Efficacy and safety of appendicectomy versus antibiotics for uncomplicated acute appendicitis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

Zhu Mengchuan ¹ , Zeng Yongjuan ¹ , Liu Dengrui ² , Chen Jian ² , Ding Wenxia ² , Yang Pei ² ,  Gao Mingtai ²

1. First Clinical Medical College of Lanzhou University, Lanzhou, 73000, P.R.China;
2. First Affiliated Hospital of Lanzhou University, Lanzhou, 73000, P.R.China;

Corresponding author：

Gao Mingtai, Email: ldyy6865@163.com

Keywords：

Acute appendicitis; Anti-bacterial agents; Appendicectomy; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201610083

Video：

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ObjectiveTo systematically review the effectiveness of appendicectomy versus antibiotics for uncomplicated acute appendicitis (UAA). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Science, CBM, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about appendicectomy versus antibiotics for uncomplicated acute appendicitis from inception to September 2016. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 10 RCTs studies involving 2 028 patients were included. The results of meta-analysis showed that, compared with antibiotics, the appendicectomy could shorten duration of hospital stay (MD=–1.89, 95%CI –2.75 to –1.04, P<0.000 01), the therapeutic time of antibiotics (MD=–4.42, 95%CI –5.06 to –3.79, P<0.000 01), improve the efficiency of clinical treatment (OR=23.48, 95%CI 7.99 to 68.96, P<0.000 01), decrease the recurrence rate (OR=0.02, 95%CI 0.01 to 0.05, P<0.000 01), however, there was no significant difference in the incidence of postoperative complications between two groups (OR=1.35, 95%CI 0.31 to 5.87, P=0.69). ConclusionThe current evidence shows that, compared with antibiotics, the appendicectomy for uncomplicated acute appendicitis can shorten duration of hospital stay and the therapeutic time of antibiotics, improve the efficiency of clinical treatment, decrease the recurrence rate. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.

Citation： Zhu Mengchuan, Zeng Yongjuan, Liu Dengrui, Chen Jian, Ding Wenxia, Yang Pei, Gao Mingtai. Efficacy and safety of appendicectomy versus antibiotics for uncomplicated acute appendicitis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(2): 188-194. doi: 10.7507/1672-2531.201610083 Copy

1.	黄忠荣. 急性单纯性阑尾炎保守与手术治疗的临床疗效对比. 现代诊断与治疗, 2014(5): 1138-1139.
2.	Wilms IM, Hoog DED, Visser DCD, et al. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev, 2011, (11): CD008359.
3.	Liu Z, Chao LI, Zhang X, et al. Meta-analysis of the therapeutic effects of antibiotic versus appendectomy for the treatment of acute appendicitis. Exp Ther Med, 2014, 7(5): 1181-1186.
4.	Rocha LL, Rossi FM, Pessoa CM, et al. Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say. World J Emerg Surg, 2014, 10(1): 1-6.
5.	Coldrey E. Five years conservative treatment of acute appendicitis. J Int Coll Surg, 1959, 32: 255-261.
6.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Available at: http://handbook.cochrane.org.
7.	Hansson J, Korner U, Khorram-Manesh A, et al. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg, 2009, 96(5): 473-481.
8.	Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs. Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA, 2015, 313(23): 2340-2348.
9.	Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World J Surg, 2007, 31(3): 1033-1037.
10.	Svensson JF, Patkova B, Almström M, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg, 2014, 261(1): 67-71.
11.	Tanaka Y, Uchida H, Kawashima H, et al. Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg, 2015, 50(11): 1893-1897.
12.	Vons C, Barry C, Maitre S, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet, 2011, 377(377): 1573-1579.
13.	尹建军. 保守治疗与手术治疗急性单纯性阑尾炎患者的临床效果对比分析. 世界最新医学信息文摘, 2015, 15(98): 60.
14.	张子会, 刘志永, 朱建英. 急性单纯性阑尾炎患者经保守治疗与手术治疗的临床效果比较探讨. 世界最新医学信息文摘, 2016, 16(2): 100, 110.
15.	朱勇. 急性单纯性阑尾炎保守治疗和手术的临床价值分析. 现代诊断与治疗, 2013(19): 4505-4506.
16.	范莉. 急性单纯性阑尾炎保守治疗和阑尾切除术效果分析. 河南外科学杂志, 2016, 22(2): 94-95.
17.	La-Shell M, Tankersley M. Antibiotics for the allergist: part 2. Ann Allergy Asthma Immunol, 2009, 102(1): 1-8.
18.	Varadhan KK, Neal KR. Re: Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ, 2014, 344(7): e2156.
19.	Madore JC, Collins CE, Ayturk MD, et al. The impact of acute care surgery on appendicitis outcomes: results from a national sample of university-affiliated hospitals. J Trauma Acute Care Surg, 2015, 79(2): 282-288.
20.	杜亚琼, 花豹, 吴巨钢, 等. 腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效对比分析. 中国普外基础与临床杂志, 2016(10): 1231-1235.
21.	Binnebösel M, Otto J, Stumpf M, et al. Acute appendicitis. Modern diagnostics--surgical ultrasound. Chirurg, 2009, 80(7): 579-587.
22.	Çavuşoğlu YH, Erdoğan D, Karaman A, et al. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int, 2009, 25(3): 277-282.
23.	Tzanakis NE, Efstathiou SP, Danulidis K, et al. A New Approach to Accurate Diagnosis of Acute Appendicitis. World J Surg, 2005, 29(9): 1151-1156.
24.	Mason RJ, Moazzez A, Sohn H, et al. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect, 2012, 13(2): 74-84.
25.	Sallinen V, Akl EA, You JJ, et al. Meta-analysis of antibiotics versus, appendicectomy for non-perforated acute appendicitis. Br J Surg, 2016, 103(6): 656-667.
26.	Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg, 2009, 13(5): 966-970.

