or appendectomy. Five randomised trials and five observational cohorts met the inclusion criteria. The primary outcome was treatment success (resolution without surgery). Secondary outcomes included complication rates. Pooled risk ratios (RR) were calculated using random-effects models. In pooled analysis, initial antibiotic therapy achieved high short-term success (roughly 90% of children) compared with near-100% success after immediate surgery. Complication rates were similar between groups. Importantly, recurrence among non-operatively managed children was substantial, whereas recurrence after appendectomy was negligible. The combined analysis of the ten studies revealed a pooled RR for treatment success favouring surgery (RR: 0.75, 95%CI: 0.68–0.83). The findings from the observational studies closely aligned with those of RCTs. The pooled results of all studies indicated nearly identical outcomes. Non-operative management is feasible and safe for many children with uncomplicated appendicitis, but it yields a lower definitive cure rate than surgery and carries a notable recurrence risk. Appendectomy remains the most reliable treatment, especially if an appendicolith is seen on imaging. The findings can inform shared decision-making, helping clinicians and families weigh the trade-offs of antibiotics versus appendectomy in paediatric appendicitis.