Non-operative management of appendiceal abscess in children: a systematic review.

BACKGROUND

Non-operative treatment (NOT) has gained widespread acceptance as the initial therapy for pediatric patients with appendiceal abscess. The subsequent management methods encompass interval appendectomy (IA) and active observation (AO). The aim of the study is to compare the IA and AO alternatives after successful NOT of pediatric appendiceal abscess.

METHODS

Systematic literature research of PubMed was performed for relevant studies published. Variables as length of hospital stay (LOS), recurrence rate, complication rate, cost, operative time were analyzed.

RESULTS

Six articles were selected, including 396 patients with successful NOT of appendiceal abscess. 145 patients were in IA group while 251 patients were in AO group. There was no statistically significant difference in complication rate and cost was observed between IA and AO with recurrence group, while IA resulted in a shorter LOS and operative time. Moreover, the incidence rate of recurrence in AO was reported as 2.4%∼34.2%. The pooled estimate of the risk of recurrence was 9.9% (CI:4.8-20.6).

CONCLUSION

Following successful NOT of pediatric appendiceal abscess, the choice of management options is still controversial. More well-designed randomized controlled trials are needed to discover optimal treatment strategy.