1. 黄忠荣. 急性单纯性阑尾炎保守与手术治疗的临床疗效对比. 现代诊断与治疗, 2014(5): 1138-1139.
2. Wilms IM, Hoog DED, Visser DCD, et al. Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev, 2011, (11): CD008359.
3. Liu Z, Chao LI, Zhang X, et al. Meta-analysis of the therapeutic effects of antibiotic versus appendectomy for the treatment of acute appendicitis. Exp Ther Med, 2014, 7(5): 1181-1186.
4. Rocha LL, Rossi FM, Pessoa CM, et al. Antibiotics alone versus appendectomy to treat uncomplicated acute appendicitis in adults: what do meta-analyses say. World J Emerg Surg, 2014, 10(1): 1-6.
5. Coldrey E. Five years conservative treatment of acute appendicitis. J Int Coll Surg, 1959, 32: 255-261.
6. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Available at: http://handbook.cochrane.org.
7. Hansson J, Korner U, Khorram-Manesh A, et al. Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg, 2009, 96(5): 473-481.
8. Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs. Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA, 2015, 313(23): 2340-2348.
9. Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus Antibiotic Treatment in Acute Appendicitis. A Prospective Multicenter Randomized Controlled Trial. World J Surg, 2007, 31(3): 1033-1037.
10. Svensson JF, Patkova B, Almström M, et al. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg, 2014, 261(1): 67-71.
11. Tanaka Y, Uchida H, Kawashima H, et al. Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg, 2015, 50(11): 1893-1897.
12. Vons C, Barry C, Maitre S, et al. Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: an open-label, non-inferiority, randomised controlled trial. Lancet, 2011, 377(377): 1573-1579.
13. 尹建军. 保守治疗与手术治疗急性单纯性阑尾炎患者的临床效果对比分析. 世界最新医学信息文摘, 2015, 15(98): 60.
14. 张子会, 刘志永, 朱建英. 急性单纯性阑尾炎患者经保守治疗与手术治疗的临床效果比较探讨. 世界最新医学信息文摘, 2016, 16(2): 100, 110.
15. 朱勇. 急性单纯性阑尾炎保守治疗和手术的临床价值分析. 现代诊断与治疗, 2013(19): 4505-4506.
16. 范莉. 急性单纯性阑尾炎保守治疗和阑尾切除术效果分析. 河南外科学杂志, 2016, 22(2): 94-95.
17. La-Shell M, Tankersley M. Antibiotics for the allergist: part 2. Ann Allergy Asthma Immunol, 2009, 102(1): 1-8.
18. Varadhan KK, Neal KR. Re: Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. BMJ, 2014, 344(7): e2156.
19. Madore JC, Collins CE, Ayturk MD, et al. The impact of acute care surgery on appendicitis outcomes: results from a national sample of university-affiliated hospitals. J Trauma Acute Care Surg, 2015, 79(2): 282-288.
20. 杜亚琼, 花豹, 吴巨钢, 等. 腹腔镜与开腹阑尾切除术治疗急性阑尾炎的疗效对比分析. 中国普外基础与临床杂志, 2016(10): 1231-1235.
21. Binnebösel M, Otto J, Stumpf M, et al. Acute appendicitis. Modern diagnostics--surgical ultrasound. Chirurg, 2009, 80(7): 579-587.
22. Çavuşoğlu YH, Erdoğan D, Karaman A, et al. Do not rush into operating and just observe actively if you are not sure about the diagnosis of appendicitis. Pediatr Surg Int, 2009, 25(3): 277-282.
23. Tzanakis NE, Efstathiou SP, Danulidis K, et al. A New Approach to Accurate Diagnosis of Acute Appendicitis. World J Surg, 2005, 29(9): 1151-1156.
24. Mason RJ, Moazzez A, Sohn H, et al. Meta-analysis of randomized trials comparing antibiotic therapy with appendectomy for acute uncomplicated (no abscess or phlegmon) appendicitis. Surg Infect, 2012, 13(2): 74-84.
25. Sallinen V, Akl EA, You JJ, et al. Meta-analysis of antibiotics versus, appendicectomy for non-perforated acute appendicitis. Br J Surg, 2016, 103(6): 656-667.
26. Malik AA, Bari SU. Conservative management of acute appendicitis. J Gastrointest Surg, 2009, 13(5): 966-970.

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Efficacy and safety of appendicectomy versus antibiotics for uncomplicated acute appendicitis: a meta-analysis

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