American journal of surgery · 2026
Long-term outcomes of non-operative compared to operative management of acute uncomplicated appendicitis - a systematic review and meta-analysis.
Сравнительное исследованиеСтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Kahana Noam, Boaz Elad, Emile Sameh Hany, Reissman Petachia, Rosenthal Raul J, Wexner Steven D, Horesh Nir
Аннотация
BACKGROUND: We evaluated long-term outcomes of non-operative management (NOM) versus surgical management of acute uncomplicated appendicitis.
METHODS: Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate.
RESULTS: 9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery.
CONCLUSIONS: NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.
METHODS: Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate.
RESULTS: 9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery.
CONCLUSIONS: NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.