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The 30-day adverse event rate is 11% after surgical removal of acute appendicitis. Some experts believe that acute appendicitis actually consists of 2 types: Uncomplicated appendicitis and complicated appendicitis. Complicated appendicitis can be broken down into appendicular abscess, appendicular phlegmon, and free perforated appendicitis with generalized peritonitis.
No consensus exists among surgeons regarding the optimal treatment of complicated acute appendicitis in children. This study hoped to differentiate the complication rates between perforated appendicitis, appendicular abscess, and appendicular phlegmon with regards to early appendectomy versus conservative management.
14 studies were included in this meta-analysis for a total of 1288 patients.
- Children with appendicular abscess and appendicular phlegmon had fewer complication rates and readmission rates if treated with nonoperative management.
- Children with free perforated appendicitis showed lower complication rate and readmission rate if treated with operative management.
- The costs were not significantly different between nonoperative management and operative management.
References
Fugazzola et al. Early appendectomy versus conservative management and complicated acute appendicitis in children: a meta-analysis. J Pediatr Surg. 2019 Feb 25 S0002-3468 (19)30125-3.