Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials
| Autor: | Fausto Catena, Filippo Gazzotti, Eddi Pasqualini, Luca Ansaloni, Antonio Daniele Pinna, Giorgio Ercolani, Federico Coccolini |
|---|---|
| Přispěvatelé: | L.Ansaloni, F.Catena, F.Coccolini, G.Ercolani, F.Gazzotti, E.Pasqualini, AD.Pinna |
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Antibiotics MEDLINE appendiciti law.invention Randomized controlled trial law Antibiotic therapy medicine Appendectomy Humans Intensive care medicine acute appendiciti Acute appendicitis Antibiotic treatment Meta-analysis Systematic review Acute Disease Anti-Bacterial Agents Appendicitis Treatment Outcome business.industry Standard treatment Gastroenterology medicine.disease Surgery business |
| Zdroj: | Digestive surgery. 28(3) |
| ISSN: | 1421-9883 |
| Popis: | Background/Aims: Although standard treatment typically consists of an early appendectomy, there has recently been an increase in the use of antibiotic therapy as primary treatment for acute appendicitis (AA). The aim of this analysis is to systematically evaluate the evidence available in relevant literature in order to compare the relative effectiveness of antibiotic therapy as a viable alternative to appendectomies in the treatment of AA. Methods: Literature was searched for randomized clinical trials (RCTs) comparing the efficacy of surgery versus antibiotic therapy. Differences in pooled odds ratios (OR) for outcomes within 95% confidence intervals (CI) were calculated. Results: Four RCTs were identified including 741 patients. Efficacy was significantly higher for surgery (OR = 6.01, 95% CI = 4.27–8.46). No differences were found in the numbers of perforated appendices (OR = 0.73, 95% CI = 0.29–1.84) and patients treated with antibiotics (OR = 0.04, 95% CI = 0.00–3.27). Complication rates were significantly higher for surgery (OR = 1.92, 95% CI = 1.30–2.85). Conclusion: Although a nonsurgical approach in AA can reduce the complications rate, the lower efficacy prevents antibiotic treatment from being a viable alternative to surgery. Since only a small number of RCTs of poor methodological quality are available, well-designed RCTs are needed for further investigation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|