Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis

Objectives To compare conservative treatment with index admission appendicectomy in children with acute uncomplicated appendicitis. Design Systematic review and meta-analysis. Data sources Medline, Embase and the Cochrane Library (CENTRAL) from 1950 to 18 February 2017. Eligibility criteria for selecting studies Studies that assessed both appendicectomy and non-operative management of acute uncomplicated appendicitis in children of less than 18 years of age. Endpoints were postintervention complications, readmission and efficacy (successful outcome of the initial therapy). Results Five studies met the inclusion criteria (conservative treatment n=189; surgical intervention n=253). Compared with patients undergoing index admission appendicectomy, conservative treatment showed a reduced treatment efficacy (relative risk 0.77, 95% CI 0.71 to 0.84; p Conclusions Conservative treatment was less efficacious and was associated with a higher readmission rate. Index admission appendicectomy should in the present still be considered to be the treatment of choice for the management of uncomplicated appendicitis in children.