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

Détails

ID Serval
serval:BIB_7BC593AB565C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Conservative treatment versus surgery for uncomplicated appendicitis in children: a systematic review and meta-analysis.
Périodique
Archives of disease in childhood
Auteur(s)
Kessler U., Mosbahi S., Walker B., Hau E.M., Cotton M., Peiry B., Berger S., Egger B.
ISSN
1468-2044 (Electronic)
ISSN-L
0003-9888
Statut éditorial
Publié
Date de publication
12/2017
Peer-reviewed
Oui
Volume
102
Numéro
12
Pages
1118-1124
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Meta-Analysis ; Review
Publication Status: ppublish
Résumé
To compare conservative treatment with index admission appendicectomy in children with acute uncomplicated appendicitis.
Systematic review and meta-analysis.
Medline, Embase and the Cochrane Library (CENTRAL) from 1950 to 18 February 2017.
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).
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<0.001) and an increased readmission rate (relative risk 6.98, 95% CI 2.07 to 23.6; p<0.001), with a comparable rate of complications (relative risk 1.07, 95% CI 0.26 to 4.46). Exclusion of patients with faecoliths improved treatment efficacy in conservatively treated patients. One study was randomised, with the remaining four comprising cohorts assembled by patient or physician choice. Different antibiotic regimens were used between investigations. Follow-up varied from 1 to 4 years.
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.

Mots-clé
Acute Disease, Anti-Bacterial Agents/adverse effects, Anti-Bacterial Agents/therapeutic use, Appendectomy/adverse effects, Appendicitis/therapy, Child, Conservative Treatment/methods, Humans, Patient Readmission/statistics & numerical data, Treatment Outcome, Appendicectomy, Appendicitis, Conservative Treatmant
Pubmed
Web of science
Création de la notice
16/10/2017 13:01
Dernière modification de la notice
03/03/2018 18:36
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